scars. Products to treat mild to moderate acne are
available without a doctor’s prescription. Prescrip-
tion-only medications, such as topical and oral
antibiotics, are necessary for moderate to severe
acne. Most people use several kinds of products
concurrently.
Over-the-counter products and self-care Prod-
ucts available without a doctor’s prescription to
treat acne generally contain astringents, exfoliants,
and antimicrobials, sometimes in combination with
one another. The common product Clearasil, for
example, combines resorcinol, which slows the
production of keratocytes, and sulfur, an antimi-
crobial. Such products cleanse excess oils, debris,
and dead cells from the skin. Antiseptic or antimi-
crobial substances help suppress P. acne and other
bacteria normally present on the skin, reducing the
potential for INFECTIONand inflammation.
COMMON INGREDIENTS IN OVER-
THE-COUNTER ACNE PRODUCTSProduct Actions
acetone astringent
ALCOHOL antimicrobial
benzoyl peroxide antimicrobial, exfoliant
lactic acid exfoliant, mild antimicrobial
resorcinol exfoliant
salicylic acid exfoliant, astringent
sulfur antimicrobial
Prescription medications The two general cate-
gories of medications doctors prescribe for acne
are antibiotics and retinoids, in topical and oral
forms. ANTIBIOTIC MEDICATIONStarget bacteria such
as P. acne. Oral antibiotic therapy may extend over
six months or longer, at doses lower than those
typically prescribed to treat acute infections.
Isotretinoin causes BIRTH DEFECTS. Cur-
rent practice standards require two
negative PREGNANCYtests and use of reli-
able CONTRACEPTION(such as oral contra-
ceptives) before dermatologists may
prescribe isotretinoin therapy for
women of childbearing age.In people who have severe or pitting acne,
treatment with oral isotretinoin nearly always
ends further acne outbreaks because the
isotretinoin permanently alters the structure and
function of the sebaceous structures. However,
oral isotretinoin has numerous, and potentially
serious, side effects that make it a treatment
option when other methods have failed to control
the acne. All of the retinoids can cause BIRTH
DEFECTS; women who are or could become preg-
nant should not use these medications. Oral con-
traceptives (birth control pills) often improve acne
that follows the MENSTRUAL CYCLE.COMMONLY PRESCRIBED MEDICATIONS FOR ACNE
Antibiotics
erythromycin (topical and oral) minocycline (oral)
tetracycline (topical and oral) doxycycline (oral)
sulfacetamide (topical)
Retinoids
isotretinoin (topical and oral) tretinoin (topical)
adapalene (topical) tazarotene (topical)Outlook Acne is self-limiting. Most acne ceases
when the body’s hormone levels stabilize. For
adolescents, this occurs at the culmination of
puberty, generally by the late teens (females) or
early twenties (males). In women, acne outbreaks
may occur regularly with the menstrual cycle.
Acne related to the hormonal changes of preg-
nancy generally goes away within three months
of childbirth. Acne is uncommon in post-
menopausal women.Risk Factors and Preventive Measures
Because acne results from a convergence of fac-
tors, key among them hormonal shifts in the body,
there are no known measures for preventing its
occurrence. Many myths have prevailed through
the years about the relationship between foods
and acne. Though nutritious eating habits are
important for overall health and development as
well as the skin’s general health, foods do not
influence the course or severity of acne. Similarly,
though poor hygiene contributes to numerous
problems with the skin and may exacerbate acne
by encouraging the growth of bacteria, it does not
in itself cause acne.
Diligent daily hygiene, such as gentle cleansing
with an antibacterial soap, helps prevent acne
lesions from becoming infected. Zealous washing132 The Integumentary System