The mainstays of Western medical treatment for acne have long been antibiotics, retinoids, birth control pills, and Accutane, but I often see patients who are interested in alternative treatments.
A good place to begin is with higher concentrations of salicylic acid. Salicylic acid is a naturally occuring beta-hydroxy acid that can be found in the bark of willow trees. Essentially, it's aspirin. A concentration of 2% salicylic acid can be found in many over the counter acne cleansers, but in a medically controlled setting, higher concentrations (up to 30%) are safe and can be quite effective for stubborn acne. The salicylic acid is applied as a masque for 2 minutes, essentially a chemical peel. It works as an anti-inflammatory and a keratolytic (causing the outer layer of skin cells to loosen and shed). Salicylic acid kills bacteria. It also unclogs pores and helps prevent those pores from becoming clogged again by reducing their size. Most patients undergo a series of salicylic acid peels every 2 weeks for 3 months for their best results.
An excellent addition to salicylic acid is phototherapy, or treatment with red and blue light. The treatments are performed with a medical device that is calibrated to deliver a specific dose of light in a 20 minute session. (Similar but much less effective devices can be bought over the counter for use at home.) Red light is anti-inflammatory, and it speeds healing of any visible acne lesions. It also promotes collagen production, leading to improvement of acne scars. Blue light kills Propionibacterium acnes, the bacteria responsible for acne, without harming skin cells and without the potential side effects of antibiotics. The treatments are performed twice a week for up to 12 weeks. Most patients see about a 75% improvement in their acne, which lasts even after the treatments are completed.