Acne Treatment in Istanbul, Turkey

Acne treatment is a multifaceted medical process applied to stop the chronic inflammation occurring in the hair and sebaceous gland unit, eliminate active pimples, and prevent the formation of permanent scars on the skin. The basic strategy for successful recovery is to balance sebum production, remove cellular blockages in the pores, and suppress the bacterial colonization that causes acne. This dermatological management is achieved through the use of evidence-based medications such as topical retinoids, benzoyl peroxide, oral antibiotics, or isotretinoin in personalized combinations according to the patient’s clinical picture. The process aims not only to eliminate existing imperfections but also to preserve long-term skin health by extinguishing the inflammation beneath the skin.

How Is the Acne Treatment Plan Determined and According to What?

Each patient’s skin is as unique as a fingerprint, and for this reason, unfortunately, it is not possible to write a single prescription that fits everyone in the acne treatment process. When starting treatment, the most important task before dermatologists is to correctly analyze the severity of the current condition. While making this analysis, we do not only look at the number of pimples; we focus on the type of lesions, their location, and their potential risks. Acne is basically evaluated in two main groups: non-inflammatory (blackheads and whiteheads) and inflammatory (red bumps, pus-filled tips, painful cysts).

In mild acne cases, superficial blockages are usually at the forefront and the risk of scarring is low. However, in moderate and severe cases, nodules and cysts extending into the deep layers of the skin come into play. This condition carries the potential to cause tissue loss and permanent indentations. One of the most critical factors affecting the treatment decision is the risk of “scar” formation. Even if a patient has a low number of active pimples, if there are pitted scars left from the past or a family history of severe acne, the treatment plan should be created in a much more proactive and powerful way.

In addition, the patient’s psychological condition is also an important parameter determining the severity of treatment. If the person feels seriously unhappy when looking in the mirror, avoids social environments, or experiences self-confidence problems, the treatment protocol may be planned more aggressively, as in the “severe acne” category, even if the clinical picture appears mild. The aim is not only physical improvement but also to protect the patient’s mental well-being.

The main factors affecting the decision-making process are as follows:

• Type of lesions
• Location of pimples
• Risk of scarring
• Response to previous treatments
• Psychological impact

Does Acne Treatment with Creams Give Successful Results?

One of the cornerstones of acne treatment is topical agents applied directly to the skin. Many patients have the mistaken belief that deep pimples will not go away just by applying cream. However, the molecules used in modern dermatology have the power to change the cellular functioning of the skin. The most important secret behind the success of topical treatments is the “combination” method. Acne does not result from a single cause; it is the combination of factors such as increased oil production, pore blockage, and bacterial growth. Therefore, a single ingredient acting on only one mechanism is generally insufficient.

Our most powerful weapon in this field is retinoids. These substances, which are derivatives of vitamin A, enable the shedding of sticky skin cells that cause pore blockage and open micro-blockages. Retinoids not only dry out existing pimples, but also eliminate acne precursors that have not yet surfaced from beneath the skin. For this reason, the use of retinoids is of vital importance not only at the beginning of treatment but also during the maintenance period after improvement is achieved.

In addition to retinoids, antimicrobial agents called benzoyl peroxide are also indispensable in treatment. This substance kills the bacteria that cause acne by exposing them to oxygen, and its greatest advantage is that bacteria cannot develop resistance to it. Especially if antibiotic creams are being used, adding benzoyl peroxide is a medical necessity to prevent bacterial resistance.

The main agents used in topical treatment are as follows:

• Tretinoin
• Adapalene
• Tazarotene
• Trifarotene
• Benzoyl Peroxide
• Azelaic Acid
• Clindamycin

How Can Irritation Be Prevented During Topical Acne Treatment?

Using strong creams can cause dryness, redness, and mild peeling on the skin, especially in the first weeks of treatment. Although this may be perceived as a side effect, it is actually an indication that the medication is working and the skin is renewing itself. However, if this irritation reaches a level that disrupts the patient’s comfort, adherence to treatment decreases. Therefore, the process must be managed correctly.

There are some strategies patients can apply to minimize irritation. For example, waiting 30 to 60 minutes after applying creams to the skin and then washing them off, in other words applying “short-contact therapy,” can reduce the risk of irritation while preserving the effectiveness of the drug. As the skin gradually develops tolerance to these substances, the waiting time can be extended or the application can be switched to remaining on the skin overnight. In addition, the use of moisturizers containing ceramides that strengthen the skin barrier makes the treatment process much more comfortable.

The things to pay attention to in order to reduce irritation are as follows:

• Gentle cleansers
• Barrier-repairing moisturizers
• Short-duration application
• Use every other day
• Sun protection

How Long Should Acne Treatment Containing Antibiotics Last?

In moderate and severe acne cases, especially if the pimples have spread to the back and chest, creams alone may not be sufficient. At this point, oral systemic antibiotics come into play. The purpose of the antibiotics we use in dermatology is not only to kill bacteria; at the same time, these medications have strong “anti-inflammatory” properties, meaning they reduce inflammation. In this way, they help calm red, swollen, and painful pimples. Generally, tetracycline group antibiotics are used as the first choice.

However, there is a very critical rule regarding antibiotic use: time limitation. Antibiotics are not drugs to be used for months or years. Modern guidelines mandate that antibiotic use be limited to a maximum of 3 to 4 months. This period is sufficient to suppress active inflammation. After the inflammation is brought under control, the antibiotic should be stopped and treatment should continue only with topical creams.

Using antibiotics for longer than necessary both disrupts the balance of beneficial bacteria in our body and causes bacteria to develop resistance to the drugs. In addition, while using antibiotics, creams containing benzoyl peroxide or retinoids must be used alongside them to increase the effectiveness of the medication and prevent resistance. Antibiotic use alone is an incomplete approach that has no place in modern acne treatment.

The things to pay attention to during antibiotic use are as follows:

• Drink plenty of water
• Swallow in an upright position
• Avoid the sun
• Probiotic support
• Regular doctor check-ups

How Is Acne Treatment with Isotretinoin Applied in Stubborn Cases?

Isotretinoin, generally known among the public by its trade names, is a very powerful derivative of vitamin A and is considered the “gold standard” in dermatology. This medication is the only agent that can affect all four main factors that cause acne at once. Its most prominent effect is that it radically shrinks the sebaceous glands and stops the production of sebum (skin oil). When oil production stops, the food source of bacteria is cut off, pores do not become clogged, and inflammation subsides.

Isotretinoin treatment is generally preferred in severe, cystic, scar-prone acne or in stubborn cases that do not respond to other treatments. The treatment process requires patience and usually lasts 6 months or longer. The dose of the medication is calculated precisely according to the patient’s weight and the severity of the acne.

The most important part of this treatment is the safety protocols. Since the medication can cause temporary changes in liver enzymes and blood lipids, regular blood tests are mandatory before and during treatment. In addition, the most serious side effect of the medication is that it is teratogenic; in other words, it causes severe disabilities in the baby in case of pregnancy. Therefore, female patients undergoing treatment must absolutely not become pregnant during the treatment period and for one month after the treatment ends.

The most common side effects are dry lips and dry skin. These effects are expected and manageable situations. The process can be passed comfortably with the use of intensive moisturizers and lip balm. In some patients, conditions such as muscle pain or a slight decrease in night vision may also be seen, but these usually improve at the end of treatment.

The steps followed during the isotretinoin treatment process are as follows:

• Blood tests
• Pregnancy test
• Dose adjustment
• Moisturizer support
• Periodic check-ups

Is Hormonal Acne Treatment Different in Women?

In women who continue to experience acne despite having passed adolescence or who suddenly develop acne after the age of 25, the situation is somewhat different. In this picture, called “Adult Female Acne,” pimples usually concentrate on the jawline and neck area, are in the form of painful, deep cysts, and tend to flare up during menstrual periods. The main culprit behind this condition is usually hormones. However, there is an important detail here: the patient’s hormone levels may come back completely normal in blood tests. The problem is that the sebaceous glands of the skin react with excessive sensitivity even to normal hormone levels.

In this patient group, classic antibiotic treatments are generally unsuccessful or the pimples quickly return when the medication is stopped. Therefore, hormonal treatments come to the forefront. Spironolactone is an agent we use most frequently in this field and is quite effective. Originally a blood pressure medication, this molecule blocks androgen (male hormone) receptors and prevents the sebaceous glands from overworking. Since it is not an antibiotic, there is no risk of resistance and it is suitable for long-term use.

Another option is birth control pills. These pills control oiliness of the skin by reducing the amount of androgens secreted from the ovaries. They provide dual benefits especially in patients with polycystic ovary syndrome or menstrual irregularities. Topical hormonal creams developed in recent years also offer a new treatment alternative by blocking hormones only on the skin surface without entering the bloodstream.

The agents used in hormonal treatment are as follows:

• Spironolactone
• Birth control pills
• Cyproterone acetate
• Topical clascoterone

Can Acne Treatment Be Accelerated with Clinical Procedures?

Drug treatments are necessary to solve the problem fundamentally, but it takes time for them to show their effects. Sometimes a very painful, large cyst may develop on the patient’s face, or a rapid improvement may be needed before an important upcoming social event. In such cases, as dermatologists, we resort to in-clinic procedures. These procedures do not replace treatment, but they are powerful assistants that accelerate the process.

One of the most frequently applied methods is intralesional corticosteroid, vitamin, and antibiotic injection. In this procedure, known among the public as the “acne injection,” antibiotic, vitamin, and a very low dose of cortisone are injected directly into the cystic pimple. This reduces inflammation and swelling in as little as 24 hours. It is also highly valuable in preventing the cyst from remaining on the skin for a long time, melting the tissue, and leaving a permanent pitted scar.

Another method is medical comedone extraction. This is the procedure of emptying blackheads and white-tipped pimples in a sterile environment with special instruments. This procedure allows the skin to respond more quickly. In addition, chemical peels are also effective in active acne. Superficial peelings performed with agents such as salicylic acid or glycolic acid deeply cleanse the pores and reduce bacteria.

Some lasers and microneedle radiofrequency aim to shrink the sebaceous glands by heating them and reduce oil production. These methods are especially suitable for patients who do not want to use medication or are looking for additional support to medication.

The supportive methods applied in the clinic are as follows:

• Cortisone injection
• Comedone extraction
• Chemical peeling
• Laser treatments
• Microneedle radiofrequency

How Do the Marks That Occur After Acne Treatment Go Away?

After pimples heal, the red or brown marks they leave behind bother patients at least as much as the acne itself. This condition, medically called “Post-Inflammatory Hyperpigmentation,” is actually not a permanent scar but a color change during the skin’s healing process. The biggest and most important rule in the treatment of these marks is sun protection. Ultraviolet rays stimulate pigment cells, causing the marks to darken and become permanent. Therefore, everyone undergoing treatment must use a broad-spectrum sunscreen regardless of summer or winter.

Patience is very important in spot treatment. Creams containing spot-lightening ingredients such as hydroquinone, azelaic acid, kojic acid, vitamin C, and retinoids lighten the color of the spots by suppressing pigment production. However, the effect of these creams may take months. To speed up the process, technologies targeting pigment such as chemical peels and Q-switch lasers can be utilized.

The effective ingredients used in spot treatment are as follows:

• Hydroquinone
• Arbutin
• Niacinamide
• Vitamin C
• Kojic acid
• Tranexamic acid

What Are the Acne Treatment Methods for Pitted Scars?

Unfortunately, severe acne can damage the collagen tissue beneath the skin while healing and lead to depressions that we call “atrophic scars.” These scars represent real tissue loss in the skin, and therefore it is not possible for them to improve just by applying cream. In this case, interventional methods that will physically correct the skin’s structure are needed. The treatment strategy is determined according to the shape of the scar.

In scars with a rolling, wavy appearance, the problem is generally adhesions beneath the skin. Scar tissue pulls the skin downward with fibrous bands. In the procedure called “subcision,” these bonds are cut by entering under the skin with a special needle or cannula. When the bonds are broken, the skin is freed and the depression rises upward.

In very narrow and deep “ice pick” scars that appear as if pierced by a needle, lasers are generally insufficient. For these scars, the “TCA CROSS” method is applied. High-concentration acid is touched only to the base of the scar, triggering strong collagen production there and allowing the scar to close. Alternatively, the scar can be surgically removed with “punch excision.”

For broader-based depressions, laser systems, gold microneedle radiofrequency, dermabrasion, or chemical peels come into play. These methods stimulate fresh skin formation and collagen synthesis by causing controlled damage to the upper layer of the skin. In some cases, immediate but temporary correction can be achieved by filling the depressions with hyaluronic acid fillers. Most of the time, the best result is obtained with combination treatments in which these methods are used together.

The procedures used in scar treatment are as follows:

• Subcision
• Gold microneedle
• Fractional laser
• TCA CROSS
• Filler applications, salmon DNA, youth vaccine
• Dermabrasion

What Should Be Done to Prevent Recurrence After Acne Treatment Ends?

After the active treatment period is successfully completed and the pimples are cleared, the “maintenance treatment” period begins. In this period, the aim is to maintain the achieved well-being and prevent the formation of new pimples.

The cornerstone of maintenance treatment is topical retinoids. After systemic medications are stopped, most patients are advised to use retinoid-containing creams a few nights a week or every night. These creams keep the pores open and prevent acne formation at a microscopic level. Maintenance treatment may continue for years depending on the person’s risk status. During this process, not disrupting the skin care routine, using the right cleansers and moisturizers, staying away from stress as much as possible, and paying attention to nutrition (especially avoiding foods with a high glycemic index) are the most important steps to prevent acne from returning.

Acne treatment is a long marathon that requires patience and discipline. Instead of hearsay information, neighbor advice, or uncontrolled recommendations on social media, progressing under the guidance of a dermatologist who knows the structure of the skin and masters the biology of the disease is the safest way to achieve smooth skin and protect mental health.

The things to pay attention to during the maintenance period are as follows:

• Regular retinoid use
• Skin cleansing
• Correct cosmetic selection
• Diet regimen
• Stress management

Frequently Asked Questions