Acne is typically treated by a dermatologist (skin specialist). The diagnosis of acne relies upon the patient’s medical history and a physical examination. In most cases, acne is obvious and does not require any additional testing. However, in rare cases the sudden onset of severe acne in older adults may be a sign of a more serious underlying condition, such as polycystic ovarian syndrome (an endocrine and hormonal disorder).

In some cases, an acne-like rash can develop as the result of make-up, lotions or medications. Therefore, it is important for patients to provide their physician with an accurate history of all products used on the skin and any medications taken.

The goal of acne treatment is to minimize scarring, prevent further eruptions of blemishes and improve those that are already present. Treatments that work for one patient may not work for another. As a result, certain considerations need to be made when deciding upon treatment. These include:

• Acne severity
  
  
• Types of lesions present
  
  
• Patient's age
  
  
• Patient's skin type
  
  
• Patient’s overall health and medical history
  
  
• Patient’s tolerance for specific medications, procedures or therapies
  
  
• Patient and physician’s expectations for the course of the condition
  
  
• Patient’s opinion or preference

Acne treatments may be local or systemic and generally work by reducing the inflammation in the skin, speeding up skin cell turnover, fighting bacterial infection or a combination of these methods. It is normal to see little or no improvement in the acne for six to eight weeks after starting a medication, and in many cases the acne gets worse before it gets better. When a patient’s acne fails to improve after several weeks of treatment, their physician may change treatment methods

Patients should continue using their acne medication until instructed otherwise, regardless of whether the skin has cleared. Sudden discontinuation of acne medication can lead to a recurrence of acne several weeks later.

In some cases, acne may improve with exposure to a small amount of sun. However, many treatments make the skin more susceptible to sun damage, so patients on these therapies are typically advised to avoid sun exposure. 

Acne treatments are numerous and varied. Mild acne requires less extensive treatment and often clears up quickly and with no ill effects. Severe acne may require more powerful treatments that may have serious side effects. Most patients will benefit from a combination of two or more therapies.

Topical treatments are widely available both over-the-counter and in prescription form. Acne lotions, gels and washes may dry up sebum, kill the acne bacteria or promote the proper sloughing of dead skin cells. Over–the–counter topical treatments are generally mild.

Their active ingredients may include benzoyl peroxide, one of the most commonly used topical treatments. Other ingredients include alcohol and acetone, which are used together to reduce oil concentrations and help kill bacteria.

Stronger prescription lotions may be prescribed for moderate to severe acne. These are typically retinoids (vitamin A derivatives) that work by promoting cell turnover and preventing the clogging of hair follicles or topical antibiotics. Topical antibiotics work by killing the bacteria that lead to acne and reducing inflammation.

Oral antibiotics may be prescribed for moderate to severe acne. These reduce bacteria and fight inflammation, but may take months to work. They are often used in combination with topical products. Many oral antibiotics (e.g., isotretinoin) should not be taken by women who are or may become pregnant.

When acne outbreaks coincide with a woman’s monthly period, oral contraceptives may help to control the acne.

Large, inflamed nodules or cysts may be treated by an injection with corticosteroids. It typically takes three to five days after the injection to clear up the treated nodule or cyst.

Physical treatments for acne and the scars left by acne include:

• Extraction of comedones. A whitehead or blackhead is opened and extracted with a sterile, pen-sized device, fine needle or blade.
  
  
• Drainage and surgical extraction. Also called “acne surgery,” this is the drainage and extraction of large cysts. It reduces the pain and decreases the likelihood of scarring.
  
  
• Chemical peels. Chemicals are applied to the skin in a physician’s office to loosen blackheads and whiteheads and decrease acne papules. This method may eliminate superficial scars by peeling away damaged skin. Research comparing two different types of chemical peels (glycolic acid and salicylic acid) found both to be effective.

• Microdermabrasion. Aluminum oxide crystals pass through a vacuum tube to gently scrape away scarred tissue. Multiple treatments may be required for subtle results.
  
  
• Dermabrasion. A rotating wire brush or spinning diamond instrument is used to wear down the surface of the skin. As the skin heals, a smoother layer replaces the abraded skin. This healing usually takes from 10 days to three weeks.
  
  
• Subcision. Small cuts are made under the skin to release scar tissue. This often allows skin to resume normal contours and may cosmetically improve wide, indented scars.
  
  
• Excision and punch replacement graft. A depressed acne scar is surgically removed and replaced with a patch of skin from elsewhere on the patient’s body.
  
  
• Soft tissue fillers. Small quantities of soft tissues (e.g., collagen, polymer implants, fat) are injected under the skin to elevate depressed scars to skin level.
  
  
• Laser resurfacing. Short pulses of intense light are used to remove the outer, damaged layer of skin and tighten the middle layer, leaving skin smoother. This procedure can usually be performed in the dermatologist’s office and may take from a few minutes to an hour. It may take from three to 10 days to heal.