Understanding your acne-fighting options

Acne is a common skin disease and is usually treatable.  Arm yourself with the following knowledge, and you can find your way back to clearer skin.

1. Salicylic acid. Creams and cleansers containing salicylic acid — or similar chemicals such as resorcinal and lactic acid — break down the gunky mixture of skin cells and oil that clogs pores. In one small study, salicylic acid was more effective than benzoyl peroxide for reducing the number of pimples on volunteers' faces. This drugstore remedy kills acne's main culprit: the bacterium Propionibacterium acnes. Recommended as a first step for teens and adults with mild, moderate and even severe acne, it can work as well or even better than prescription antibiotic pills and creams.
2. Benzoyl peroxide. In one large study, researchers split hundreds of acne sufferers among five different regimens that included benzoyl peroxide, antibiotic creams and pills, and placebo creams and pills. After 18 weeks, 60 percent of the group that used benzoyl peroxide plus a placebo pill had at least a moderate improvement. A cream combining benzoyl peroxide and the antibiotic erythromycin worked even better: 66 percent of people in this group saw clearer skin. In contrast, just 54 percent of those who took the antibiotics with a placebo had significant improvement. The bonus for your wallet: benzoyl peroxide was one-twelfth the cost of some of the antibiotics used in the study. Benzoyl peroxide comes in several strengths; start with the lowest to minimize side effects like redness, irritation and peeling. Increase the strength if you're not happy with the results.
3. Prescription medicines. Creams, gels and washes that contain a prescription medicine such as adapalene, tazarotene or tretinoin all work by speeding the shedding of dead skin cells. This in turn helps prevent pores from clogging. These treatments may also cool inflammation, easing redness and swelling. Expect results in eight to 12 weeks. In one review of five well-designed studies involving 900 people with acne, tretinoin and adapalene each reduced the number of pimples on volunteers' faces by about 54 percent. In another study, tazarotene produced similar results. Other research suggests retinoids may clear up 70 percent of blemishes.
4. Antibiotic creams. Prescription-strength antibiotic creams cleared up 35 to 66 percent of red, bumpy, inflamed blemishes in seven well-designed studies involving more than 1,600 people with acne. Volunteers got results when they used the creams for at least 12 to 15 weeks.
5. Azelaic acid. This cream stops the growth of bacteria and decreases the skin's production of pore-clogging keratin, cleared up 73 percent of inflamed blemishes in one well-designed Swedish study and worked as well as tetracycline capsules in another. This remedy's advantage: it's not a true antibiotic and doesn't cause the antibiotic resistance that can make acne flare again, as antibiotic creams, pills and capsules can.
6. Isotretinoin. The biggest gun in the acne arsenal, isotretinoin (Accutane) can eliminate stubborn cystic acne when nothing else works. This vitamin A derivative, usually taken for 15 to 20 weeks, cleared up 90 percent of blemishes in a well-designed study of people with severe nodular acne. But Accutane can also cause birth defects in the babies of women who become pregnant while taking it — and there's growing concern that it may raise the risk of depression and even suicidal thoughts among teens. Use only in close consultation with your doctor.

These simple guidelines will help you choose the best acne-fighting treatment for you.