I see a lot of teens for the usual visits — colds, stomach problems — and often notice that they have some acne. After talking to them about their acne, I realize that a lot of them are trying home remedies or simple diet changes that simply aren’t working well. And all too often, I’ve seen an older person with severe acne and some scarring, and they usually say they’ve tried many things but nothing worked well. Many teens — and adults — seem a bit embarrassed but resigned to this “normal” course. But the good news is that there’s no need to have severe acne, and the treatments can be very simple.

I found a pretty good review of simple over-the-counter products at Mayoclinic.com (Over-the-counter acne products: What works and why), but the mainstay for treatment is not just changing your diet. Many people and some doctors will swear that an elimination diet, especially of sweets and chocolate, can help a lot. But in terms of evidence, there actually isn’t much evidence for eliminating any type of food, including chocolate. I personally do feel that my own acne (which I still have!) flares up with processed foods and especially shellfish, so I do feel it’s warranted to have people experiment with elimination diets; usually, teens are eating too much sugars and sodas anyway, so a nutrition discussion is always good.

But I’ve never seen anyone’s acne disappear with diet changes alone, so that’s where the many over-the-counter medicines come in. My favorite has always been benzoyl peroxide 5% cream, which helps a lot to dry out the skin and eliminate most mild cases of acne — only as long as you keep taking it, and the effects take a few weeks to be noticed. Many people make the mistake of stopping this medicine too soon, or taking it irregularly.

Acne Isn’t Normal, It’s An Infection

But the underlying concept I try to tell patients is that acne is not simply a normal rite of teen passage, it’s actually a multiple-level problem; you need to think of acne as an inflammatory disease which is triggered by a bacterial infection in your skin. So, you need to attack acne on multiple levels, often for many years:

• Address your diet
• Use a topical cream like benzoyl peroxide nightly
• Use special acne facial soaps and not regular soap
• Give it time! All treatments take many weeks to notice an effect
• Don’t squeeze whiteheads! This sets up your face for scarring

The Next Level: Prescription Creams and Pills

If it gets bad, especially if you develop cysts or some scarring, you should definitely talk to a doctor about the next level of treatment. Some patients have a great response with a combination cream of benzoyl peroxide plus an antibiotic, usually clindamycin cream. Another excellent prescription-only cream is the group of vitamin A- based (“retinoid”) creams, generically called isotretinoin. These can work very well, and they actually have potential to lessen scarring a bit and make your skin healthier. (By the way, this cream also helps with wrinkles!)

If these creams aren’t working well, your doctor may put you on a daily antibiotic pill like doxycycline. This can quickly get you under control, and many patients also take a small dose for many months just to keep things stable.

The Last Resort — Isotretinoin Pills

For the vast majority of patients, a combination of the above treatments can dramatically control their acne. Usually it isn’t eliminated 100%, but it may come close. For those unfortunates who still have severe acne and cysts, there’s the big gun — isotretinoin pills, known in the US as Accutane. Usually taken for 4-5 months, this drug can be a miracle for many people who had given up on their face. Accutane literally can permanently improve your acne and truly eliminate it forever in a certain percentage. I personally have taken this two times in my lifetime, the first time during my vulnerable teen years, and I had a dramatic improvement which really helped my self esteem at a crucial time.

If it sounds too good to be true, it is — in terms of severe side effects that limit its use. The most notorious is the high frequency of severe birth defects in new babies from moms who had been on isotretinoin during pregnancy; this is why there are strict measures in place to limit any chance of pregnancy while on this. Men are luckier with side effects, but all patients need to have blood tests during treatment to monitor for side effects on the liver and other organs. There is also some suggestion that depression symptoms may flare up while on this.

The Bottom Line?

Acne can be a physically and emotionally debilitating condition during the crucial teen years, so parents and teens should never accept bad acne as a normal condition! If you’ve tried the diets and soaps and over-the-counter creams and still have acne, you really should see a doctor and discuss the many options for prescription creams and pills.