Frequently used topical retinoids include adapalene, isotretinoin, retinol, tazarotene, and tretinoin. They often cause an initial flare-up of acne and facial flushing, and can cause significant skin irritation. Generally speaking, retinoids increase the skin's sensitivity to sunlight and are therefore recommended for use at night. Tretinoin is the least expensive of the topical retinoids and is the most irritating to the skin, whereas adapalene is the least irritating to the skin but costs significantly more. Most formulations of tretinoin cannot be applied at the same time as benzoyl peroxide. Tazarotene is the most effective and expensive topical retinoid, but is not as well-tolerated. Retinol is a form of vitamin A that has similar but milder effects, and is used in many over-the-counter moisturizers and other topical products.
Alternative and integrative medicine approaches used in the treatment of acne include fish oil, brewer's yeast, probiotics, oral zinc and topical tea tree oil. More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and traditional Chinese medicine. Talk with your doctor about the pros and cons of specific treatments before you try them.
Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity. In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus. Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B). Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel. Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm. Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester. Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy. In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters. Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X). Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects. Finasteride is not recommended as it is highly teratogenic.
Frankincense oil is a personal favorite for me and my wife, Chelsea. Containing antibacterial and anti-inflammatory properties, it’s amazing for almost all skin types and perfect for acne-prone skin. Frankincense invites new cell growth, which can help reduce the appearance of scars. It also helps prevent or eliminate bacteria, part of what can cause acne in the first place.
Your pimples need TLC, too. The study on acne vulgaris found that, in an attempt to dry out acne lesions, patients often use too many products or apply excessive amounts to problem areas, resulting in further irritation and over drying of the skin. Vigorous scrubbing and using harsh exfoliants can make acne worse by rupturing whiteheads and blackheads, turning them into painful red ones. And remember: no matter how satisfying it is, picking and popping your zits will also increase inflammation and opportunity for infection.
A BHA product often cited includes salicylic acid, it must be between a pH between 3 and 4 to work. A BHA works to slough (to get rid of) off dead skin cells and encourage new skin growth. As a result, you may experience dry skin and scaliness around your acne, but this will dissipate over time as your skin begins to regenerate faster. Use this in a cleanser or spot treatment daily on the acne-affected areas of your skin.
Benzoyl peroxide (BPO) is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly skin irritation). In the skin follicle, benzoyl peroxide kills C. acnes by oxidizing its proteins through the formation of oxygen free radicals and benzoic acid. These free radicals are thought to interfere with the bacterium's metabolism and ability to make proteins. Additionally, benzoyl peroxide is mildly effective at breaking down comedones and inhibiting inflammation. Benzoyl peroxide may be paired with a topical antibiotic or retinoid such as benzoyl peroxide/clindamycin and benzoyl peroxide/adapalene, respectively.
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This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
Antibiotics are an acne treatment used to kill acne-causing bacteria. They may be applied directly on the skin (topical) or taken by mouth (oral). Topical antibiotics kill bacteria in the upper portion of your pores, while oral antibiotics can reach to the lower depths of the pores. Antibiotics used for acne treatment include clindamycin or tetracyclines like doxycycline or minocycline. These antibiotics are the most effective for treating acne because they both kill bacteria and act as anti-inflammatory agents to calm down the skin.
Combined oral contraceptives. Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine estrogen and progestin (Ortho Tri-Cyclen, Yaz, others). You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help.