Acne Advice By Doctors Warn: The “Ultimate Weapon” Retinoic Acid May Cause Liver Dysfunction

According to dermatologists, acne can range from a mild nuisance to a serious concern—especially when it covers the entire face, affecting appearance and self-esteem. International studies show that people with severe acne are 63% more likely to suffer from depression compared to those without acne. In fact, acne-related depression can sometimes be even more severe than depression caused by cancer.

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Acne and Doctor: When You Should Look for a Doctor for Acne?

That’s why recurring or severe acne, acne scars, and pitted scars should always be addressed by a professional dermatologist. Improper self-treatment may worsen the condition, prolong recovery, and increase the risk of deep scarring. While mild acne can initially be managed with good lifestyle habits like a balanced diet and regular sleep, worsening conditions or concerns about scarring should prompt a visit to a skin specialist—to avoid lifelong skin damage and the potential psychological impact.

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Acne Doctor’s Guide: Do Acne Creams Actually Work?

The term “acne cream” is too broad, dermatologists say. Acne varies in severity, and different types require different treatments. For example, acne caused by excess keratinization is handled differently than acne due to bacterial infection.

Over-the-counter acne creams come with various active ingredients—some focus on vitamin A derivatives, some contain sulfur, and others use antibiotics. But these products often lack the clinical strength needed to treat moderate to severe acne. Relying on them too long may delay appropriate medical treatment.

Moreover, acne creams require proper usage. Without understanding your specific skin condition and how to apply the product correctly, you may end up irritating your skin or causing allergic reactions. For instance, using steroid-based creams without supervision can make acne worse.

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Acne Doctor’s Guide: Should You Never Pop Pimples?

Dermatologists strongly advise against popping pimples. The best way to deal with pus-filled pimples is to let them mature and dry out naturally. Popping or scraping pimples—especially those not visible on the surface—can worsen inflammation, damage the skin, and lead to dark marks or permanent scars.

This is because pimples often form deep in the dermis. Even if you manage to squeeze out the pus on the surface, underlying inflammation remains. Popping can cause the pus to rupture internally, infecting nearby tissues and spreading the inflammation. This also stimulates melanin production (causing hyperpigmentation), increases redness, and can damage blood vessels at the site.

In some cases, dermatologists will professionally drain pustules using sterile tools to allow medication to penetrate deeper. This is done to reduce swelling and inflammation while avoiding further tissue damage. For serious acne, early medical intervention is crucial to prevent scarring and discoloration.

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Acne Doctor’s Guide: Should You Exfoliate When You Have Acne?

Not necessarily. When acne or open wounds are present, physical exfoliants like scrubs should be avoided.

Scrubs aren’t suitable for everyone. In healthy skin, dead cells naturally shed as part of the skin’s renewal cycle. However, for those with oily skin or poor cleansing habits, dead skin may accumulate and clog pores. In such cases, gentle exfoliation once a week may help. But for acne-prone skin with comedones, papules, or inflamed pimples, physical scrubs can rupture the lesions, worsening inflammation or even triggering folliculitis (infected hair follicles).

For oily skin types seeking exfoliation, dermatologists recommend chemical exfoliants—such as low-concentration AHA masks or combined acid peels—over physical scrubs.

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Acne Doctor’s Guide: Should You Use a Facial Cleansing Brush?

Many people use facial cleansing devices, but dermatologists suggest that no matter your skin type, washing your face with your hands is the safest option.

The rotating motion and bristles of cleansing brushes can damage sensitive or acne-prone skin. They can rupture pimples and spread infection, creating open wounds and aggravating inflammation. Over-cleansing is another risk—our skin isn't as dirty as we think, and excessive scrubbing can destroy the skin’s protective lipid barrier, weakening immunity and causing more problems.

Chronic inflammation may also result in "sensitive skin syndrome," which makes acne treatment even more difficult.

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Acne Doctor’s Guide: The 4 Stages of Acne & Common Prescriptions

Dermatologists tailor acne treatment based on severity. Acne is generally classified into four stages:

1. Mild Acne – Non-inflammatory blackheads and whiteheads

Prescription: Topical treatments like antibiotic creams, retinoids, or benzoyl peroxide gels.

2. Moderate Acne – Papules

Prescription: Oral tetracycline antibiotics + topical medications

3. Severe Acne – Pustules

Prescription: Oral tetracycline or low-dose birth control pills (for females) + topical medications

4. Very Severe Acne – Cysts or nodules

Prescription: Oral Retinoic Acid (vitamin A acid) + topical treatments

Note: The above information is for reference only. Please consult your dermatologist for a professional diagnosis and treatment plan.

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Acne Doctor’s Guide: How Do Dermatologists Treat Acne?

For oily skin with mild acne or blackheads, dermatologists may recommend over-the-counter skincare products containing low concentrations of AHAs, salicylic acid, or vitamin A derivatives like retinol. These help regulate oil, reduce inflammation, and promote skin renewal.

For more persistent, widespread, or painful acne, medical treatment is necessary. Dermatologists may prescribe:

• Topical antibiotics or retinoids
• Instructions on proper cleansing and moisturizing
• Oral medication for severe cases

There are three main types of acne medications:

1. Antibiotics – e.g., tetracycline, macrolides
2. Hormonal Regulators – Drugs that reduce male hormones to control oil production (only suitable for women; not for pregnant or breastfeeding individuals)
3. Retinoic Acid (Vitamin A acid) – Taken for 6–8 months, this can treat up to 80% of acne cases.

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Acne Doctor’s Guide: Other Acne Treatments

In addition to prescription medications, dermatologists may recommend medical-grade peels using high-concentration AHAs, salicylic acid, or combination acids. These help reduce excess oil, unclog pores, and treat blackheads, whiteheads, and papules.

Light and laser therapies like intense pulsed light (IPL) and laser resurfacing can improve cell turnover, boost collagen production, balance oil and moisture levels, and help repair damaged skin. These methods also reduce red, brown, or purple acne marks and can minimize broken capillaries and facial redness.

For acne scars and pitted skin, fractional laser treatments, radiofrequency, or microneedling with RF can promote collagen growth and smooth out uneven texture.

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Acne Doctor’s Guide: How to Treat Raised Acne Scars?

While most people worry about pitted scars, some acne sufferers also experience raised scars or keloids. These are often linked to genetic predisposition.

For hypertrophic scars or keloids, dermatologists may recommend corticosteroid injections to reduce scar tissue.

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Acne Doctor’s Guide: What Do Antibiotics Do?

Tetracyclines are among the most commonly prescribed antibiotics for acne. They treat bacterial infections and prevent worsening of acne. These drugs either kill bacteria or stop their growth and are effective for acne, rosacea, and other skin infections.

Typical dosage for adults: 500mg twice daily for 6 to 12 weeks. If needed, a repeat course may be prescribed.

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Acne Doctor’s Guide: Side Effects & Precautions of Antibiotics

Common side effects of tetracyclines include:

• Stomach upset (nausea, vomiting, diarrhea)
• Difficulty swallowing
• Esophageal irritation
• Tooth discoloration or malformation (if taken during dental development)

Not suitable for:

• People with liver or kidney conditions
• Children under 12
• Pregnant or breastfeeding women

Usage precautions:

• Swallow tablets/capsules whole with plenty of water
• Do not lie down within 30 minutes of taking the medication
• Avoid taking with antacids, milk, or calcium/magnesium supplements
• May increase skin’s sensitivity to sunlight

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Acne Doctor’s Classroom: The Effectiveness of Oral Retinoic Acid (A Retinoic Acid Derivative)

For many long-term or severe acne sufferers, oral Retinoic Acid is considered the ultimate "last resort." However, most dermatologists will start with more conservative treatments, such as a combination of oral antibiotics and topical antibiotic or retinoid creams.

Why is Retinoic Acid shrouded in mystery? It's a derivative of vitamin A produced during its metabolism and is a prescription-only medication. Its acne-fighting mechanisms include:

1. Gradual shrinkage of sebaceous glands, significantly reducing oil production
2. Suppression of acne-causing bacterial growth
3. Accelerated shedding of dead skin cells and inhibition of follicular keratinization, thereby reducing comedone (clogged pore) formation
4. Reduction of skin inflammation

Doctors say Retinoic Acid targets the fundamental causes of acne. After 6 to 8 months of use, many patients can see up to 80% improvement.

Given its effectiveness, why not prescribe it from the start? Dermatologists explain that Retinoic Acid is a double-edged sword with significant side effects. Therefore, they typically begin with milder options such as antibiotics, topical treatments like retinoids or azelaic acid. Also, taking Retinoic Acid requires patience and strict adherence to medical guidance—short-term use yields little effect, and self-medicating with high doses can lead to severe side effects. Close communication between doctor and patient is crucial.

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Acne Doctor’s Classroom: Who Should Avoid Oral Retinoic Acid

1. Pregnant women (or those who may become pregnant during treatment)
2. People with impaired or abnormal liver function
3. Individuals with hypervitaminosis A
4. Patients with high blood lipid levels
5. Those allergic to Retinoic Acid or any of its ingredients

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Acne Doctor’s Classroom: Side Effects of Oral Retinoic Acid

As a frontline acne treatment, Retinoic Acid is highly effective, but its side effects can be quite pronounced. Dermatologists emphasize that one must weigh the pros and cons and consider individual health conditions before starting treatment. It is also costly and requires completion of the full course under medical supervision. Thus, it’s usually not recommended for mild acne.

Common side effects include:

1. Initial "purging phase"—breakouts may worsen temporarily for 7–10 days
2. Dry skin and mucous membranes—nosebleeds, chapped lips, peeling skin, dry eyes, etc.
3. Birth defects and increased miscarriage risk if taken during pregnancy
4. Potential liver function and lipid abnormalities—usually reversible after stopping the drug
5. Night vision reduction, which also resolves after stopping
6. Muscle, joint pain, and headaches in some patients
7. Hair loss in rare cases
8. Increased risk of ulcerative colitis

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Acne Doctor’s Classroom: Precautions When Taking Oral Retinoic Acid

1. Stay moisturized—lips and body included, not just the face
2. Always wear sunscreen whether using topical or oral retinoids
3. Long-term or high-dose users may require regular liver function blood tests
4. Must use effective contraception one month before, during, and one month after treatment
5. Do not breastfeed while on Retinoic Acid
6. Avoid prolonged sun exposure and tanning lamps
7. Do not donate blood while taking the medication
8. Avoid nighttime driving during the course
9. Do not take it on an empty stomach or with alcohol

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Acne Doctor’s Classroom: Causes of Acne Formation

According to dermatologists, acne has many triggers, including but not limited to:

1. Naturally oily skin and genetic predisposition
2. High levels of androgen (male hormone)
3. Incorrect skincare practices—e.g., over-cleansing, damaging the skin barrier
4. Food allergies or dietary triggers—studies link milk, dairy, sugar, and high glycemic index foods to acne
5. Psychological stress
6. Medication side effects
7. Environmental factors—temperature and pollution

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Acne Doctor’s Classroom: Acne Care and Prevention Tips

Dermatologists advise that to prevent worsening or recurring acne, proper care is key:

1. Proper face washing

Use gentle, neutral cleansers twice a day—morning and night. Cleanse with hands only; avoid scrubbing.

2. Use non-comedogenic skincare products

Look for products labeled “non-comedogenic,” especially those for oily or acne-prone skin.

3. Don’t squeeze pimples

Avoid touching your face and resist popping pimples to prevent worsening inflammation, scarring, and pigmentation.

4. Watch your diet

Try to avoid dairy, sugary foods/drinks, high-GI foods, chocolate, coffee, peanuts, oily or spicy foods.

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Acne Doctor’s Classroom: Can’t Exfoliate? Here’s How to Remove Dead Skin and Acne Marks

Doctors advise against invasive or exfoliating treatments during Retinoic Acid therapy. Wait at least six months after completing your course before considering such options. Even if acne is 70–80% resolved, the lingering red, brown, or pigmented marks can be frustrating. If you're looking for a post-acne healing treatment, the Acne Treatment may be ideal.

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What Is the Acne Treatment? A Gentle Way to Remove Dead Skin

This is not an invasive or laser-based treatment. The core technique is vacuum microdermabrasion, which uses precision applicators of different textures and vacuum strength to gently buff away dead skin from acne-prone areas like the chin, forehead, nose, and cheeks. The process is painless and leaves no wounds.

More than just exfoliation, the treatment includes a purifying serum that dissolves pore-clogging debris, removes blackheads, excess oil, and dead skin, deeply cleanses, calms inflammation, and hydrates—helping to prevent new acne. It also stimulates skin cell renewal and helps rebuild a healthy skin barrier—allowing you to say goodbye to acne for good.