Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells, leading to the formation of pimples, blackheads, and whiteheads. It develops on the face, chest, back, and shoulders. Dermatologists are the medical specialists who treat acne, providing interventions that go far beyond what is available over the counter. Seeking professional care is the most effective path toward achieving clear skin and preventing long-term damage.
Identifying When to Consult a Dermatologist
A consultation with a dermatologist is appropriate when over-the-counter (OTC) acne products fail after six to eight weeks of consistent use. If mild to moderate acne persists or worsens despite using ingredients like benzoyl peroxide or salicylic acid, professional intervention is necessary.
The presence of deep, painful lesions, such as nodules or cysts, requires immediate attention, as these forms of acne are unlikely to respond to surface treatments. These deeper lesions carry a high risk of permanent scarring if left untreated. If the skin develops signs of infection, such as increasing redness, swelling, or tenderness, a dermatologist can quickly prescribe targeted treatments.
Acne can cause emotional distress or affect self-esteem. When the condition impacts mental health, seeking professional help is justified, regardless of the physical severity of the breakouts. Early treatment is also recommended to prevent the complications of long-term scarring.
How Dermatologists Classify Acne Severity
Dermatologists classify acne severity based on the number and type of lesions present on the skin, which guides the selection of the treatment plan. Lesions are broadly categorized into non-inflammatory and inflammatory types, with severity increasing as the number of inflammatory lesions rises.
Non-inflammatory lesions include open comedones (blackheads) and closed comedones (whiteheads). Inflammatory lesions appear when the clogged follicle wall ruptures, leading to inflammation and swelling.
Inflammatory lesions range from small, red, tender bumps called papules to pus-filled spots known as pustules. More severe forms include nodules, which are large, hard, painful lumps deep beneath the skin, and cysts, which are deeply seated, painful, pus-filled lumps. Mild acne is characterized primarily by comedones with few papules, while severe acne involves numerous papules, pustules, and multiple nodules or cysts, indicating a higher risk of scarring.
Prescription Treatments and Clinical Procedures
Dermatologists offer prescription treatments and in-office procedures designed to address the underlying causes of acne. Prescription topical medications are the first line of defense, especially for mild to moderate acne. Topical retinoids, synthetic derivatives of Vitamin A, promote faster cell turnover to prevent the clogging of pores.
Topical antibiotics, such as clindamycin or erythromycin, control acne-causing bacteria and reduce inflammation. These are frequently combined with benzoyl peroxide, which acts as an antiseptic and helps prevent bacterial resistance. For more widespread or deeply rooted breakouts, dermatologists may prescribe oral medications.
Oral antibiotics are used for a limited time to decrease bacteria and systemic inflammation in moderate to severe cases. For women whose acne is influenced by hormones, hormonal therapies, such as specific oral contraceptives or anti-androgen agents, can help regulate oil production. Isotretinoin is reserved for severe, scarring, or persistent acne that has not responded to other treatments, working by reducing the size and output of oil glands.
In-office procedures provide targeted treatment for active lesions or enhance medication effects:
- Chemical peels use medical-grade acids, such as salicylic or glycolic acid, to exfoliate the skin, unclog pores, and improve texture.
- Microdermabrasion is a gentler physical exfoliation that removes dead surface skin cells.
- Corticosteroid injections can be administered directly into large, inflamed cysts to rapidly reduce swelling and pain.
Addressing Scarring and Long-Term Maintenance
Even after active acne is controlled, marks or texture changes may remain. Post-inflammatory hyperpigmentation (PIH) or erythema (redness) is a discoloration that is not true scarring and typically fades over several months, though treatment can accelerate this process. Structural scarring occurs when the dermis is damaged, resulting in atrophic scars that appear as depressions.
These depressed scars are classified into ice pick, boxcar, and rolling scars. Dermatologists use several procedures to address scarring:
- Microneedling creates controlled micro-injuries to stimulate collagen production and remodel the tissue.
- Laser treatments, particularly fractional lasers, resurface the skin and encourage the growth of new cells.
- Dermal fillers can be injected beneath indented scars to plump the area, though this effect is temporary and requires maintenance.
Long-term maintenance involves a personalized regimen of prescription topical treatments to prevent new breakouts. Consistent use of sunscreen is also recommended to protect the skin following resurfacing procedures.