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Acne is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing acne:

• abnormal clumping of cells in the follicles
• increased oil production
• bacteria
• inflammation.

    All medicines can have side effects. Some medicines and side effects are mentioned in this booklet. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.

Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

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People with moderate-to-severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Prescription Topical Medicines Several types of prescription topical medicines are used to treat acne. They include:

• Antibiotics—help stop or slow the growth of bacteria and reduce inflammation
• Vitamin A derivatives (retinoids)—unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples are tretinoin, adapalene, and tazarotene
• Others—may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or azelaic acid.

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Your doctor will consider your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based gel or solution, which tends to dry the skin. Your doctor will tell you how to apply the medicine and how often to use it.

For some people, prescription topical medicines cause minor side effects, including stinging, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, such as tretinoin, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away, notify your doctor.

As with OTC medicines, the benefits of prescription topical medicines are not immediate. Your skin may seem worse before it gets better. It may take from 4 to 8 weeks to notice improvement.

Prescription Oral Medicines For patients with moderate-to-severe acne, doctors often prescribe oral antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Prescription oral and topical medicines may be combined. Common antibiotics used to treat acne are tetracycline, minocycline, and doxycycline.

Other oral medicines less commonly used are clindamycin, erythromycin, or sulfonamides. Some people taking these antibiotics have side effects, such as an upset stomach, dizziness or lightheadedness, changes in skin color, and increased tendency to sunburn. Because tetracyclines may affect tooth and bone formation in fetuses and young children, these drugs are not given to pregnant women or children under age 14. There is some concern, although it has not been proven, that tetracycline and minocycline may decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be necessary to achieve the desired results.

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People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin, a retinoid (vitamin A derivative). Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

Advantages of Isotretinoin Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Disadvantages of Isotretinoin Isotretinoin can cause birth defects in the developing fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin.

Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin; however, the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels unusually sad or has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, it's important to consult your doctor.

Other possible side effects of isotretinoin include:

• dry eyes, mouth, lips, nose, or skin (very common)
• itching
• nosebleeds
• muscle aches
• sensitivity to the sun
• poor night vision
• changes in the blood, such as an increase in fats in the blood (triglycerides and cholesterol)
• change in liver function.

To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.

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In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens. The doctor may prescribe one of several drugs to treat women with this type of acne:

• Birth control pills—to help suppress the androgen produced by the ovaries
• Low-dose corticosteroid drugs, such as prednisone or dexamethasone—to help suppress the androgen produced by the adrenal glands
• Antiandrogen drugs such as spironolactone—to reduce the excessive oil production.

Side effects of antiandrogen drugs may include irregular menstruation, tender breasts, headaches, and fatigue.

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    Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.
    Early treatment is the best way to prevent acne scars. Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding down" scars, is sometimes used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.

Below you will find products from amazon that we have carefully selected based on the high reviews they have received from customers. We have included information about the products as well as some reviews. By clicking on the image of the product you will be directed to a page where you will have the opportunity to purchase the product well below suggested retail. We hope these products will help you in your fight. If you have any comments or questions about these products please post a message on our blog. For more acne fighting products visit our Acne Shop.

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Product Features

• MicroClear technology
• Non-comedogenic (won't clog pores)
• Treats acne even before it emerges
• Hydrates and softens
• Reduces redness

Product Features

• Severe acne system
• Dermatologist preferred
• Benzoyl peroxide plus retinol formula
• For all ages and skin types
• 4 easy steps-clinically proven to fight acne 24/7

Customer Reviews:
146 Total Amazon Reviews - 4 out of 5 Stars on average
Worked BETTER than Proactiv!!, January 28, 2007 By G. Holder   
"First off I want to explain that I have had terrible acne off and on (mostly on though) for the past 8 years. I had to be put on Accutane my sophmore year for 6 months in high school and then again my freshman year of college for another 3 months. I have been struggling ever since then and needed an alternative to dermatoligist bills and prescriptions for acne treatment.
    I was having extremely painful and frequent breakouts in the later half of last year and in early November I happened to stumble upon this product. I had my doubts because I had already given Proactiv a couple of tries in the past.
    The first week of using the 4 products in the package my face became EXTREMELY dry! At first I was worried because it would always be a little red and irritated for the first hour or two after going through the routine. However, within 4 days ALL of my blemishes (big and small) had cleared up! Within a couple of weeks my skin even became smoother, softer, and more even-toned. Trust me, if you have problem skin and want to try something new, this product is definitely worth a shot!
    Also, I love that you can buy this in pretty much any Walgreens and Walmart so it's very convenient...no waiting for it to be delivered. I purhased mine at Walmart for $20-something in November 2006 and still have more than half remaining of each product in the pack.
    Thank you University Medical for making an affordable product that actually works! Best of luck to all of you who are struggling with acne...and don't mark this one off your list!"
Great product!, November 18, 2011 By Berudandi -
"I've had severe acne problems since HS and I could never get rid of it even into adulthood. I did use Accutane, but stopped because I was not fond of the side effects. This product has been great! After a week of using the product, I noticed a HUGE difference in my skin. After a few weeks following the directions, my acne cleared. My friends and family commented on how quickly my acne went away. Since I do not want to strip my skin, I now use the product once every other day as part of my regimen."

Product Link:
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Product Features

• Set includes:
• 4 oz Proactiv Micro Crsytal Advanced Cleanser
• 4 oz proactiv Toner
• 2 oz Proactiv Micro Crystal Advanced Lotion

_ Customer Reviews:
22 Total Amazon Reviews - 4 out of 5 Stars on average
Worth the price, April 20, 2011 By Angel
  "My skin is acne prone and I have tried many things in the past to make it clear up, but nothing has worked. At first Proactiv was a little irritating and drying for me. Word of advice, don't get it near your eyes because the cleanser does sting. The 3 step worked right away for me, within a couple weeks my skin started getting clear and brighter. Occasionally I have minor breakouts, but nothing compared to before starting this kit. It's been a year now and I've never used any of the other products in the line, except this 3 piece kit and another moisturizer. The kit alone dries out my skin, so I use a separate moisturizer and SPF. The price is a little high for this kit, but here on Amazon I compared to the Proactiv site and another site who also sell these products and this price here is most competitive. I like being able to purchase what I need instead of an entire kit at one time. A friend recommended Proactiv to me. I would recommend this kit to most anyone except those with extremely sensitive or dry skin. The formula is kind of strong and at first, like I said it dried my skin and stung a little if I got it near my eyes."
Good product, December 2, 2010 By Luckyguy00
"Very very good product when it comes to eliminating pimples, blemishes and blackheads. It works very well. The only complain I have is that it dries out your skin tremendously, but besides that it really got rid of my blackheads on my back."
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