By Debra Jaliman, MD
I’m often asked which treatment is best for acne. The honest answer is there is no one best treatment, for what works best is a combination of treatments.
Acne, especially severe acne, has to be attacked simultaneously from different angles. Dermatologists try to treat pimples, cysts, blackheads, inflammation, and redness — all of which are part of the complete acne picture — at the same time. For example, we have creams that combine tretinoin (Retin-A) and clindamycin, because tretinoin works on the clogged pores that lead to acne, while clindamycin, an antibiotic, treats the skin infection.
The same thing goes for creams that combine benzoyl peroxide, which kills bacteria and increases oxygen to the affected area to speed healing, and antibiotics. And of course, dermatologists often prescribe a combination of creams and oral medications that contain time-released antibiotics. For acne sufferers, time-released oral antibiotics are a great idea because they use lower doses that are constantly attacking the pimples as they form.
For many people, it’s the redness and inflammation associated with acne that bothers them most, and it’s certainly something that should be treated at the same time. One of the most effective treatments is 5% dapsone gel, which can be used alone or in combination with a product that contains salicylic acid.
I’m always bothered by dermatologists who prescribe the same acne treatment over and over for every patient. Acne treatments should be tailored to the individual patient, because the combo treatment that works for one patient will not work for another. Good dermatologists vary acne treatments endlessly, working with their patients until they find the right combination. By the way, acne treatments work best when combined with extraction of blackheads done in a dermatologist’s office, and in cases of cystic acne, cortisone injections into cysts.
Be aware that over time skin can also change in its reactions to acne treatments, so what worked so well six months ago may suddenly cause irritation or fail to prevent outbreaks. When this happens, schedule another appointment with your dermatologist, as you may need a new treatment regimen.