Mild acne conditions are usually best treated by topical ointments. More severe cases may be treated in a variety of ways including oral antibiotics, ointments, and physical treatments such as chemical peels and drainage.
Physical treatments must be conducted by a dermatologist. Although popping pimples is a form of physical treatment, it is ill-advised. It can cause acne-causing bacteria to spread and may lead to scarring. Physical treatments done under controlled conditions (i.e. in a doctor’s office) minimize risk while providing the best outcome.
The top layer of skin can be removed either chemically or with abrasion. Chemical peels are usually done with salicylic acid or glycolic acid. These work by destroying a microscopic layer of skin cells to unclog pores and remove the build-up of dead cells. The same effect can be achieved by using an abrasive cloth or liquid scrub. Glycolic acid treatments can be done every two to four weeks over a period of about six months, but salicylic acid treatments are milder and are often included in over-the-counter medications. They can be used on a daily basis.
Comedones (blackheads and whiteheads) can be removed by a dermatologist using sterile instruments. An anesthetic cream is used in the immediate area and then the comedones are extracted using a pen-like instrument which opens the top to allow removal of the plugged skin cells and sebum. The procedure is usually followed by an application of antibiotic cream. It is important not to try this at home; squeezing or picking at pimples can lead to infection and permanent scarring.
Severe acne can sometimes cause cysts to form under the skin. These cysts can be painful and disfiguring. Smaller cysts can be treated with cortisone injections which flatten the lesion in a day or two. Larger cysts may need to be drained and surgically removed. Drainage can help relieve the pain associated with cysts and also reduce the chance of scarring. It is performed in the dermatologist’s office with sterile instruments. It is important not to try to drain cysts by yourself because of the risk of infection which could lead to permanent scarring.
Light therapy is sometimes used to combat the acnes bacteria that cause acne. It is particularly useful in treating hard-to-reach areas but may have a short-term effect because it does not do anything about the production of sebum or the accumulation of dead skin cells.
Laser therapy is useful for treating the scars caused by acne. It can be used for both surface-level scarring as well as deep tissue scarring caused by serious acne conditions. Research is currently being conducted on the use of lasers for acne treatment. Several approaches are being examined – burning away the follicle sac which produces the hair; burning away the gland which produces sebum; and forming oxygen in the bacteria to kill them. It is not yet known if laser acne treatment can cause permanent damage to the skin.