📚 Demystifying Acne Treatment · Series Table of Contents

• 1. The True Nature of Acne

  • 1.1 Folliculitis vs Acne

• 2. The Decision Point That Leaves Scars

  • 2.1 Scarring Risks by Size and Type

• 3. How to Stop It Now

  • 3.1 The Importance of Extrusion (Drainage)

  • 3.2 Understanding Acne Injections Correctly

• 4. Stopping It with Medication

  • 4.1 Types of Medication and Their Roles (Current Article)

• 5. Managing Remaining Marks

  • 5.1 PIH · PIE · Atrophic · Hypertrophic

Many people buy Cleartin at the pharmacy and apply it diligently morning and night, only to find no change. This is not because you are applying it incorrectly, but because salicylic acid specifically targets "dead skin cells and clogged sebum." If your acne has already turned red and pus-filled, or has hardened and deepened, the underlying issues are bacteria, sebaceous glands, and inflammation—which require medications that target these exact points. Acne medications are divided into topical and oral options, categorized by whether they target dead skin cells, bacteria, or sebum. Let's map out how to choose the right medication for your specific stage.

If Cleartin doesn't work, it's not a failure—it means your acne stage has evolved

Cleartin is a topical solution with salicylic acid (BHA)* 2%. It dissolves dead skin cells and clogged sebum inside the pores, making it ideal for non-inflammatory stages like whiteheads and blackheads. Since it is an over-the-counter medicine you can buy at pharmacies without a prescription, it is often the very first treatment people try.

The problem arises when your acne has already progressed to red papules, yellow pustules, or hard nodules. At this stage, the core issues are the bacteria and inflammation spreading inside the pore, as well as excess sebum—not just clogged pores. A medication that only dissolves dead skin cells cannot reach those deeper concerns. Therefore, if your acne is not healing with Cleartin, it isn't because the medication is weak; it's a signal that your acne has already progressed past the stage that salicylic acid can treat.

* Salicylic Acid (BHA): An oil-soluble exfoliating ingredient. It clears dead skin cells and sebum inside the pores to relieve clogging, but it does not directly treat inflammation that has already spread.

Topical medications split the work "on the surface"

Topical medications work on the skin surface to perform different tasks. They generally fall into two main categories:

• Exfoliation, Sebum Control, and Root Prevention: Salicylic acid (Cleartin) and topical retinoids* fall into this category. Representative retinoids include Differin (adapalene) and Stieva-A (tretinoin). They normalize the pore-clogging process to prevent comedones and reduce recurrence. Since it takes about 6 to 12 weeks to see significant results, consistency is key.

• Targeting Bacteria and Inflammation: Topical antibiotics like Cleocin T (clindamycin) and BPO combination formulas like Epiduo Gel and Duac Gel fall into this category. They provide both antibacterial and anti-inflammatory benefits, making them highly effective for red papules and pustules. However, using antibiotics alone for long periods can lead to drug resistance, so they are typically combined with BPO or retinoids.

Depending on whether the concern is clogging (dead skin cells) or active inflammation (bacteria/pus), the target point of the topical medication changes. What works best for each stage is also summarized in the Korean Dermatological Association General Practice Guidelines.

* Retinoid: A vitamin A derivative. It normalizes pore keratinization to reduce the very formation of comedones, making it a foundational treatment for both active therapy and recurrence prevention.

Oral medications work "from within" for wider, stronger effects

If your acne is too deep to be reached by topical creams, it is time for oral medications. They work systemically from the inside out, offering a wider range and stronger clinical power.

Oral antibiotics such as doxycycline and minocycline belong to the tetracycline family. They are prescribed for moderate acne where multiple inflammatory lesions flare up simultaneously. They suppress bacteria and soothe inflammation, and are usually taken for a few months in combination with topical treatments.

The ultimate option in acne treatment is isotretinoin* (Roaccutane, Isotinon). It directly shrinks the sebaceous glands, stopping sebum production at its source. It is the gold standard for deep, persistent acne like nodules and cysts, or cases that keep recurring. However, because it causes significant dryness and is strictly contraindicated during pregnancy, it must be carefully guided during medical consultations alongside regular blood tests.

* Isotretinoin: An oral vitamin A derivative. By directly reducing the size of the sebaceous glands and sebum secretion, it targets the root cause of acne, making it the most powerful card for severe or recurrent acne.

Why salicylic acid has no oral option, and why the ultimate sebum drug has no topical form

This points to an interesting asymmetry: there is no oral form of salicylic acid, and there is no topical form of the drug that shrinks sebaceous glands at their root (isotretinoin).

This is because their "working sites" are completely different. Clogged dead skin and sebum are surface issues, so applying a treatment topically is highly effective—there is no need to ingest it. Conversely, sebaceous glands are located deep within the dermis, meaning topical ointments cannot reach them to reduce their size. Therefore, an oral drug acting from the inside out is necessary to tackle the root cause. To put it simply: dead skin is treated on the outside, while the sebaceous glands are managed from within.

So, simply choose based on "your active stage"

Since every medication has a different target, observing which stage your acne is currently in will help narrow down your options. Here is a helpful summary by stage:

If Cleartin is no longer working, it typically means your skin has progressed from the comedonal stage to the inflammatory stage. At this point, rather than applying the same cream for longer, it is better to switch to a medication with a different target or seek a medical consultation to adjust your treatment plan. Prolonged inflammation damages the dermis and hardens into lasting scars. Knowing the unique role of each medication and soothing your skin quickly according to your stage is the best way to prevent scarring.

Frequently Asked Questions

Q. Can I apply Cleartin and Differin together?

Both target dead skin and sebum, so there is some overlap. Using them together may lead to severe dryness and irritation. It is generally safer to choose one, alternate them between morning and evening, or consult with your doctor to find a personalized combination if you have a mix of non-inflammatory and inflammatory acne.

Q. Is it safe to take oral antibiotics long-term?

Oral antibiotics for acne are typically prescribed for a few months at a time, and taking them alone for extended periods is not recommended due to potential resistance. They are usually combined with topical BPO or retinoids, transitioning to a topical-only maintenance regime once the skin improves.

Q. Is taking isotretinoin absolutely necessary? I'm worried about the side effects.

It is not a medication needed for every type of acne. However, for deep, recurring lesions like nodules and cysts where shrinking the sebaceous glands is the only way to solve the issue, it is a highly effective, direct approach. While there are key precautions like dryness and pregnancy contraindications, it is a safe and manageable treatment when supervised under regular clinic visits and laboratory tests.

Recommended Reading

• "Is it good news if my acne marks are red?" The truth about the recovery signals your skin is sending

• Boxcar, Icepick, Rolling: Why your laser treatment changes depending on your scar shape

• Are there professional clinics in Hongdae that specialize in thorough acne treatment?

• Don't believe the myth that you shouldn't apply barrier-recovery creams on red acne marks