What Are the Best Treatments for Acne?
Physical Health
Acne is the most common skin condition, affecting about 50 million Americans each year. Despite this, it’s often difficult to treat. With so many different options available — from over-the-counter (OTC) to prescription treatments — it’s hard to know which treatments actually deliver results.
With proper treatment, most people with acne can achieve clearer skin. Continue reading to learn more about what causes acne and the various treatments available for it.
What Is Acne?
Acne is a skin condition where the pores of your skin become clogged, causing pimples. Acne is also known by its medical name, acne vulgaris.
Acne can occur anywhere on your body where you have oil glands. The most common places people develop acne include the face, chest, shoulders, and upper back.
Types of Acne
There are several types of acne:
- Cystic acne — severe inflammatory acne that causes painful pus-filled pimples deep under your skin
- Nodular acne — severe inflammatory acne that causes the formation of hard lumps deep under your skin
- Hormonal acne — acne that develops in adulthood as a result of hormonal changes that increase the amount of sebum (oil) your skin makes
- Fungal acne — acne caused by a build-up of yeast in your hair follicles that causes small, itchy bumps on your skin
Who Gets Acne?
Most people experience acne at some point in their lives, and it affects people of all ages and races. About 80% of people between the ages of 11 and 30 have acne. Acne is most common in teens and young adults during periods of hormonal change. Males are more likely to develop acne as teenagers. Females are more likely to develop adult acne.
What Causes Acne?
Acne develops when a hair follicle or pore becomes clogged. Several factors are involved in pores becoming clogged, including:
- Increased sebum production
- Hair follicles that become clogged with sebum and dead skin
- Bacteria
- Inflammation
Acne Triggers
Some things can make acne worse (called a trigger). Acne triggers may include:
- Hormonal changes — such as puberty, pregnancy, or menopause
- Medications — including lithium, corticosteroids, and testosterone
- Friction — such as when you wear a tight hat or headband
- Air pollution
- High humidity
- Using greasy products on your skin — such as make-up or cream
- Oil on your skin — such as from frying oil
- Stress
Some foods can also trigger acne, including:
- Carbohydrate-rich diet
- Whey protein
- Skim milk
Although it’s a popular myth that chocolate or greasy foods can cause acne, science doesn’t back this up. Research has found that eating chocolate and greasy food doesn’t have an effect on acne.
Another acne myth is that poor hygiene can cause acne. Studies have found that poor hygiene actually has little effect on acne. In fact, washing your face too often can make acne worse.
What Are the Symptoms of Acne?
Acne symptoms depend on the type of acne and how severe it is. The main symptom of acne is pimples. There are different types of pimples, including:
- Whiteheads (closed comedones) — a clogged pore that stays beneath the skin and has a white top
- Blackheads (open comedones) — a clogged pore that forms an open bump on the skin with a black top
- Papules — a small, discolored, pus-filled bump on your skin
- Pustules — a papule with a white or yellow top and a red or discolored base
- Nodules — a large, painful, solid lump under your skin
How Is Acne Diagnosed?
Your physician can diagnose acne by looking at your skin. Acne can be diagnosed and treated by your primary care physician or a physician who specializes in treating skin conditions, called a dermatologist.
To help with your ace diagnosis, your physician may ask you questions, such as:
- How long have you had acne symptoms? What makes it better or worse?
- Do you have a family history of acne or other skin conditions?
- What medications are you taking?
Most of the time, laboratory tests or other blood tests aren’t necessary for an acne diagnosis. However, your physician may order additional tests if they suspect another condition may be causing acne symptoms. If you’re an adult with acne, if your symptoms started suddenly, or if your symptoms are very severe, you may need more testing.
If you have a lump that doesn’t get better, your physician may order a bacterial culture to check for bacteria growing in the lump.
Acne Severity
Your physician may classify your acne as grade 1, 2, 3, or 4 based on how severe your symptoms are.
- Grade 1 — Mild acne with whiteheads and blackheads but few inflammatory lumps
- Grade 2 — Moderate acne with papules and pustules mainly on the face
- Grade 3 — Moderately severe acne with many papules and pustules and some inflamed nodules on the face, chest, and back
- Grade 4 — Severe acne with mostly large and painful nodules and pustules
How Is Acne Treated?
The goal of acne treatment is to heal the pimples you currently have, prevent new pimples from forming, and prevent long-term scars left by acne. Acne treatments work by reducing the amount of oil your skin makes, stimulating the growth of new skin, or fighting bacterial infections.
A dermatologist or other physician can help you choose the best acne treatment for you. The best treatment for you depends on many factors, including:
- Your age
- The type of acne you have
- How severe your acne is
Topical Acne Treatments
Topical acne treatments are applied directly to your skin.
Many effective acne treatments are available without a prescription. However, it’s still a good idea to talk to your physician before you start any new acne treatment. Several acne-fighting active ingredients can be found in OTC products.
Benzoyl Peroxide
Benzoyl peroxide fights acne in several ways. It works by killing bacteria that cause acne and removing excess oil and dead skin that can clog your pores.
You can find benzoyl peroxide in several OTC products, including gels, creams, and face washes. Benzoyl peroxide is available in different strengths, from 2.5% to 10%. If you’re new to using benzoyl peroxide, it’s best to start at the lowest strength and work your way up. Research shows that the lower strengths work as well as higher strength formulations.
Side effects of benzoyl peroxide may include:
- Dry or scaly skin
- Skin irritation
- Burning or stinging skin
- Bleaching of hair, clothing, and towels
Topical Retinoids
Topical retinoids are vitamin A derivatives that work by unclogging your pores and exfoliating your skin to prevent pimples. Most topical retinoids are only available with a prescription from your physician. Examples of prescription topical retinoids include tretinoin (Retin-A) and tazarotene (Tazorac).
Topical retinoids are recommended for people with mild or moderate acne. While these medications are very effective for many people, it can take several months before you see the results you’re looking for.
Side effects of topical retinoids include:
- Dry skin
- Peeling
- Sun sensitivity
Adapalene
Adapalene is a retinoid that works by unclogging your pores. Adapalene is available OTC as a 0.1% gel under the brand name Differin. Higher strengths are also available with a prescription from your physician. Like other topical retinoids, it can take several months to begin to see positive effects.
Salicylic Acid
Salicylic acid can improve acne by unclogging your pores. You can find salicylic acid in a variety of OTC products, such as facial cleansers and lotions.
Salicylic acid side effects may include stinging, irritation, and skin discoloration.
Azelaic Acid
Azelaic acid is an acid naturally made by yeast that has some antibacterial properties and helps unclog pores. In addition to treating acne, azelaic acid may help lighten dark spots that remain after acne goes away.
Azelaic acid is available in some OTC products in a 10% strength. Higher strength, 20% formulations are available with a prescription under the brand name Finacea or Azelex.
Side effects of azelaic acid include skin irritation and redness.
Dapsone
Dapsone (Aczone) is an acne medication that works by killing acne-causing bacteria on your skin. Your physician may prescribe dapsone if you have inflammatory acne.
Possible side effects of dapsone include skin irritation, redness, peeling, and dryness.
Topical Antibiotics
Topical antibiotics can treat acne by killing acne-causing bacteria and reducing inflammation. Clindamycin and erythromycin are common antibiotics used in topical products. These medications are only available with a prescription. Topical antibiotics are often combined with benzoyl peroxide to avoid antibiotic resistance (where bacteria become resistant to the antibiotic).
Oral Acne Treatments
Oral acne treatments are medications you take by mouth. All oral acne treatments are only available with a prescription from your physician.
Oral Antibiotics
Oral antibiotics can help improve acne symptoms by killing the bacteria. Your physician may prescribe an oral antibiotic for acne if topical treatments don’t work or if you have severe acne on parts of your body other than your face.
Tetracycline antibiotics such as doxycycline and minocycline are the most common antibiotics used to treat acne. If you can’t take a tetracycline antibiotic, you may be prescribed a macrolide antibiotic such as azithromycin.
It usually takes several weeks for antibiotics to improve acne. Most people will take an oral antibiotic until their acne improves and then stop. Oral antibiotics are not a long-term treatment for acne because they can cause antibiotic resistance. Additionally, antibiotics can rarely cause potentially life-threatening diarrhea caused by a bacterium called Clostridioides difficile (C. diff). You’re up to 10 times more likely to get C. diff while taking an antibiotic.
Other antibiotic side effects may include:
- Sun sensitivity
- Stomach upset
- Dizziness
Isotretinoin
Isotretinoin is an oral retinoid that works by shrinking the size of your oil glands, decreasing inflammation, killing bacteria, and unclogging your pores. Your physician may prescribe isotretinoin if you have moderate to severe acne that hasn’t responded to other treatments. There are several brand names for isotretinoin, including Amnesteem, Claravis, and Myorisan.
For many people, isotretinoin is a very effective treatment that can provide long-term results after just a few months of treatment. However, there are some significant risks to consider before taking this medication. Your physician will carefully review all the risks and benefits with you before you start taking isotretinoin.
One of the biggest risks of isotretinoin is the potential to cause severe birth defects if pregnancy occurs while taking it. If you’re able to get pregnant, you’ll need to take a pregnancy test each month before getting a new prescription and take measures to prevent pregnancy while taking this medication.
If you start treatment with isotretinoin, you’ll take it for at least 4 to 5 months. Depending on how you respond to the medication, your treatment may be shorter or longer.
Common side effects of isotretinoin include:
- Skin dryness
- Dry mouth
- Chapped lips
- Sun sensitivity
- Joint pain
- Thinning hair
- Night blindness
- Temporary worsening of acne
Serious side effects may include:
- Inflammatory bowel disease
- Depression and suicidal thoughts
- Liver damage
- Increased pressure on your brain
Oral Contraceptives
There are several oral contraceptives that may improve acne in women. Oral contraceptives may improve acne by regulating hormones. Examples of oral contraceptives approved to treat acne include Yaz, Beyaz, Ortho Tri-Cyclen, and Estrostep.
Spironolactone
Spironolactone is an anti-androgen drug that can help improve acne by blocking the effect that hormone androgen has on oil glands. Spironolactone is only effective for women with acne. Your physician may prescribe spironolactone if other treatments, such as antibiotics and oral contraceptives, don’t work for you.
Spironolactone side effects may include breast tenderness and menstrual irregularities.
Other Acne Treatments
Your physician may recommend other acne therapies alone or in combination with topical or oral medications. If you have inflamed nodular or cystic lumps, your physician may inject the area with a steroid medication to reduce inflammation. Your physician may also use a tool called an extractor to remove whiteheads and blackheads to temporarily improve the appearance of your skin.
If you have scars from acne, treatments that remove the top layers of skin, such as laser therapy or chemical peels, can encourage the growth of new, smoother skin.
Choosing the Best Treatment for Acne
Choosing the best acne treatment can be overwhelming. But you don’t have to choose alone. Acne isn’t just a cosmetic problem. It’s a medical problem that should be treated by a physician. Your physician can help you find the most appropriate treatment for you based on your symptoms.
It’s important to remember to be patient with acne treatments. Unfortunately, no acne treatment is a quick fix. The most effective treatments, such as topical retinoids, can take months to work.
