Treating Blackheads and Small red pimples
For non-inflammatory acne (blackheads and papules) the treatment of choice is the prescription drug tretinoin (Retin A, retinoic acid), a vitamin A derivative, or adapalene (Differin), also a vitamin A derivate prescription cream, or benzoyl peroxide 5% (Panoxyl) in the evening.
Both Retin A and Panoxyl may cause redness, burning and scaling (the irritation effect), and sensitivity to sunlight. When this occurs, apply the medication every second evening until the skin settles.
Tretinoin should never be applied with over-the-counter medication. Note that benzoyl peroxide can be bought over-the-counter or as per prescription.
Other drugs that can be used include salicylic acid (OTC), tazarotene, and topical antibiotics.
Treating red and yellow pimples
For mild inflammatory acne (papules and a bit of pustules) a topical antibiotic such as Eryderm, Ilotycin, Benzamycine, Zynaryt or clindamycin may be added for application in the morning.
Alternative topical antibiotics include erythromycin and sulphonamides.
For moderate inflammatory acne (pustules) a systemic (oral) antibiotic, such as Oxytetracycline, is the treatment of choice. Minocycline is preferred by most dermatologists (dosage 50 mg to 100 mg per day) or doxycline and trimethoprin.
Topical treatment (tretinoin included) should be continued to combat inflammation.
Be aware though that antibiotics may make women susceptible to yeast infections.
For resistant cases, oral minocycline may be prescribed. The tetracycline group of drugs causes yellow teeth of the foetus if taken after the third month of pregnancy.
These drugs should be stopped if you become pregnant and only started again following the completion of breast-feeding. Read online all about acne medication and pregnancy and find a remedy for pimples that suits you.
Tetracyclines must not be given to children before the permanent teeth have erupted because these drugs can cause yellow discolouring of permanent teeth.
Treating severe acne
For marked inflammatory acne (deep, chronically inflamed cysts), the drug Roaccutane may be prescribed. This drug has potentially severe side-effects during pregnancy and the treatment must be monitored.
The cure rate is between 70 and 80% after five months of treatment. All forms of treatment should be continued for a minimum of three months.
If the condition shows improvement the current therapy regimen may be continued. If not, modification of treatment should be considered.
An anti-androgenic contraceptive pill (Diane-35) may be useful in some women with inflammatory acne.
For treatment to be successful, it should be as regular as clockwork.
Revision date: June 22, 2011
Last revised: by Sebastian Scheller, MD, ScD