So the clogged pore is the primary event in acne.  Sometimes that is all there is - so retinoids, like Retin-A, Tazorac (the most potent), or differin and extractions are all that is needed.

However, most cases of acne show inflammatory (red) lesions, including some large painful cysts.  These are controlled by application
preventively of topical antibiotics, benzoyl peroxide, and particularly effective in females - Aczone.  Additionally, oral medications can be used for one of 3 purposes:
  1. Anti-inflammatory effects - doxycycline derivatives (they probably don't yield their benefits by killing bacteria);
  2. Blocking testosterone in females - birth control pills or spironolactone; and
  3. Preventing inflammatory lesions - Accutane type drugs.
Three pearls of wisdom for acne therapy:
  1. Washing does not help acne (sorry Mom) - dirt has nothing to do with it and chemicals in soap are off the face in a minute so they have no time to penetrate;
  2. Topical medications can be more effective than pills because they are delivered only to the target (skin and then into blood stream); and
  3. You need to apply preventively: all over the place where you expect pimples.
Time, not usually medications, get rid of existing pimples. 80-90 % of patients are doing very well within a month on these regimens.


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