Read about acne treatment.

When you consider how many myths there are about acne, it’s not surprising so many people are unsure how to get the best from acne treatments. Much advice is given by well-meaning parents who may never have been given correct information themselves – and so the myths continue!

The good news about acne is that, for most people, it can be fairly straightforward to treat successfully. It can be very satisfying to see an improvement and to feel back in control of your skin. The goal of acne treatment is to stop new spots forming and to reduce any redness. Treatments are not, however, intended to reverse any existing scars or be a one-off wonder that needs to be used for only a few days. It takes persistence and determination to keep some acne under control.

Fast facts

• The aim of treating acne is to stop new spots forming.
• You need to give any treatment at least two months before judging it as being either good or bad.
• Acne needs to be treated before scarring appears.
• It’s never too soon to start using treatments.

Even a greasy complexion is a sign of acne and can soon cause problems if left untreated. Some people worry that products may end up doing more harm than good, but it is very rare that using spot products causes more problems than it solves. There is a combination of over 100 treatments that can be prescribed by a doctor, plus literally hundreds of over-the-counter products designed to help acne skin types, so there should be little excuse for acne to persist.

Above: Washing your skin can't get rid of blackheads or acne. Why? Blackheads form below the skin's surface, when oil, also called sebum, reacts with air in a partially clogged pore. When the pore is totally blocked, you get a whitehead.

Wash your face only twice a day, using a mild cleanser and warm water -- not hot water. Remedies for acne vulgaris work on reducing sebum production that causes blackheads and on the bacteria than cause acne.

Getting the most from acne treatments

For many people there may be some barriers in the way of finding success with treatments. The reasons for these failures may be put down to one or more of the following:

• Lack of willpower or determination
• Impatience
• The effect of acne medication wears off
• Using the wrong treatment for the particular acne type

For a relatively small percentage of people, acne may last many years or even decades. If you just wait to grow out of it or give up using treatments because you feel frustrated or disheartened, the only person that will suffer will be you. It’s completely understandable to believe that giving up is easier than sticking to a medicine regime which requires patience and determination. However, having a strategy in place to counteract the above barriers might include:

• Decide when you would use treatments to best fit in with your daily routine. You might connect taking or using your medication with other daily activities such as cleaning your teeth or putting in your contact lenses. If these are regular activities that you can do without thinking about them, then use this time to remind yourself to take all use your acne treatments.
• If it helps, use a sticky note on your bathroom bedroom mirror to remind you to use your medicine.
• Use a diary to log when you can expect to give your skin a proper assessment, using the two-month rule (see below). This will help ensure that you are keeping your expectations realistic. Remember, the skin may go through many changes during the course of treatment, sometimes looking better, sometimes worse; but by two months any changes overall should be apparent. Be patient – no treatments work overnight, ever!
• Take a minute to imagine how good it will feel to have clearer skin, and remind yourself of the benefits to you of taking using your medication.
• If you don’t like tablets or using creams, then don’t get them! Tell your doctor or nurse which type of treatment you would prefer before they prescribe you a treatment. If you walk away with a prescription for a cream that you know, deep down, you will not use then you will be wasting your time and money.

Over time, some people may find that the effects of their acne medication start to wear off, or that their results become erratic. It’s worth being aware that skin will naturally have fluctuations when it may appear better at some days and worse on others – just as we have our good or bad hair days.

Sticking to a regime

This can be a challenge for people with acne problems, for all the reasons described above. It is natural to want lotions or creams to work instantly, and some spot cream manufacturers are keen to promote the idea of instant cures. If only it were that simple! Treating a spot when it has appeared is already leaving it too late. Emergency or home-made remedies can leave the skin looking worse. If you can get to the earliest stages of acne, and help to stop the spot forming in the first place, then the skin will be more likely to show great improvement. So what can help you to stick to a regime? The two month rule may help.

The two month rule

Despite some marketing campaigns, no treatments can work overnight or, worse still, instantly. While some treatments will soothe redness and help to make a spot look better, they will fail to get to the source of the problem. Helping to reduce the small blockages under the skin, which are usually the starting point of all acne, will help, but many quick cures will not touch this aspect of acne. So how long is long enough? Use the two-month rule:

Before two months

• Try to estimate how many spots (on an average day) you have before starting treatment. 
• Whatever you use to help your acne – whether it is self-medication, prescribed acne treatment, home remedies or complementary therapies – try them as directed for a minimum of two months.

After two months

• If you have more spots (on average) than you did before using the treatment you should change treatment.
• If you have about the same number of spots you should change treatment.
• If you have less than half the average number of spots and stick to the treatment and reassess in another two months.

This may not seem like a huge difference, but it is more realistic to expect a 50% improvement than a 100% clearance. When acne treatments are tested in trial conditions, improvement rates tend to be around the 50 to 75% level. As yet, no known acne treatment has given a 100% total clearance for 100% of patients. The bottom line is, stick to acne treatments as directed and give them long enough to work.

When not to stick to the two-month rule If your skin shows a sudden worsening of acne or it you develop an allergic reaction to whatever treatment you are using (rather than a slight drying of the skin, which is common with acne creams and usually improves) then it is advisable to stop immediately. If the allergic reaction is severe, seek medical help straight away. If you have a mild reaction or a mild flare-up of acne, it may be worth persevering for a few more days to see if the skin settles; if it does, continue for the two-month period as suggested previously.

Choosing the right acne treatment for you

There are two main categories of treatments:

• Oral (tablets taken by mouth)
• Topical (applied or used on the skin).

Some people may prefer one type to another. It is usually just a matter of preference. Some may prefer to take tablets every day creams or gels. These types of topical products may burn, sting or tingle and even give off an unappealing smell. Others may choose to use these types, saying that they prefer to keep medicine out of the body and use products directly on the area affected. Often, however, the ideal treatment regime may be a combination of both types. If you have a strong opposition to using one particular type of medication, remember to tell your doctor or nurse before it is prescribed for you. If you are not sure what has been prescribed for you, then ask if it is to be used on the skin or taken by mouth. Many prescribers may not give the type of treatment a second thought until you ask. There are enough treatments to be able to give most patients a choice.

Beginning topical acne treatments

Anything applied topically to the skin has the potential to burn, sting, irritate, cause redness or peeling or produce an unwanted smell. While nobody would really rate these effects as desirable, they may often be a sign that the product is working. It is also fairly normal for new topical skin treatments to cause a bit of a reaction. Give the skin a chance to adapt and grow used to products by trying the 'step-up' regime:

1. Start with using a small amount rather than ‘slapping it on’.
2. If you are worried that your skin might react badly, then try testing in one small area only for a few days.
3. Applied to all areas usually affected, even when there are no spots to be seen.
4. Leave on the skin for up to 20 minutes.
5. After 20 minutes, remove gently with warm water on a cotton pad or with a gentle face wipe.
6. Apply oil- free moisturiser – as much as you feel your skin needs.
7. Start off applying at night only – this will allow any initial angry skin reaction to occur at night.

Gradually build up a tolerance with this regime, increasing the amount of time the product is on the skin every week. This might be from 20 minutes to one hour, from one hour to overnight then from overnight to the full recommendations of the prescriber (this might be twice or three times a day).

Above: apply small amounts of a topical acne treatment initially

Coming off treatments

When is the best time to stop using your acne medication?

This will usually vary from person-to-person but a general rule would be to consider a gradual reduction in treatment to see if it makes any difference to the skin (unless directed otherwise by your doctor or nurse). You might, for examples, have a prescribed gel or lotion that you use twice a day. When you feel you have reached a maximum level of benefit and your skin has fully improved, it might be wise to take a step wise approach by reducing its use to once a day for two weeks. Then, if the skin is no worse after another two weeks, reduce it to once every other day for another two weeks. However, if the skin gets worse, then step back up again and maintain the dose that seems best for you. It will not be until you have stopped taking treatments that you will really know if they are helping any more or not. It is a matter of trial and error. This regime should be carried out under the agreement of the person who prescribed your treatment.

Stopping any treatment suddenly can result in the skin temporarily flaring up and seeming far worse. This is known as rebound acne and, as the name suggests, can make the acne return after a couple of days. Many doctors will not consider this possibility when they prescribe treatments, so ask about withdrawing in a stepwise fashion at the time of prescribing. If you are on more than one treatment for your acne, such as an antibiotic tablet and cream, consider reducing the tablets first, in the way suggested above, before reducing the cream.

Tips for using treatments

• Every product or treatment prescribed by your doctor should be used in the following way (with the exception of emergency spot treatments):
• Apply creams or lotions to all areas usually affected by acne, not just the spots that you can see. Do this every time you apply creams or topical lotions directly onto the skin. Remember, the spots seen on the surface have probably taken a few days to form deeper beneath the surface of the skin.
• Use treatments for a minimum of two months.
• It may be helpful to use photos to decide if your skin is looking better, worse or no different. Take a picture before beginning treatment, making sure you can see the skin clearly enough. Take another photograph after two months. You are looking for a visible difference in the skin. Ignore spots that are healing or scarring. Bear in mind that the skin may vary slightly from day to day, which may be influenced by factors such as the menstrual cycle, humid weather or lack of sleep.

Myths about acne treatment

It’s not just what gives you acne that is shrouded in myths. Treatments are just as likely to be a victim of well meaning, but often futile, advice. By taking time to discover the truth about how acne treatments work, how to use them on how to manage any unwanted effects, it’s likely that you will get better results.

Let us consider the most common myths about treatment:

Myth: Slap on acne creams/lotions in double quantity on spots as they appear.

Fact: Applying more than is needed is likely to increase skin irritation and may over dry the skin, which promotes more oil production and can produce more spots.

Myth: If they don’t work after three days don’t bother; they must be rubbish.

Fact: Some spots may respond quickly to treatments, but as it takes several days for a spot to form this is not giving enough time to effectively work on the causes.

Myth: Any treatment that dries skin out will make the problem worse.

Fact: Dryness is a cosmetic problem and can leave the skin feeling tight and uncomfortable. Some degree of drying will help remove the surface grease, which will reduce blockages in the skin and therefore be helpful. It is when the skin is over dry that you will make it worse.

Myth: Antibiotics are bad for you because when you fall ill in the future they will not work.

Fact: There are many types of antibiotics and they work on a wide variety of bacteria throughout the body. By keeping antibiotics restricted to essential use only and by prescribing those that target the P.acne is most effectively, there is little chance of your needing those antibiotics to save your life in the future. The strongest antibiotics reserved for life threatening conditions are not used for acne.

Myth: Some acne creams can cause skin cancer.

Fact: Creams are tested to decide if they may cause cancer in the future or not. It is only if the studies show satisfactory results that a product can be licensed. Data from patients using creams are also used to decide if they are safe to continue to use; if they are not, they will be withdrawn from the market based on evidence of harm.

Myth: Treatments that doctors give will cause you more harm than good.

Fact: Some people hold certain beliefs about medicines causing harm to the body. Everyone is entitled to their own beliefs and may wish to avoid medicines for this reason. However, careful steps are taken to ensure that all medicines prescribed are as safe as possible.

Myth: You have to treat from the inside first.

Fact: Acne can be just as effectively treated from the outside (using creams) as it can from the inside (taking tablets). There is no particular evidence to suggest that one is better than another. There are probably many more myths, but these give you an idea of the common concerns that might hold a person back from really giving their treatment chance to work.

Golden rules of treating acne

When it comes to treating acne, there are a few golden rules that will help ensure that you get the maximum benefit. These are so simple that if everyone followed them, most people with acne would find that their skin improved. When it actually starts to clear up, not only does it improve confidence, but it also reduces the chances of developing scars that may last a lifetime.

• Always use treatments as prescribed or directed. Take time to read the leaflet that comes in the medicine packet. If you need any further help ask your doctor or pharmacist.
• Apply topical treatments on all areas usually affected. This is even when you are unable to see any black heads or spots.
• Use the 20 minute wash-off rule.
• Use treatments for at least two months before you start to judge how well they are working.
• Some treatments will need to be used for a period of many months as long as your skin is in a state of acne flare-up.
• Avoid suddenly stopping acne treatment as this may cause what is known as rebound acne.

Top questions to ask your doctor about your treatments.

• How do I use this medication?
• What side effects might I expect?
• What sort of improvement can I expect?
• What else can I try if this does not work?

By sticking at acne treatments for long enough and using the right amount of treatment exactly as prescribed, you will greatly improve your chances of keeping in control of your skin. However, if your skin becomes progressively worse over a period of a few weeks, or if you experience any unwanted side-effects, then you may need to consider changing treatment. Fast facts Side-effects of medication can be very common and will usually reduce over time as the skin becomes used to it. If, however, you notice any extreme or unexpected effects, contact your doctor or pharmacist immediately. You can report a side-effect of your medicine at www.mhra.gsi

Read more: 

• First line acne treatments
• When to see your doctor or nurse about your acne
• Second line acne treatments

Acne treatments on eNetMD.com