Non-Surgical
Active Acne Treatment

Topical retinoids (retinol, retinaldehyde, tretinoin) are among the most effective topical treatments for acne. Retinoids increase skin cell turnover, reduce comedones, and improve inflammation. Benzoyl peroxide kills acne bacteria and reduces inflammatory lesions effectively. Salicylic acid exfoliates and unblogs follicles, helping with comedonal acne. Topical antibiotics (clindamycin, erythromycin) reduce bacterial colonization and inflammation. Combination products containing retinoids and benzoyl peroxide or antibiotics provide enhanced benefits. Azelaic acid treats acne and improves postinflammatory hyperpigmentation simultaneously. Niacinamide reduces sebum production and has anti-inflammatory effects. The most effective approach combines multiple topical medications with different mechanisms. Starting treatments gradually and building concentration prevents irritation. Dr. Hazany personalizes topical regimens based on acne type and skin sensitivity. Consistent use for 6-8 weeks is necessary to assess topical medication effectiveness.

Oral antibiotics are appropriate for moderate inflammatory acne that doesn't respond adequately to topical treatments. Antibiotics reduce bacteria, suppress inflammation, and improve pustular and nodular acne. Doxycycline is commonly used due to its anti-inflammatory properties beyond bacterial killing. Minocycline works similarly but with slightly different side effects. Azithromycin is useful for patients unable to take tetracyclines. Oral antibiotics typically show improvement within 4-6 weeks. They work best when combined with topical treatments like benzoyl peroxide and retinoids. Long-term antibiotic use carries risks of bacterial resistance and fungal overgrowth. Antibiotics should be used for limited periods (2-3 months) before switching approaches. Hormonal treatments or isotretinoin may be necessary if antibiotics lose effectiveness. Dr. Hazany prescribes antibiotics strategically, combining them with topical medications to optimize results while minimizing resistance.

Isotretinoin (Accutane) is a powerful oral medication derived from vitamin A used for severe, scarring acne that hasn't responded to other treatments. Isotretinoin works by shrinking sebaceous glands, dramatically reducing sebum and bacterial growth. Unlike other acne treatments that suppress symptoms, isotretinoin can produce long-term remission or cure of acne. Improvement develops over months of treatment, with results becoming apparent within weeks. Isotretinoin requires careful monitoring due to potential side effects including skin dryness, lip chapping, and potential mood changes. Isotretinoin is teratogenic (causes birth defects), so pregnancy prevention is essential for women of childbearing age. Monthly blood work monitors liver function and lipids. Despite requirements for careful monitoring, isotretinoin offers the only potential cure for severe acne. The dramatic improvement in quality of life for patients with severe acne justifies the treatment requirements. Dr. Hazany carefully evaluates whether isotretinoin is appropriate and manages the treatment closely.

Oral contraceptives can be very effective for hormonal acne in women by suppressing androgen levels. Hormonal acne often improves within 2-3 months of starting appropriate oral contraceptives. Certain formulations are FDA-approved specifically for acne treatment. The effectiveness depends on the progestin type—some progestins have anti-androgenic activity that improves acne. Combination of oral contraceptives with topical retinoids or antibiotics provides optimal results. Spironolactone, an androgen-blocking medication, is often combined with oral contraceptives for enhanced anti-androgenic effects. Regular monitoring ensures the hormonal treatment remains appropriate. Individual responses vary; some women see dramatic improvement while others see modest benefit. Oral contraceptives also provide benefits beyond acne treatment for birth control. Dr. Hazany and the team at Hazany Derm coordinate with women's healthcare providers to optimize hormonal acne treatment.

Spironolactone is a potassium-sparing diuretic that blocks androgen receptors, reducing sebum production driven by male hormones. For hormonal acne—particularly in women—spironolactone can be remarkably effective. Spironolactone works gradually, with improvement typically appearing after 2-3 months. Combination with oral contraceptives provides enhanced anti-androgenic effects. Benefits include improved acne and smoother skin from reduced sebum. Spironolactone requires monitoring of potassium levels through blood work as high levels could develop. Regular blood pressure monitoring is advisable. Spironolactone is particularly useful for women with PCOS (polycystic ovary syndrome) who often have hormonal acne. Side effects are generally minimal, though increased urination may occur. Dr. Hazany offers spironolactone as an option for women with hormone-driven acne who want hormonal treatment options.

Duration of acne medication depends on the treatment and individual response. Topical retinoids and other topical treatments are often used long-term or indefinitely to prevent acne recurrence. Oral antibiotics are typically used for 2-3 months before tapering or switching therapies to avoid bacterial resistance. Oral contraceptives and spironolactone are used as long as they're effective and the patient tolerates them. Isotretinoin is taken for 4-6 months total in a cumulative dose. Some patients require maintenance therapy after stopping antibiotics. Combination therapy (topical + oral) may eventually reduce to topical-only maintenance. The goal is achieving long-term control with minimal effective therapy. Periodic reassessment helps determine if medication adjustments are needed. Dr. Hazany discusses treatment duration at initiation and adjusts plans based on results.