Acne Treatment

Acne results from excess sebum production, follicle clogging, bacterial colonization, and inflammation. In adults — particularly women — hormonal fluctuations related to the menstrual cycle, PCOS, or stress are common drivers, which is why adult acne often requires a different treatment approach than teenage acne.

When OTC benzoyl peroxide or salicylic acid products haven't produced meaningful improvement after 8–12 weeks, when acne is moderate to severe, when it involves the chest or back, or when it's causing scarring — prescription treatment should be discussed with a clinician.

Isotretinoin is most commonly used for severe nodular or cystic acne, but it may also be appropriate for moderate acne that has not responded to multiple antibiotic and topical treatment courses, or when acne is causing significant scarring or psychological distress.

Most topical treatments show initial improvement at 6–8 weeks, with full effect at 3–4 months. Antibiotics act faster but are limited to shorter courses to minimize resistance. Isotretinoin typically produces sustained remission after a single 4–6 month course.

Topical retinoids commonly cause initial dryness and peeling. Antibiotics carry resistance and GI side effect concerns with prolonged use. Isotretinoin requires iPLEDGE enrollment due to teratogenicity and monitoring for mood changes, lipid levels, and liver function.