Propionibacteria acnes, the bacteria causing acne, cannot live in an environment where there’s too much oxygen. That’s why, under normal circumstances, this common bacteria is no problem. Living either on the skin or in the pores which are fully exposed to the air, they never grow to be a threat. But, once excess oil fills the pores and traps the dead cells inside, the environment become anaerobic or oxygen poor. This is the ideal environment for explosive growth. Benzoyl peroxide is the perfect counter because it opens the pores and allows more oxygen to enter. There’s no need to pay extra and buy a packaged product. The basic “chemical” as a lotion of about 2.5% usually works best. Anything stronger can irritate the skin. If you prefer, you can start off at a lower strength and then move up to 2.5% if the first results are disappointing after the first two weeks.

The best approach is cleansing the whole face twice a day. Don’t dab the lotion on the spots. Spread a thin layer over the skin. This removes the dead skin and acts as a spot preventer across all the skin cleaned. Because benzoyl peroxide is a bleach, try not to get it on your clothes or a towel. If you are going to clean the skin on your shoulders or back, it may be best to wear an old T-shirt unless you are confident you have removed all of it before you dress. If you are going to bed at night, it can also bleach your pillow and sheets. After application, it can be a good idea to apply a moisturizer to prevent your skin from drying out.

Various combinations are on the market. In recent research trials, benzoyl peroxide on its own at different strengths was matched against combinations with salicylic acid and clindamycin. Over two to four weeks, the combination with salicylic acid produced the best results. But after ten to twelve weeks, there was no real difference between benzoyl peroxide on its own and either of the two combinations. Should the acne be more severe and the over-the-counter products prove ineffective, the guaranteed treatment is Accutane. In men, there is little risk. But, if you are able to produce children, Accutane needs great care. It can damage the fetus during pregnancy. In the US, the formal approach is to use the iPledge – Accutane only used when there is proof you are using at least two contraceptive treatments. Although this may seem intrusive, it’s better to take precautions and lose the acne, not the baby. You can avoid this regime by buying online. Alternatively, there’s always benzoyl peroxide.

We have to cross to seas to distant islands going under the name of New Zealand. Even though these people live too far away to be considered properly civilized – no developed court system for suing manufacturers marks them out as still primitive – they have witch doctors who have been studying the effect of the key drug used to treat acne. Remarkable though this may seem, they actually managed to round up 1,700 people who have been taking this drug and followed their health for six years. All participants had severe acne that had failed to respond to the usual treatments – rubbing the skin with live toads was the standard. They all took this fierce Western drug in low doses and, remarkably, there did not seem to be any serious side effects. A few had slight cracking of the skin of their lips and minor inflammation but this cleared quickly. When people were taking a dose equivalent to 0.25mg/kg of their body weight, about 3.5% were affected by tiredness and minor mood changes but, overall, only 13 people stopped taking the drug because of the side effects.

And this is interesting because? Well, in the US, Accutane is considered a little controversial. This should not be surprising. The drug was originally developed as chemotherapy for the treatment of some cancers. As you can imagine, the effects on the body can be dramatic at the dosages required to stop cancer from spreading. But, when used as a treatment for acne, the lower dosages are less threatening. Indeed, if you believe the 6-year study from New Zealand, at the lowest possible dosages, you get the benefit of clear skin without almost no side effects. Well, no side effects so long as all women taking Accutane take full measures to prevent conception. Even at low dosages, this drug causes birth defects.

What’s the controversy? Well, one or two legal cases have been working their way through the courts alleging Accutane has caused major depressive illness and, in one or two instances, inflammatory bowel disease. This then defines the difference between a major developed country like the US and backward islands somewhere in the sea near Australia, or perhaps down towards the Antarctic depending on your point of view. In the US, the manufacturer is thinking of suspending sales. In New Zealand, it’s freely available to everyone with serious acne not responding to other types of treatment. Fortunately, you can buy this highly effective (but controversial in the US) drug from an online pharmacy. It really does cure almost every case of acne. There’s a tiny risk of serious side effects but, so long as you ask tell a lawyer, there’s no problem in taking it.