What do dermatologists prescribe for cystic acne

Treatment for acne

The therapy of acne should be directed against the overproduction of skin oil, the narrowing of the sebum gland openings as well as against the inflammation and bacterial infections.

Acne treatment takes time and the effects usually only show after six to eight weeks. In the first one to two weeks, the complexion can worsen even with the right treatment! This is important to know because the treatment should still not be stopped.

ExpressionmediumType of application
easy-mediumRetinoids Benzoyl Peroxidelocal
medium-difficultin addition antibioticslocal
hardly inflammableAntibiotics isotretinoinorally

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Topical treatment (local or topical therapy)

Mild to moderate forms of acne (acne comedonica and acne papulo-pustulosa) are treated locally with retinoids (vitamin A derivatives) or benzoyl peroxide (basic therapeutic agents). These agents have an anti-inflammatory effect, reduce acne bacteria and stop the narrowing of the sebum glands and the formation of new blackheads. They are available as a cream, gel, lotion or solution and are administered individually or in combination.

Depending on the severity of the acne, the basic therapeutic agents can be combined with local antibiotics (erythromycin, clindamycin, nadifloxacin, tertracycline) to further reduce the colonization with acne bacteria. Antibiotics should be used as briefly as possible (until the pustules have receded permanently or less than six weeks), otherwise resistance can develop.

Retinoids should not be used if there is potential for sun exposure, or during pregnancy and breastfeeding. As an alternative, azelaic acid is available in these cases.

Systemic treatment

If the therapy is unsuccessful and in the case of very severe, inflammatory courses of acne (acne papulo-pustulosa with nodule formation and acne conglobata), the doctor can use oral antibiotics (e.g. tetracycline, erythromycin) in addition to the above-mentioned agents. These reduce pro-inflammatory processes and the colonization with acne bacteria.

In the case of particularly severe acne with cyst formations, in which the above-mentioned procedures remain ineffective, the dermatologist can treat with oral isotretinoin (a derivative of vitamin A acid). It reduces sebum production and inhibits inflammatory reactions and the formation of blackheads.

Under no circumstances should these drugs be used during pregnancy or breastfeeding, as they can be teratogenic. They should therefore only be prescribed in combination with a reliable method of contraception. Likewise, they should not be taken in the case of kidney and liver dysfunction.

Additional therapy options for women

Women who have moderate to severe acne (acne papulo-pustulosa or acne conglobata) can benefit from contraceptive pills with anti-androgens (anti-male hormones). By eliminating the androgen effect on the sebum glands, sebum production is greatly reduced. Depending on the severity of the acne, the pill can be combined with the therapeutic agents mentioned.

In addition to the various therapy options, professional cosmetic skin cleansing and blackhead removal are recommended for all degrees of severity with the exception of acne conglobata in order to accelerate the healing of acne.

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Acne Scar Removal

Acne scars can be alleviated or even removed by various methods, such as abrading the skin (dermabrasion) or laser treatment. When treating scars, it is generally important to ensure that there is no longer any inflammation. A suitable therapy method can be selected depending on the type of scar. These treatments are performed by dermatologists or plastic surgeons.

Treatment of acne during pregnancy and breastfeeding

If a woman becomes pregnant while undergoing acne treatment, it is important to inform the treating dermatologist as soon as possible, as the therapy may have to be changed.

Benzoyl peroxide or azelaic acid can be used as local therapeutic measures during pregnancy. If antibiotic therapy is necessary, erythromycin can be given after careful risk / benefit assessment. Retinoids must not be used during pregnancy and should be discontinued in the event of pregnancy - after consulting a doctor. If the acne is very severe, therapy with glucocorticoids is also possible during pregnancy and breastfeeding.

Zinc tablets are also often recommended for treating acne during pregnancy. Zinc stimulates the immune system and slows down inflammatory processes, which can improve acne symptoms.

In addition to local and medicinal therapy, women can undergo dermatocosmetic treatments during pregnancy.

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Dr. med. Kerstin Lehermayr
Medical review:
Univ.-Prof. Dr. Ichiro Okamoto
Editorial editing:
Dr. med. Christian Maté (2013)

Status of medical information:

German Dermatological Society: Guideline for Acne Therapy; Classification S2k; AWMF Register No .: 013/017 - Treatment of Acne; current status 02/2010, corrected version 10/2011, valid until 01.12.2015

EbM guidelines for acne; 04/30/2009; Article ID: ebd00265 (013.060), © 2012 Duodecim Medical Publications Ltd

Minor I .: dermatology; Georg Thieme Verlag KG Stuttgart; 7th edition 2010; Chapter 18.1: Acne vulgaris; P.427-432

ICD-10: L70, L70.0, L70.1, L70.2, L70.3, L70.4, L70.5, L70.8, L70.9