Acne Treatments

Acne is the most common skin disorder in the United States. Commonly known as a rite of passage for teenagers, acne can actually affect people of all ages, including young children and even babies. According to Angela Palmer, acne specialist at About.com, "Acne occurs when oil and dead skin cells become trapped within the hair follicle creating a plug within the pore." Teenagers are more prone to acne problems simply because of a change in hormone levels that contributes to more oil production within the pores. Most teenagers outgrow the problem as they enter adulthood, but for many the problem continues well into their adult years. Experts say that one in five women between the ages of 25 and 40 suffer from some degree of adult acne.

Regardless of age, those who suffer with acne will benefit from a regular cleansing routine. While acne is not caused by poor hygiene, regular cleansing helps to remove dirt and makeup buildup, both of which can clog pores. Experts recommend cleansing both night and morning with a gentle, water-soluble cleanser (see the ConsumerSearch report on facial cleansers ) and following up with a leave-on acne product to treat and prevent blemishes.

Treatments for mild to moderate acne

According to experts, most cases of mild to moderate acne can be treated effectively with an over-the-counter topical medication or a combination of them. The ingredients of these topical treatments vary but the most common are benzoyl peroxide, salicylic acid, alcohol, sulfur and tea tree oil.

One of the most heavily marketed acne treatments is the Proactiv Solution 3-Step System (*est. $50 for 3-bottle kit). The system includes Renewing Cleanser, Revitalizing Toner and Repairing Lotion. Some users complain that it works well in the beginning but that as their skin builds up a tolerance, it no longer works for them. Some experts and users feel that the "smooth tiny beads" in the cleanser are too harsh on the skin, and some object to the "club" approach to sales from the Proactiv website, which automatically sends you more kits and charges your credit card every 60 days. Still there are many who swear by the system as the only product that clears up their skin. Experts generally agree that Proactiv is a viable option for those who suffer from mild or moderate acne. Paula Begoun, who believes that most acne kits contain at least one problem product, gives each of the products in the Proactiv kit a reasonable review. Her main complaints are that the cleanser is not ideal for use around the eyes and that the toner is an alpha hydroxy (AHA) product rather than a beta hydroxy (BHA) product. She says that "when it comes to most kinds of breakouts, research indicates that BHA (salicylic acid) rather than AHA (glycolic acid) is the best way to exfoliate for breakout prevention." Begoun particularly recommends the Repairing Lotion, giving it her highest rating and praising it for its inclusion of anti-irritants.

Good Housekeeping chose the Proactiv system as the best acne-control kit based on its ingredients and claims. Their dermatologists praised it for "providing the best antibacterial coverage, because its cleanser includes benzoyl peroxide." It should be noted that the Repairing Lotion is also a benzoyl peroxide product. Good Housekeeping likes that it uses a 2.5 percent solution rather than a higher concentration "which could irritate the skin."

Experts claim that benzoyl peroxide is one of the most effective over-the-counter treatments for acne. Paula Begoun claims that the research is "exhaustive and conclusive" as to its effectiveness. It is a disinfectant that can penetrate into the hair follicle, killing the bacteria that cause blemishes. Benzoyl peroxide can, however, dry out the skin. Consumers should therefore start with the lowest dosage possible (2.5%) once a day and increase in frequency and concentration only as needed.

Another well-liked benzoyl peroxide product is Clinique Acne Solutions Emergency Gel Lotion (*est. $15. for 0.5 oz.). It contains a 5% benzoyl peroxide solution that experts love because it also includes anti-inflammatory agents that reduce redness. Users also rave that is extremely effective without being harsh on their skin. Clinique recommends daily use of a sunscreen with this product.

Salicylic acid is another acne treatment product that can penetrate the pores. It is a powerful exfoliant that can cut through the oil that is prevalent for many acne-prone individuals. It sloughs dead skin cells from the surface of the skin and from inside the pore walls.

One popular salicylic acid product is Clean & Clear Advantage Invisible Acne Patch (*est. $10 for a two-pack) . InStyle beauty experts chose it as the best acne spot treatment for their 2007 Best Beauty Buys awards, stating that it "allows you to apply makeup over a breakout while salicylic acid works to shrink it all day." The acne patch uses chitosan to smooth the skin for easy makeup coverage and salicylic acid to heal blemishes at the same time. Dermatologists at Health Magazine call it a "quick drying solution" that "battles bacteria and inflammation." Paula Begoun, on the other hand, believes that the Invisible Acne Patch is problematic because it contains harsh ingredients including alcohol as well as cedar and cinnamon bark extracts. Clean & Clear's website includes a list of ingredients for each product and shows that the Acne Patch does indeed contain alcohol, but it is fairly low on the ingredient list and therefore may not cause problems for all skin types. If excessive dryness and irritation occur with this, or any acne treatment, consumers should use the product less frequently or discontinue use altogether.

A major concern with salicylic acid treatments for Paula Begoun is that most of the products do not have the right concentration or pH balance for effectiveness. She says that BHA products should have a concentration of 1-2% and a pH between 3 and 4. We did not, however, find mention of this from any other expert. Nor is it easy to find products that meet this description because most companies do not list the pH balance of their products. As with any other acne product, it may take some trial and error to find the right match for your skin.

Neutrogena Oil-Free Acne Stress Control 3-in-1 Hydrating Acne Treatment (*est. $8 for 2 ounces) is one product that meets Begoun's specifications for effectiveness. It has 2 percent salicylic acid with a pH of 3.4, according to Begoun. Many experts choose it as a favorite because it contains antioxidants as well as anti-irritants and is moisturizing as well. Experts at Shape Magazine recommend it for normal skin types and say that it "sops up oil without over drying." Users are also big fans of the 3-in-1 Hydrating Acne Treatment, with many of them raving that it is smooth and light and that it helps to control redness. A handful of users complain that the treatment made breakouts worse, an effect that might be attributed to the silicone base used in the product (some people are allergic to silicone).

Experts agree that the most effective regimen for mild to moderate acne is a combination of both benzoyl peroxide and salicylic acid products. Both products perform equally important functions in the fight against blemishes. Stacy Colino of Real Simple magazine says, "A regimen that includes one product with salicylic acid and another with benzoyl peroxide offers a one-two punch against pimples."

Physician-prescribed treatments for moderate to severe acne

Cystic acne is the most severe form of acne. It consists of blemishes, or cysts, that are fluid-filled lumps located under the skin's surface. They can become large and painful. Because cysts begin deep within the skin, this type of acne must be treated by a dermatologist. Over-the-counter medications are generally not powerful enough. Experts recommend early intervention to reduce instances of scarring, which is much more likely in cystic acne cases. Common treatments include oral antibiotics, topical antibiotics, oral contraception, retinoids and Accutane.

Because of the risk of creating drug-resistant bacteria, oral antibiotics (doxycycline, tetracycline and erythromycin) should be taken with extreme caution and under a doctor's advice. Experts agree that these drugs should only be used when all other topical treatments have failed to produce results.

Topical antibiotics (clindamycin and erythromycin) warrant great caution as well. A 2005 study in Archives of Dermatology found that acne patients participating in antibiotic treatment were twice as likely to suffer from upper-respiratory tract infections as those who were not involved in this type of treatment. What's more, a 2005 British study found that over-the-counter benzoyl peroxide was more effective at treating blemishes than either type of antibiotic or combination of them.

Most doctors would agree that Accutane is the most effective treatment for severe acne. In 2001, the FDA said, "Considered the biggest breakthrough in acne drug treatment over the last 20 years, Accutane is the only drug that has the potential to clear severe acne permanently after one course of treatment." It can, however, cause harsh side effects. Severe birth defects occur in 90 percent of babies born to women who become pregnant during the course of treatment.

For this reason, the FDA introduced the iPLEDGE program in March of 2006. The program tries to protect against pregnancy by requiring Accutane patients to submit to periodic pregnancy tests before and throughout treatment. Patients are also required to agree to the use of two forms of effective birth control while using the drug. They must do the same for an entire month prior to beginning treatment and for one month after it ends.

Other common side effects of Accutane use include dry skin and lips, hair loss and headaches. Some, though less commonly, have reported changes in mood, depression and thoughts of suicide. Because the side effects are potentially serious, we chose not to include Accutane in our ConsumerSearch Fast Answers section. It is, however, a viable, physician-supervised option for those who have had no success with other acne treatments.

Retinoids, on the other hand, are very effective with relatively few side effects. According to Paula Begoun, "…retinoids are backed by mounds of solid research supporting their mechanism of action, efficacy, and tolerability." They are helpful for all types of acne, from mild to severe and are even more so when used in combination with hormonal, antibiotic or benzoyl peroxide treatments.

There are basically three types of retinoids available: tretinoin (Retin-A, Renova), tazarotene (Tazorac) and adapalene (Differin). Studies show that all are equally effective but that Retin-A and Tazorac tend to have more bothersome and harsh side effects than Differin. These side effects include burning, peeling and redness of the skin -- effects which tend to diminish with continued use. Physicians generally prescribe various retinoids based on individual acne cases and may switch prescriptions as needed.

As with over-the-counter medications, it may take some experimentation to find the right prescription-strength treatment.

Important Features: Acne treatments

Reviewers say the following about acne treatments:

• Acne is not caused by junk food. It can, however, be caused by an allergic reaction to certain foods, including nuts and dairy products.

• It may take some experimentation to find the right treatment. There is no single product or combination of products that is right for everyone. Finding a perfect match will more than likely take a lot of trial and error as well as mixing and matching of products. This is true of over-the-counter treatments as well as prescription medications.

• Results may not be immediate. It can take six to eight weeks to see results from any particular product. In some cases, conditions may get worse before they get better. You should, however, discontinue use if you experience irritation or an allergic reaction.

• You don't have to "feel" it for a product to be working. Experts say that "tingly" sensations are nothing more than a marketing ploy. The ingredients that create them will not fight blemishes and may irritate your skin.

• Acne treatments generally do not treat existing blemishes, but prevent new blemishes from forming.

• Over-the-counter acne treatments work best when applied to the entire affected area and not just to "spots."

• Moderate to severe acne may require the care of a dermatologist. Some cases of acne will not respond to over-the-counter treatments. This type of acne requires the immediate attention of a dermatologist to help prevent scarring.

Our Consensus Report shows how many times products are top-ranked by reviewers included in our
All The Reviews Reviewed chart.

# of picks	Model (with Retailer Links)	Details from Amazon.com
5	Neutrogena Oil-Free Acne Stress Control 3-in-1 Hydrating Acne Treatment (*est. $8 for 2 ounces)	details
3	Clean & Clear Advantage Invisible Acne Patch (*est. $10 for a two-pack)	details
3	ThermaClear Acne Treatment Device (*est. $150)	details
2	MD Skincare HydraPure Redness Soothing Serum (*est. $85 for 1 ounce)	details
2	Proactiv Solutions 3-Step System (*est. $50 for 3-bottle kit)	-
2	Sonya Dakar Drying Potion (*est. $25 for 0.5 ounce)	-
2	Neutrogena Advanced Solutions Complete Acne Therapy System (*est. $30 for 3-tube kit)	details
2	Olay Daily Facials Clarity Scrub Salicylic Acid Acne Treatment (*est. $8 for 6 ounces)	-
2	Differin (*price varies with prescription)	-
2	Daniel Kern's Regimen Gel (*est. $20 for 8 ounces)	-
1 each	Clinique Acne Solutions Emergency Gel Lotion , Mary Kay Acne Treatment Gel , Zapzyt 10% Benzoyl Peroxide Acne Treatment Gel , MD Skincare All-Over Blemish Solution , Neutrogena Rapid Clear Pads , Clean & Clear Cooling Daily Pore Toner , Murad Acne Spot Treatment , Clean & Clear Advantage Acne Spot Treatment , Clarins Truly Matte Blemish Control , L'Oreal Paris Acne Response Intensive Adult Acne Peel Kit, Wexler Anti-Aging Acne Serum, Sephora Face Concealing Blemish Pen , Decleor Aromassage Purify Masssage Treatment, Decleor Aroma Purete Matte Finish Skin Fluid , Acne Recovery Treatment Lotion, Nature's Cure Body Acne Treatment Spray, Neutrogena On-the-Spot Acne Treatment , Neutrogena Clear Pore Cleanser/Mask , Klear Action Acne Treatment System , Burt's Bees Doctor Burt's Herbal Blemish Stick with Tea Tree Oil , Jan Marini Bioclear , Clean & Clear Advantage Acne Control Kit , Clearasil Ultra Vanishing Acne Treatment Cream , Paula's Choice 2% BHA Liquid

Neutrogena Oil-Free Acne Stress Control 3-in-1 Hydrating Acne Treatment is one of the most powerful salicylic acid products at the drugstore for all-over blemish control. Clean & Clear Advantage Invisible Acne Patch is an acclaimed salicylic acid spot treatment that allows for easy makeup coverage. Proactiv Solutions 3-Step System combines benzoyl peroxide and glycolic acid in one simple-to-use acne-fighting kit. Differin is a proven prescription retinoid that can clear up acne with less of the harsh side effects found in other retinoids. While the ThermaClear Acne Treatment Device is recommended in a handful of reviews, clinical research on this electronic product is inconclusive and user reviews are mixed.

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