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BANISH ACNE
"Accutane is the most rigorous treatment for severe acne," says Wieder. "Photodynamic therapy is the next best thing, and for less serious breakouts, try salicylic acid, benzoyl peroxide, and topical and oral antibiotics."
What the Derm Can Do
• For cystic acne, "Accutane is the closest thing to a cure," says Wieder. One course of the oral prescription, which contains a high dose of vitamin A, takes 15 to 20 weeks. It works by decreasing oil production, so side effects include dry skin and chapped lips. Accutane causes birth defects, so you must not get pregnant while on it.
• For moderate acne, topical or oral antibiotics are good options. Ziana is the only approved prescription acne gel to combine an antibiotic (clindamycin) with a retinoid. "For adults with acne who also want to fight wrinkles, Ziana is great," says Brandt. A new prescription oral antibiotic is Solodyn. One extended-release pill a day battles the bacteria that cause acne.
• Experts consider photodynamic therapy the best in-office procedure for serious acne. First, a solution called Levulan is applied to the skin. It is absorbed by oil-producing glands, making them sensitive to light. Then, when a light treatment is used, oil glands shrink and bacteria are destroyed. "For someone with scarring, this treatment is a two-in-one, as it can also reduce existing scars," says Alster. It can be painful, depending on the light source employed to activate the Levulan, and skin will be red and peeling for a few days after. You must avoid sun exposure after each session, and up to six treatments are recommended, every two to four weeks. The cost is $500 to $1,000 per session. Though results are said to be long-term, it's often not covered by insurance.
Best Skin-Care Options
• For occasional breakouts, products with salicylic acid help unclog pores, while benzoyl-peroxide products boost cell turnover and kill bacteria. "Low-percentage salicylic acid, such as 0.5 to 2 percent, is often better tolerated than benzoyl peroxide," notes Wieder, who recommends treating minor breakouts with over-the-counter products containing salicylic acid or, if acne is more persistent, 5 to 10 percent benzoyl peroxide. If wrinkles are also a concern, try Patricia Wexler M.D. MMPi 20 Anti-Aging Acne Serum ($55), which has 2 percent salicylic acid and line-fighting ingredients.
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