Acne: DiagnosisTreatmentand Steps to Take

Diagnosis of Acne

To diagnose acnehealth care providers may:

• Ask about your family historyandfor girls or womenask about their menstrual cycles.
• Ask you about your symptomsincluding how long you have had acne.
• Ask what medications you are currently taking or recently stopped.
• Examine your skin to help determine the type of acne lesion.
• Order lab work to determine if another condition or medical disorder is causing the acne.

Treatment for Acne

The goals of treatment are to help heal existing lesionsstop new lesions from formingand prevent scarring. Medications can help stop some of the causes of acne from developingsuch as abnormal clumping of cells in the follicleshigh sebum levelsbacteriaand inflammation. Your doctor may recommend over-the-counter or prescription medications to take by mouth or apply to the skin.

Topical medicationswhich you apply to the skininclude:

• Over-the-counter productssuch as benzoyl peroxidewhich kills bacteria and may decrease the production of sebum.
• Antibioticswhich are usually used with other topical medications.
• Retinoidswhich come from vitamin A and can help treat lesions and reduce inflammation. They can also help prevent the formation of acne and help with scarring.
• Salicylic acidwhich helps break down blackheads and whiteheads and also helps reduce the shedding of cells lining the hair follicles.
• Sulfurwhich helps break down blackheads and whiteheads.

Topical medicines come in many formsincluding gelslotionscreamssoapsand pads. In some peopletopical medicines may cause side effects such as skin irritationburningor redness. Talk to your doctor about any side effects that you experience.  

For some peoplethe doctor may prescribe oral medicationssuch as:

• Antibioticswhich help slow or stop the growth of bacteria and reduce inflammation. Doctors usually prescribe antibiotics for moderate to severe acnesuch as severe nodular acne (also called cystic acne).
• Isotretinoinan oral retinoidwhich works through the blood stream to help treat acne and open up the pore.  This allows other medicationssuch as antibioticsto enter the follicles and treat the acne. Similar to topical retinoidstaking the medication by mouth can also help prevent the formation of acne and help with scarring.
• Hormone therapyused primarily in womenwhich helps stop the effects of androgens on the sebaceous gland.
• Corticosteroidswhich help lower inflammation in severe acneincluding severe nodular acne. 

Some people who have severe acne or acne scarring that does not respond to topical or oral medications may need additional treatmentssuch as:

• Laser and other light therapies. Howeverresearchers are still studying the best types of light and the amount needed to treat acne.
• Injecting corticosteroids directly into affected areas of your skin.
• Superficial chemical peels that a doctor recommends and applies to the area.
• Filling acne scars with a substance to improve their appearance.
• Treating acne scars with tiny needles to help induce healing.
• Surgical procedures to help treat and repair scarring.

In addition to experiencing significant scarringpeople of color can develop skin discoloration after acne heals. Your doctor can suggest a treatment approach that can fade existing dark spots. Using sunscreen when outdoors is especially important to help treat and prevent dark spots.

Who Treats Acne?

The following health care providers may diagnose and treat acne:

• Dermatologistswho specialize in conditions of the skinhairand nails.
• Primary health care providersincluding family doctorsinternistsor pediatricians.