Q: I’ve tried the diet and hygiene approach to fight my acne, and they haven’t worked. What’s next?
A: No magic solution or voodoo exists to prevent pimples or zap acne overnight, but smart skin care will help. Washing with an antibacterial soap twice a day is the first line of defense, and a relatively easy one. Those of you with simple blackheads and whiteheads will want to use a topical keratolytic medicine to unblock the pores (examples include adapalene and topical tretinoin), plus a topical treatment to kill bacteria on the surface of the skin (clindamycin, benzoyl peroxide or erythromycin)—a double whammy in the fight against acne. (“Topical” means you apply the ointment, cream or gel directly to the skin.) For those who want to keep it simple, azelaic acid (brand name Azelex) works well; and it doesn’t bleach the skin, so you don’t end up with lighter and darker areas.
Let’s say you have more than a few pimples. You might want to use benzoyl peroxide in addition to a topical antibiotic. The two work better applied together than if used individually. You can use over-the-counter or prescription formulations of the former, but your dermatologist will need to write you a prescription for the latter. For a higher price, there are combo meds, such as the topical antibiotic clindamycin containing benzoyl peroxide. The best of these call for only one application a day, rather than the standard two a day. That’s a bonus for those who don’t like too much fuss when it comes to face or skin care.
If your acne is bad enough—with blemishes on the face and perhaps pimples on your back or chest as well—you might want to use an oral antibiotic in addition to the topicals, so you can fully kill the bacteria trapped under the skin.
If these strategies don’t work, you need to talk with your dermatologist about possibly going on Accutane, which is the pill form of isotretinoin. If you’re a girl and think you might need Accutane, it’s worth trying the birth control pill first, since Accutane makes periods irregular and also cause birth defects if you get pregnant while taking it (or shortly thereafter).
Guys, you’re not off the hook, because Accutane can also cause liver damage, making annual blood tests necessary. Before trying Accutane, both girls and guys should have maxed out on topicals and oral antibiotics—meaning using all medications faithfully and washing your face twice a day. If that has not cleared up your face in six to eight weeks, it may be worth pursuing Accutane.
When you make a change in your skin care, especially for acne treatment, it takes six to eight weeks to see a difference. If your acne regimen isn’t working after that, it’s time to go back to the doctor. There’s a silver lining to all this: those of you with really oily, pimple-laden faces may actually have fewer wrinkles later in life compared to your dry-skinned, pimple-free classmates. Your naturally elevated production of skin oil protects you better against aging and wrinkles—assuming that you don’t smoke, keep your arteries young and avoid too much sun.
Photo:  30thstreetclinic.com
Michael F. Roizen, MD, is Professor of Internal Medicine and Anesthesiology, Chief Wellness Officer and Chair of the Wellness Institute at the Cleveland Clinic. He has co-founded 12 companies, including the popular websites RealAge.com and YOUBeauty.com.
Mehmet C. Oz, MD, is Vice-Chair and Professor of Surgery at Columbia University and director of the Cardiovascular Institute and Complementary Medicine Program at New York Presbyterian Hospital. His TV show—The Dr. Oz Show— recently won its third Emmy, with Dr. Oz his second as the best daytime talk show host.