Your first line of defense against acne is over-the-counter medications. If they don't seem to be helping, and after six to eight weeks you acne is getting worse... it's time to see a doctor. You will know it's time for medical help when

- Your acne causes you psychological distress.

- There are big, tender pimples on your face.

- You begin to see some scarring

- If you have dark skin and dark patches form where the pimples used to be.

What treatment can you expect the doctor to recommend?

First of all your family doctor may send you to a dermatologist if you have severe acne.

Acne can be treated with medications that are either applied to the skin or taken by mouth. Any treatment will be designed to attack the things that trigger acne, like....

- An increase in sebum that leads to a narrowing of the sebaceous glands and produces the bacteria that causes acne

In most cases you can continue with any home remedies that you have been using. The treatment of teenage acne usually will continue until the suffer moves into their 20s.

The first attempt at treatment often begins with lotions or creams that are applied directly to the skin's surface.

Your doctor may initiate a treatment with azelaic acid (eg Skinoren cream) or benzoyl peroxide (eg Panoxyl, Acnecide) for mild to moderate acne. These medications help prevent the narrowing of the openings of the sebaceous glands and slow the growth of the acne bacterium.

A common treatment is a product that combines benzoyl peroxide with a topical antibiotic such as erythromycin (Benzamycin gel), or clindamycin (Duac once daily gel), or treat the outbreak with a topical antibiotic alone, eg clindamycin (Dalacin T), erythromycin (Eryacne gel), tetracycline (Topicycline).

Doctors often prescribe adapalene (Differin) for people with blackheads, whiteheads and mild inflammatory acne. Women should only use adapalene if they are using effective contraception, such as contraceptive pills. Pregnant women must not use adapalene. Topical tretinoin (Retin-A) and isotretinoin (Isotrex gel) have similar uses and exclusions.

"Systemic treatment" means medicines that are taken orally.

Strange as it may seem adult women with severe acne may benefit from treatment with contraceptive pills containing anti-androgens (Dianette).

For people with severe inflammatory acne, long-term treatment with oral antibiotics such as tetracycline or minocycline (eg Minocin), combined with one of the medications mentioned above are often effective. Tetracycline antibiotics are never given to pregnant women; women who are breastfeeding; or children under 12 years of age.

For patients with severe cystic acne that does not improve with other medications, oral isotretinoin (Roaccutane) is used as a last resort. It is very important that women should neither be pregnant, nor get pregnant, while taking isotretinoin.

Isotretinoin is not suitable for people with liver or kidney disease. The medicine has several severe side effects which is why it can only be prescribed by a dermatologist, but it also often effect an almost miracle like cure of acne.

That brings us to rule number one... don't stress over your acne. You aren't the only one who has ever had the problem. Just relax and get to work doing everything you can to keep it under control.