The main oral therapy treatment for acne is with antibiotics, although Bactrim, Dapsone, oral contraceptives and Isotretinoin are occasionally used.
Tetracycline remains the antibiotic of choice, but erythromycin is preferable for girls who are or might become pregnant. Minomycin or doxycycline for some patients is more successful, but the proper dosage enhances patient compliance if the tablets are being taken for months.
Various hormonal oral therapies exist for reducing sebaceous gland activity such as contraceptive pills, spironolactone, and medroxyprogesterone which increases SHBG (sex hormone binding globulin) thereby reducing available testosterone for girls.
Isotretinoin (Roaccutane) is mainly used for severe and intractable acne. Many patients will show remission for years and the relapse rate is much less than that seen with conventional treatment. The main action of Roaccutane is a reduction of sebaceous glands activity. However, oral therapy can introduce many side effects, especially Isotretinoin. For this reason, Isotretinoin is restricted only for specialists to use.
There are many abrasive (physical) methods which can be used only for specific stages of acne, or stages of recovery from active acne. For removal of closed comedones (white heads) we can use mainly peels or fractional lasers. For removal of blackheads – even hot compresses following manual excretion with comedo remover is helpful.
Treatment for scars following acne is a different issue and we have to be sure that the acne is no longer active. Some scars, over a period of many months, become less noticeable. Depending on the scar size, shape and depth we can use dermabrasion (using of a high-speed wire brush), excision for small well-defined scars, and also fat transplant or fillers for soft scars which are easily stretched.
Finally the best treatment for scarring is laser resurfacing or fractional laser, depending on the severity and depth of the scarring. The theory behind the laser treatment is to remodel collagen and the elastic fibres to allow for new advanced collaged production, which can eliminate or improve the great majority of scars. Keloids following acne are difficult to treat and usually require many sessions with steroid injections and laser treatment.
All the methods can have some side effects such as post inflammatory pigmentation for a few months or hypopigmentation (white patches) for years. For this reason, physical methods to treat acne require considerable skill and experience.