6 Things to Know If You Want to Get Rid of Acne—for Good

Acne is like a Kardashian—seemingly everywhere and often misunderstood. Here's how a derm treats breakouts.

Topical medications work best in combination. The bacterium that helps drive acne, called Propionibacterium acnes, can develop resistance to topical antibiotics if you use only one. Benzoyl peroxide plus another antibiotic (prescription 1 percent clindamycin lotion is my favorite) can lead to far greater improvement than either therapy alone.

__If you're prone to blackheads and whiteheads:__An over-the-counter benzoyl peroxide gel or wash might help a little, but a prescription-strength retinoid cream (such as tretinoin or adapalene) is what you really need.

Pimples along the jaw and the sides of the cheeks tend to be hormonally driven. These are the patients I often start on birth control pills, which are FDA-approved for the treatment of acne.

If you have deep, painful blemishes or indented scars, you need a prescription pill. Topical therapies can't reach deep-seated acne, and one scarring pimple every month over four years quickly adds up to 48 scars on the face—something I consider totally unacceptable for my patients. Temporary use of antibiotics, birth control pills, or isotretinoin can halt the process.

When medication isn't helping, the problem may not be acne. It's what we call PIPA (postinflammatory pigmentary alteration), the pink or dark spot that forms after a blemish. PIPA can take weeks, months, or years to clear up, especially in richly pigmented skin. The best treatment is near-obsessive use of a noncomedogenic, broad-spectrum sunscreen, such as Cetaphil DermaControl Oil Control Moisturizer SPF 30 or Neutrogena Clear Face Liquid-Lotion Sunscreen SPF 30.

Isotretinoin, the drug often called Accutane, is the closest thing we have to a cure for severe acne. I have seen it change my patients' lives, and it did the same for me when I was an adolescent. For a number of women, the skin remains clear for life. Because the drug causes birth defects in the children of women who become pregnant while taking it, two methods of contraception are essential. Most side effects—dry skin and lips and sun sensitivity—resolve after the medication is stopped. There have been reports of depression and suicide (though scientific research has not proven a link).

Laurel Naversen Geraghty is a writer and dermatologist in her final year of residency at Stanford University.

PHOTO: CONDÉ NAST DIGITAL ARCHIVE

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