Any good toilet soap may be used. Large comedones may be removed carefully once or twice a week, preferably with a Schamberg loop extractor after hot water compresses. Picking the crust covering an opened lesion may delay healing for several weeks and produce a pitted scar. Sunlight causes mild dryness and slight scaling. Oral tetracycline may be helpful in superficial pustular acne.
Topical treatment is unsatisfactory for severe, deep lesions.
The most common side effect with prolonged antibiotic use is a candidal vaginitis. Oral isotretinoin is the best treatment for patients in whom treatment with antibiotics is unsuccessful or in patients with very severe deep acne. Since isotretinoin is teratogenic, women taking the drug must use strict contraceptive measures not only 1 mo before and while taking it but also for at least 1 mo after discontinuing the drug. X-ray therapty is not justified. Topical corticosteroids, especially the fluorinated ones, may worsen acne.