Let’s state the obvious: Acne sucks. There is nothing like a big red angry zit in the middle of your forehead to throw off your day and sour your mood. While we all get the occasional pimple from time to time, frequent breakouts can be challenging and take a toll on your self-confidence. If you’re starting to see those pesky zits pop up more often, you may be wondering if it’s time to get on the 3 month wait list to see a dermatologist. But have no fear! If you're new to acne treatment, a visit to your primary care provider can be a great first step to getting your skin under control.
Types of acne (Acne Vulgaris)
There are two main types of acne: inflammatory and comedonal. Inflammatory acne are the type of raised red bumps we typically think of when we say we have a pimple. They can be red, painful, and so tempting to pop, but please don’t as it can lead to scarring. Comedonal acne are the small bumps on your skin that we typically call white heads or black heads. Pimples can start as comedonal acne and then progress to inflammatory acne if they don’t resolve. There are other types of acne out there that may benefit from different and unique treatments, but for the purpose of this guide, we will focus on inflammatory and comedonal acne.
So do you need to purchase expensive face creams to treat your acne? No. With a little bit of strategic guidance, you can treat your acne effectively without hurting your wallet.
How to treat comedonal acne
To treat those stubborn white heads and black heads, a retinoid cream should be your weapon of choice. Retinoid creams are vitamin A derivatives that help prevent the formation of comedones and have an anti-inflammatory effect. As it can make your skin photosensitive (sensitive to sunlight) or feel dry and irritated, you may want to use it at night before bed. You can try some of the over the counter creams out there, but if you turn to your primary care provider , they can prescribe retinoids such as adapalene, tretinoin, and tazarotene which are quite effective in keeping comedones at bay. Certain retinoids are not suitable for individuals who are pregnant or approved for children, so talk to your provider to see which one is right for you. Retinoids are sometimes not covered by insurance, so using a medical coupon can help keep the cost in check.
How to treat inflammatory acne
Trying to understand which acne face wash is best for you? Look for the ingredient “Benzoyl Peroxide” as it’s your ally in treating inflammatory acne and is the main component of the spot acne treatment creams you may find on the shelves of your local pharmacy. Benzoyl peroxide is bactericidal, meaning it kills the bacteria that causes acne, breaks up comedones, and has an anti-inflammatory effect. It comes in several different strengths, with many over the counter preparations coming in at 2.5%, but can be prescribed as high as 10%. While this is a great option for many people, it can be quite irritating to the skin, causing burning and can even bleach hair and clothes. Children and adolescents should speak with their primary care provider before starting as the safety and effectiveness of benzoyl peroxide is unclear for children under 12.
Do antibiotics help?
If a retinoid cream and a benzoyl peroxide wash are not working for you, then your primary care doctor may recommend topical or oral antibiotics. This can be helpful against stubborn acne that is moderate in severity, or if you can’t tolerate the other treatments. Topical antibiotics include clindamycin or erythromycin, which can be bactericidal (kill bacteria) and bacteriostatic (prevent the growth of bacteria). They are prescribed in a solution, gel, foam or even a pad. Topical antibiotics can cause burning and skin irritation, but the biggest risk is creating bacteria that is resistant to the antibiotic. That’s why topical antibiotic treatment is frequently recommended in conjunction with benzoyl peroxide, which helps prevent the bacteria from evolving and becoming resistant to antibiotics. Oral antibiotics can be used for moderate to severe acne, but should not be used for longer than 12 weeks because of their side effects, impact on gut health, and the risk of creating drug resistant bacteria. Again, pregnant individuals, children, and adolescents will need special considerations when choosing the right treatment, so its important to speak with your provider to determine which treatment is right for you.
When to see a dermatologist
Your primary care provider can prescribe the treatments above and other agents in different combinations or durations.. If these treatments aren’t successful or your primary care provider would like some assistance in managing your acne, your provider may refer you to a dermatologist for more specialty care.
One very effective treatment for acne is isotretinoin isotretinoin, also known as Acutane, which helps shrink your oil glands and reduce the occurrence of acne. Providers need specialized training in order to prescribe isotretinoin because of the risk of severe side effects while on the medication. It can cause severe dryness and irritation to the skin, and also lead to liver damage, which is why individuals who take this medication need regular check ins and lab work. Most notably, isotretinoin is teratogenic, meaning that if the individual is pregnant while taking it, it can cause severe birth defects. While this all may seem scary, isotretinoin is highly regulated and monitored to prevent severe side effects. For many, the risk is worth the reward, as the medication is not only highly effective in treating existing acne, the changes to your oil glands can be permanent and prevent the occurrence of acne long after you finish treatment. You read that right, isotretinoin can “cure” people of their acne and significantly reduce the risk of recurrence.
Looking for some guidance in treating your acne? Book an appointment today and your primary care provider will be happy to help find the right treatment for you.
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