Dermatology Associates of Ithaca addresses our patients’ acne through the use of customized regimens for your unique skin needs.
Frequently Asked Questions (Acne)
Acne is the most common skin condition seen in the U.S. It primarily affects adolescents, although adult acne is increasingly widespread. Many effective treatments are available for acne. If untreated, dark spots and permanent scars can appear on the skin as acne resolves slowly on its own. Treating acne will decrease the risk of scarring and dark spots.
- Avoid greasy skin and hair products; accessories such as tight backpacks, hats, and bandanas that can rub against acne-prone skin and cause breakouts; and any skin and make-up products that do not say “non-comedogenic” or non-pore-clogging on the label.
- Avoid touching your face (including no picking, squeezing, or popping of acne lesions).
- Wash sweat off immediately after exercising.
- Females with irregular menstrual cycles and/or excessive body hair should discuss this with their provider since it could be a sign of a hormonal irregularity
Tretinoin, adapalene, and tazarotene (also known as Retin-A®, Renova®, Differin®, and Tazorac®) are prescription medications derived from Vitamin A. They are effective treatments for skin conditions including mild to moderate acne. When used long-term, they may reduce some fine lines and wrinkles, freckles, and brown spots. They commonly cause dryness, flaking, and irritation of the skin when first applied. This improves with use and time. Keep in mind that the medication needs to be used for about two months before improvement is noted, and that although in the first couple of weeks of use acne may worsen, over time it prevents the development of new acne lesions.
Directions for use
- Use this medication at night.
- Wait 15-30 minutes after washing the face, so the skin is completely dry before applying.
- Use a pea-sized amount for the entire face. Dab it onto the forehead, nose, cheeks, and chin, then rub in gently. Apply the medication to the entire face, making sure to avoid the eyes and lips. Do not use the medication for spot treatments.
- Start by applying the medication twice a week. If you have no irritation, increase to every other night and gradually increase to nightly as tolerated. If you experience irritation, you may need to use it less often. An adequate trial period is important since irritation lessens with use and time.
- You may use a moisturizer if your skin becomes dry. Make sure to find a non-comedogenic (non-pore plugging), oil-free product such as Cetaphil® cream.
- These medications may make your skin more sensitive to the sun. As always, protect your skin from direct sunlight. Wear a hat and SPF 30 or higher sunscreens with both UVA and UVB protection.
- Do not use if pregnant.
- We recommend benzoyl peroxide as an important part of your acne regimen, as it helps both with inflammation as well as with decreasing the bacteria on your skin that can cause acne.
- Benzoyl peroxide is available as a 5% wash over the counter so no prescription is needed.
- We recommend that benzoyl peroxide wash be used whenever washing the affected areas; however, if dryness or irritation is noted, then you may decrease the frequency to once a day or less.
- Please note that benzoyl peroxide can bleach towels and clothing, so make sure to rinse off thoroughly and use towels that are white or where bleaching is not a problem.
- If we prescribe a retinoid at the same time as starting benzoyl peroxide, start the retinoid first so your skin can get used to it and after 2-3 weeks, then start the benzoyl peroxide.
- Avoid getting this medication into your eyes, ears, or mouth.
Oral antibiotics such as doxycycline are indicated for moderate acne that does not resolve with topical antibiotics. They are particularly helpful for red inflamed bumps. Proper use of doxycycline includes:
- Taking it with a full glass of water and a calcium-free snack since taking it on an empty stomach can cause irritation and positive ion containing foods and supplements such as milk, yogurt, cheese, iron, multivitamins, calcium, antacids, or laxatives may decrease the effectiveness of doxycycline.
- Avoiding excessive sun exposure since doxycycline makes your skin more sensitive to sunlight and severe sunburns can occur.
- Stop taking doxycycline if you become pregnant since it may discolor the teeth and delay bone growth of the developing baby.
- Contact your primary care physician if you develop yeast infections while on doxycycline.
Your care provider’s goal will be to get the maximal effect of doxycycline use with the minimal dose and treatment length. Ideally, you should be on oral antibiotics for no more than a year; however, sometimes patients use these medications for longer term. Please report any unusual symptoms to your provider when using these medications.
Isotretinoin is indicated for severe, scarring acne that does not respond to other treatments. It targets the development of new acne lesions by shrinking the oil glands in the body. A typical course of isotretinoin is 5-6 months. Isotretinoin is very effective for acne with some strict guidelines, including:
- Keeping monthly appointments with your dermatologist so we can assess the effectiveness of the medication.
- Having bloodwork done monthly or as directed by your dermatologist, to assess for potential side effects that are outlined in the iPledge packet that will be given to you upon commencement of treatment. If you notice any symptoms or side effects while taking the medication, please call to let your provider know.
- Having a urine pregnancy test done in our office monthly (females). Prior to starting isotretinoin females must have two negative pregnancy tests.
- For females, using two forms of birth control for one month before treatment, during treatment, and for one month after treatment. This is because isotretinoin can cause SEVERE birth defects in the fetus.
- Birth control pills (oral contraceptives) can be particularly helpful in cases of acne where flares are noted at specific times in one’s cycle. You should discuss which oral contraceptive is best for you with your primary care physician.
- Spironolactone can be helpful for females with jawline acne and those whose acne flares the week before menses. It can cause menstrual irregularity as well as other potential side effects including increased potassium levels (for this reason we monitor potassium levels periodically while patients are on this medication, and we caution against a high potassium diet or potassium supplements while on this medication). This medication can cause severe birth defects and so should always be used with birth control. It is sometimes used for high blood pressure, so spironolactone should not be taken in addition to other blood pressure medication without discussing with your primary care physician. Patients with a personal or family history of uterine, breast, or ovarian cancer may wish to avoid this medication, although studies have shown there is no increased risk of developing cancer with spironolactone.