by Kristin Benson

Created on: April 18, 2010

Acne causes physical and emotional pain for all sufferers to some degree. Even a mild breakout feels embarrassing to a fragile teenager. Chronic or severe acne may lead to severe permanent scarring when left untreated. Over-the-counter (OTC) treatments may effectively treat mild to moderate acne. However, for acne that shows no signs of abating, speak to a dermatologist about tailoring a comprehensive treatment plan around your specific needs.

Benzoyl Peroxide

The majority of OTC acne cleansers and creams contain benzoyl peroxide. This potent ingredient controls excess oil production and digs deep into the pores to remove debris. It also fights P. acnes, the bacteria that contributes to the development of acne. OTC concentrations of the medication range from 2.5 percent to 10 percent. Excessive dryness of the skin may occur with treatment, particularly in higher concentration creams. This may subside as the skin adapts to the medication.

Salicylic Acid

Salicylic acid most effectively treats small, noninflammatory acne and blackheads. OTC products such as washes, toners, creams and masks may contain salicylic acid. Some chemical peels use salicylic acid as well. It primarily regulates the shedding of dead skin cells to prevent uneven shedding and clogged pores. Salicylic acid also reduces inflammation as it is in the aspirin family. Most OTC products contain 2 percent salicylic acid. Mild skin irritation may occur with treatment in people with sensitive skin.

Topical Retinoids

For mild to moderately-severe acne, a dermatologist might prescribe a derivative of vitamin A called a topical retinoid. These include tretinoin, adapalene and tazotarene. These medications have proven themselves highly effective at slowly unclogging pores and keeping them clear. This not only prevents acne by keeping the pores clear, but it allows other medications to reach deeper into the pores as well. Topical retinoids come in the form of a cream or a gel that is applied once daily to the face. Increased sun sensitivity, dryness, redness and burning are possible adverse effects of treatment.

Isotretinoin

The synthetic retinoid, isotretinoin, is the most effective treatment available for acne. This pill is taken once or twice daily for about four months to complete a full course of treatment. For many patients, a full or nearly full remission of acne is achieved with just one course of treatment. Results last for many months to years. Very severe cases of cystic acne may require a second treatment if symptoms return. Isotretinoin effectively treats all four potential causes of acne - oily skin, clogged pores, inflammation and bacteria. While it is highly effective, it is often reserved for severe or stubborn acne. Severe side effects have been reported with isotretinoin treatment including severe chest pain, painful swallowing, depression, nausea, vomiting, severe headache and dry skin, nose and eyes. Any women who wish to be treated with isotretinoin must undergo regular pregnancy tests and use two reliable forms of birth control. The incidence of severe birth defects associated with isotretinoin use is very high.

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