Acne Treatment Protocol

Please read the four pages regarding acne before beginning the search for your specific acne condition and its treatment.

Whiteheads and blackheads (comedones). Most acne problems start with non-inflammatory lesions: whiteheads and blackheads. As you have read in the What is Acne section, these lesions are the result of excess cells blocking the normal transition of fats and oils up a hair follicle to the surface of your skin. These early lesions usually respond to twice daily gentle washing followed by the use of one of the following over the counter agents once or twice daily. Most of our patients have already tried some of these therapies:

Papules and Pustules (Inflammatory lesions)
For some the over the counter treatments are effective. For others, either their whiteheads/blackheads persist or they develop additional types of lesions that are more inflammatory: papules and pustules. These latter lesions are the resulted of the affected hair follicle becoming inflamed (papule-red bump) or inflamed and infected (pustule-pimple). If the over the counter medicines are not helping enough, our first prescription medicine is usually a stronger form of benzoyl peroxide once or twice daily, or a combination of benzoyl peroxide in the morning and of one of the topical retinoids in the evening. This regimen, washing followed by a topical treatment twice daily usually resolves most of the more complicated problems, although we may have to increase the strength of one or both of the medicines to get the desired effect. If, however, the benzoyl peroxide formulation in the morning (e.g. Benzoyl Peroxide gel 5%) and the retinoid formulation in the evening (e.g. Tretinoin 0.1% cream) do not control the problem, we will progress to an even more complex system of medications. Typically we would add an antibiotic either topically alone or in combination with the benzoyl peroxide such as Cleocin T or Benzaclin or orally such as erythromycin or tetracycline.

If these combinations cannot be adjusted to control your problem, we would suggest that you see one of our dermatologic colleagues. The only treatment they will use that we don't use is accutane, but if all the options we have given you are not effective, then it is time to consider accutane.

After you have read through this page, please call our office and let us know to what stage you feel your acne has progressed, what you have done so far in terms of treatment, and make an appointment to begin treatment with us.