Topical medications are applied directly to the skin and are often the foundation of acne care. Peak Skin Center and Dr. Thomas Knackstedt frequently combine topical therapies to target multiple acne pathways while minimizing irritation.

Topical retinoids (tretinoin, adapalene, tazarotene)

Topical retinoids are vitamin A–derived medications that help normalize how skin cells shed inside the pore, preventing microcomedones that later become visible acne. For many patients at Peak Skin Center, Dr. Thomas Knackstedt uses retinoids as a long-term core treatment because they treat both blackheads/whiteheads and inflammatory acne over time. Noticeable improvement typically begins in 6–12 weeks, although a temporary flare can occur early. Common side effects include dryness, peeling, redness, and increased sun sensitivity.

Benzoyl peroxide

Benzoyl peroxide reduces acne by releasing oxygen in the follicle, which makes the environment less favorable for acne-causing bacteria, while also offering mild anti-inflammatory and comedolytic effects. At Peak Skin Center, Dr. Thomas Knackstedt often recommends benzoyl peroxide as part of combination therapy, especially when topical or oral antibiotics are used, because it can help reduce antibiotic resistance. Results are often seen in 2–6 weeks. Common side effects include dryness, irritation, and fabric bleaching.

Topical antibiotics (clindamycin, erythromycin)

Topical antibiotics help reduce acne-related inflammation and decrease bacteria on the skin surface and within follicles. Dr. Thomas Knackstedt at Peak Skin Center typically pairs topical antibiotics with benzoyl peroxide to improve effectiveness and help prevent resistance. Many people notice improvement in 4–8 weeks. Potential side effects include dryness, irritation, and, rarely, antibiotic resistance when used without benzoyl peroxide.

Azelaic acid

Azelaic acid helps acne by reducing inflammation, decreasing pore blockage, and providing antibacterial activity; it can also help fade post-acne discoloration. Peak Skin Center often considers azelaic acid for acne-prone skin that is sensitive or prone to redness, and Dr. Thomas Knackstedt may recommend it when acne and uneven tone coexist. Improvement is commonly seen in 6–12 weeks. Side effects may include mild stinging, dryness, and temporary redness.

Salicylic acid

Salicylic acid is a beta-hydroxy acid that penetrates into pores to exfoliate and reduce clogged follicles, making it particularly useful for blackheads and whiteheads. Dr. Thomas Knackstedt may suggest salicylic acid cleansers or leave-on products at Peak Skin Center as part of a broader regimen, especially for oily or congestion-prone skin. Results can appear in 2–6 weeks. Common side effects include dryness, peeling, and irritation if overused.

Dapsone gel

Topical dapsone has anti-inflammatory effects that can be helpful for inflammatory acne, including acne that flares cyclically. At Peak Skin Center, Dr. Thomas Knackstedt may consider dapsone for patients who need an anti-inflammatory topical option that can pair with other therapies. Improvement is often noted in 8–12 weeks. Side effects can include dryness or redness; rare temporary discoloration may occur if used alongside benzoyl peroxide.

Topical clascoterone

Clascoterone is a topical androgen receptor inhibitor that reduces the impact of hormones on oil glands in the skin, which can decrease sebum production and inflammation. Peak Skin Center may use clascoterone in hormonally influenced acne, and Dr. Thomas Knackstedt can determine whether it fits a patient’s overall plan. Improvement often develops over 8–12 weeks. Common side effects include mild redness, burning, or scaling at the application site.

Oral medications are typically reserved for more widespread, inflammatory, hormonally driven, or scarring-prone acne. Peak Skin Center evaluates candidacy carefully, and Dr. Thomas Knackstedt monitors response and tolerability throughout treatment.

Oral antibiotics (doxycycline, minocycline)

Oral tetracycline antibiotics help by reducing acne-related bacteria and calming inflammation, which can rapidly decrease painful breakouts. At Peak Skin Center, Dr. Thomas Knackstedt generally uses oral antibiotics for limited durations and pairs them with topical retinoids and benzoyl peroxide to improve results and reduce resistance. Many patients see improvement in 4–8 weeks, with continued progress over several months. Common side effects include stomach upset, sun sensitivity (especially doxycycline), dizziness (more often minocycline), and yeast infections in some individuals. In individuals unable to tolerate tetracycline antibiotics, clindamycin, erythromycin and other classes of antibiotics may be considered.

Hormonal therapy: combined oral contraceptives

Certain combined oral contraceptives can improve acne by reducing androgen activity and lowering oil production, which decreases pore clogging and inflammation. At Peak Skin Center, Dr. Thomas Knackstedt may recommend this approach for hormonally influenced acne patterns, such as jawline flares, when appropriate. Results typically take 8–12 weeks, and sometimes longer for full benefit. Possible side effects include nausea, breast tenderness, breakthrough bleeding, and a small risk of blood clots depending on individual health factors.

Hormonal therapy: spironolactone

Spironolactone, formerly used only as a blood pressure medication, is an oral medication that decreases the effect of androgens on oil glands, which can reduce sebum production and inflammatory lesions. Dr. Thomas Knackstedt uses spironolactone at Peak Skin Center for select patients with hormonally driven acne, particularly when breakouts persist despite topical therapy. Improvement is often seen in 8–12 weeks, with additional benefit over time. Common side effects include increased urination, breast tenderness, menstrual irregularities, and lightheadedness; monitoring may be recommended based on medical history.

Oral isotretinoin

Oral isotretinoin targets multiple acne pathways at once by shrinking oil glands, reducing sebum production, preventing pore clogging, decreasing bacteria, and lowering inflammation. Because it can produce long-term remission for severe or scarring acne, Dr. Thomas Knackstedt at Peak Skin Center may recommend isotretinoin when other therapies have not been sufficient. Many patients begin to notice improvement within 4–8 weeks, although courses typically last several months. Common side effects include significant dryness of lips and skin, sun sensitivity, and muscle aches; it is also strictly regulated due to the risk of severe birth defects and requires careful monitoring.