“Sometimes I see people try over-the-counter products just for a couple of weeks, they get frustrated, they say it’s not working, and they discontinue them,” Arthur says. “But it really does take a while to see the effectiveness. So unless you’re having a problem with the medication, like it’s causing severe irritation or dryness, it’s recommended to give it at least 2-3 months before switching to something else.”
Topical treatments on their own may not be enough to give you clear skin, especially in those with complicated, inflammatory cystic acne. There are several acne medication options approved for use by the FDA, but which one is best for you is a question for your dermatologist and/or general practitioner. Baldwin says if you have insurance and you have acne, a prescription may be the best step because "it makes no sense to try to handle the condition yourself or to use over the counter products that are always less effective than prescriptions meds." Here are a few of the acne medications you'll want to ask about:
Side effects include increased skin photosensitivity, dryness, redness and occasional peeling. Sunscreen use is often advised during treatment, to prevent sunburn. Lower concentrations of benzoyl peroxide are just as effective as higher concentrations in treating acne but are associated with fewer side effects. Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial antibiotic resistance.
There are a number of mild chemical peels available over the counter, but acne scar removal requires a stronger peel typically administered by a doctor or dermatologist. Trichloroacetic acid (TCA) peels are slightly stronger than alpha hydroxy acid (AHA) peels and may be used for acne scar treatment. The strongest type, phenol peels, may cause significant swelling and require up to two weeks of recovery time at home. Neither are recommended for people with active severe acne.
Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties. It opens obstructed skin pores and promotes shedding of epithelial skin cells. Salicylic acid is known to be less effective than retinoid therapy. Dry skin is the most commonly seen side effect with topical application, though darkening of the skin has been observed in individuals with darker skin types.
Cystic Acne: The most severe type of acne, cystic acne requires dermatological care and prescription acne medication to treat. Even the best acne products available over the counter are no match for this painful condition in which the area of the outbreak becomes inflamed, but not infected. Cystic acne can result in permanent scarring. However, it's important to know that all acne lesions can scar. Scarring is related to size, amount of inflammation, genetics and delay in therapy.
Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.