Treatment for Acne

1. Salicylic Acid vs. Benzoyl Peroxide. The hallmark in mild to moderate acne, salicylic acid and benzoyl peroxide are both available over-the-counter. Salicylic acid is milder in terms of sensation (sting) and side effect (peeling). It helps unclog the pores and reduce inflammation. As with other topical medications, you need to use it religiously (usually in combination with moisturizer to reduce incidence of dryness or benzoyl peroxide for optimal outcome). Benzoyl peroxide is bactericidal, it kills P. Acnes, the bacteria that causes zits. Peeling, redness, irritation are common side effects, it’s the “storm before the calm”, stop using and call your doctor if you experienced allergic reaction or if symptoms worsened.

2. Topical vs. Oral Antibiotics. If you are suffering from cystic or severe kind of acne, it is best to consult your doctor so you can be properly assessed and prescribed with antibiotics. If you have mild to moderate acne, you may respond to topical antibiotics (typically used with retinoid which helps accelerate skin turnover and unclogging pores). For severe acne, oral antibiotics like minocycline and doxycyline are used within few months and tapered off once your symptoms improve to prevent antibiotic resistance.

3. Birth control pills vs. Isotretinoin. Androgen, a hormone present in both men and women, can stimulate excess sebum production which causes acne. Hormonal therapy or isotretinoin are the next course of actions if you failed with first line treatments mentioned above. You must be carefully screened by your doctor before you can be started on hormonal therapy. If you are generally healthy but failed to respond to over-the-counter and antibiotics, oral contraceptives that contain ethinyl estradiol plus either the progestin norgestimate, norethindrone acetate or drospirenone can help with severe acne. Isotretinoin works by inhibiting the production of skin’s natural oil. It is important not to get pregnant while you’re on this medication because it can possibly harm an unborn baby.

4. Chemical Peels vs. TCA (trichloroacetic acid). A chemical peel (glycolic or salicylic acid) is usually indicated to help with active acne and/or mild scarring. TCA helps with medium depth or ice pick type scars but has social downtime involved (depending on the strength used). TCA is strictly an in-clinic procedure performed by a doctor.

5. Laser treatments vs Dermabrasion. For scarring and skin rejuvenation, laser is the preferred method in combination with the the aforementioned methods. Your acne should be under control before starting laser. It targets deep below the surface of the skin sans invasive surgery. The damaged tissue absorbs the laser energy which stimulates collagen growth. This process allows the scars to be filled in with your own skin cells resulting to tighter and firmer skin. Depending on the depth of your scars, you may require several treatments to achieve optimal outcome. There is social downtime involved relative to lasers used, ablative (CO2, Erbium) and non-ablative (Icon). Microdermabrasion is a spa/regular beauty treatment done by non-medical personnel such as aestheticians. It is good for very shallow or superficial scars. Dermabrasion is a surgical procedure performed only by a doctor. It is indicated for acne scar but has significant downtime and results in bleeding.