Divya Sadhwani has beautiful skin.  You’d never know by looking at her, but she’s had a long and difficult battle with acne.

“I first started experiencing acne when I was around the age of 13,” Sadhwani said. “At the time, I tried everything over the counter that I could get my hands on.”

Now, at age 31, she is Dr. Sadhwani, a dermatologist at USF Health Dermatology in Tampa, and hopes her journey to clear skin is one that will inspire her patients and others suffering from acne.

“There were times when I didn’t even want to leave the house, because I had so many acne pimples and pustules all over my face,” she said. “It really does affect your self-confidence.”

Eventually, Sadhwani had to turn to prescription products to get her acne under control, but there are several tiers of products to try first.

Countless products

Countless products pledge to clear skin, but finding the right combination for you is the key. Dr. Neil Fenske, Sadhwani’s mentor at USF Health Dermatology and Chairman of the USF Department of Dermatology, says there are three key products she recommends for all people who have acne.

• Salicylic Acid Wash
• Retinoid
• Benzoyl Peroxide

“We have many ways to target acne, but the most important thing is to keep the pores open, so the oil can get to the surface,” Fenske explained.  “One of the simplest things to use is a 2-percent salicylic acid wash.”

Salicylic acid products can easily be found over the counter. They exfoliate and help to unclog pores, but for many, it’s not enough.

The next line of defense is to try a benzoyl peroxide. Benzoyl peroxide products help to kill bacteria on the skin, which can cause inflammation and cystic acne.

“Benzoyl peroxides work by killing the bacteria that live in that oil gland that are starting to propagate, as you get more and more oil,” Fenske said.

The problem with benzoyl peroxide is that it can be irritating and it bleaches everything it touches, so you do have to be careful about getting it on your clothes or pillow case.

The third frontline of defense against acne is a retinoid, which is a vitamin A acid derivative. Retinoids, especially prescription strength retinoids, help to accelerate the turn-over of skin cells, which again, helps to un-clog pores. On the downside, they can cause dry, flakey skin when you first start using them, until your skin gets used to the product.

“Whenever you’re using any of these products, they can all irritate. That doesn’t mean they’re bad,” Fenske said. “It means your skin isn’t able to tolerate them. It takes a while to get used to them.”

If your skin gets irritated, don’t just stop using the products. Fenske recommends cutting back on the frequency and then building up usage.

“So, if they’re too irritating every day or twice a day, then cut back to every other day or every third day,” he said.

Prescription products

When over-the-counter products don’t work, it’s time to see a dermatologist, especially if you’re experiencing inflammatory acne, which can lead to scarring.

“When you start to get pustules and cysts, that’s what usually brings patients to the doctor,” Fenske said.  “We really want to focus on early intervention, so we can prevent scarring, because scarring is forever.”

At this stage, antibiotics are a mainstay of treatment.

“They seem to have an anti-inflammatory effect that helps with the pustules,” Fenske said.

Oral antibiotics are often prescribed first, for three to six months to get acne under control. Also, make note:  if you use an antibiotic, it’s important to also use a benzoyl peroxide in conjunction with it to help prevent resistance to bacteria.

Prescription strength retinoids, like Retin-A, are next on the list to get difficult acne cases under control.

Sadhwani still uses both.

”I needed to add on antibiotic creams, and also I use a topical retinoid at night, religiously,” Sadhwani said.

Retinoids make your skin sensitive to the sun, so when you use this product, be sure to always use sunscreen.

New product

Many dermatologists prescribe a newer product called Epiduo for difficult cases. It combines a topical retinoid called Adapaline mixed with benzoyl peroxide.

The problem is it can be very expensive — more than $400 — and insurance doesn’t always cover it. The good news, however, is that you can now get that key ingredient Adapaline, at the same strength, in an over-the-counter product. It’s called Differin and it costs about $30. If you use Differin, along with an over the counter benzoyl peroxide, you can mimic the treatment.

Fenske says if you go that route, be sure to use the Differin and benzoyl peroxide at different times, because the ingredients can actually inactivate each other if used at the same time. He suggests using one at night and one in the morning.

If that doesn’t work, you may have to turn to a higher prescription strength of Adapaline, like Epiduo Forte. You can often get an online coupon from the manufacturer to help reduce your out of pocket costs.

Dr. Divya Sadhwani battled acne into her 20s, and used a number of prescription and over the counter products to get it under control. (Photo courtesy Dr. Divya Sadhwani)

Last resort: Accutane

The final big gun for severe acne sufferers is Accutane. It is very effective, but also has serious safety concerns associated with it, including birth defects, inflammatory bowel disease, depression, and increased rates of suicide.

Even so, for the right patient, Fenske says Accutane can be a life changer.

“It absolutely works,” he said.  “It can cure, in many cases, severe, cystic acne that’s scarring.

When Sadhwani continued to experience severe acne into her 20s in med school, she turned to Accutane to finally get her skin under control.

“It definitely was a little bit scary, but once I started to see the results, it was totally worth it,” she said.

Maintaining clear skin

Today, as a doctor and an acne patient with incredible results, Sadhwani tries to give her acne patients hope.

“A lot of my patients come in and they are so frustrated. They feel like they’ve kind of hit a dead end, so I try to instill hope,” she said. “Just because one thing doesn’t work, doesn’t mean they all won’t work.”

One last, very important thing she always reminds patients: even after your skin is clear, it still takes work to maintain a beautiful complexion. Her number one tip: wash your face at night.

“I am constantly on a good regimen. I try to make sure I wash my face, put on my creams, use my topical retinoids,” she explained, smiling. “You know, the times I miss it and go to bed with my make-up on, trust me, I pay for it!”