Acne is a common skin condition in which pores become clogged by skin cells and sebum (oil), allowing bacteria to grow and triggering inflammation in the skin. The result is the development of acne lesions or pimples. Many treatments can resolve acne or help you avoid or minimize scarring.
Reach out to a board-certified dermatologist (a doctor who specializes in skin health) before starting or combining treatments to discuss the best options for you.
Treating acne may involve over-the-counter (OTC) or prescription medications, or both, depending on the cause and severity of your acne.
Salicylic Acid
Salicylic acid is a common ingredient in OTC topical acne medications. It helps break down pimples and remove dead skin cells that can plug pores.
Salicylic acid can be used for whiteheads (small white bumps) and blackheads (small black bumps), and you can find this medication in cleansers and skin moisturizers.Side effects are typically mild and can include skin irritation and stinging.
Antibiotics
Antibiotics kill acne-causing bacteria, helping control breakouts.
Benzoyl peroxide is an antibiotic commonly used in OTC topical acne treatments because it reduces inflammation and prevents the growth of bacteria that contribute to acne.
If topical OTC acne products are not effective in helping clear your acne after several weeks, a dermatologist may recommend one of these topical prescription antibiotics:
clindamycin (Cleocin T)
clindamycin with benzoyl peroxide (Benzaclin, Duac)
dapsone (Aczone)
erythromycin (Emcin Clear)
erythromycin with benzoyl peroxide (Benzamycin)
Depending on the severity of your acne, an oral prescription antibiotic may be the right choice for you. Dermatologists prescribe these to treat moderate to severe acne.
Oral prescription antibiotics include the following:
azithromycin (Zithromax)
doxycycline (Acticlate, Doryx)
minocycline (Minocin, Minocin PAC, Minolira)
sarecycline (Seysara)
erythromycin (EES Granules, Ery-Tab)
Antibiotic resistance (when bacteria change and can resist the effects of antibiotics) is a concern with oral and topical antibiotics, says Brian Zelickson, MD, dermatologist at Schweiger Dermatology Group in Edina and Plymouth, Minnesota. So antibiotics are used only for the short term, typically three to four months.
Azelaic Acid
Azelaic acid is a naturally occurring acid that kills acne-causing bacteria.It’s used in OTC and prescription topical creams, foams, and gels (Azelex, Finacea, and Finacea Plus) to treat mildly to moderately inflamed acne.
Side effects are typically mild and can include burning, stinging, tingling, dryness, and redness.
Clascoterone
Clascoterone (Winlevi) is a prescription topical cream that targets androgens, hormones that affect how much sebum is produced by the oil glands in your skin, says Helen He, MD, codirector of the Mount Sinai-Clinique Healthy Skin Dermatology Center in New York City. By decreasing sebum production, you can decrease breakouts.
This medication is approved for people 12 and older. The main side effects are skin redness, dryness, scaling, and itching.
Combination Medications
Topical combination medications are available by prescription and contain two or three active acne-fighting medications to address breakouts on multiple fronts.
Combination medications include the following:
adapalene and benzoyl peroxide (Epiduo)
clindamycin and benzoyl peroxide (Benzaclin, Duac)
tretinoin and benzoyl peroxide (Twyneo)
clindamycin and tretinoin (Veltin, Ziana)
clindamycin, adapalene, and benzoyl peroxide (Cabtreo)
Oral Contraceptives
Oral contraceptives help address hormonal changes in female bodies that cause excess oil production, a factor in acne. These hormonal medications provide a source of estrogen, which helps manage levels of testosterone, a sex hormone that drives oil production in skin.
Several oral contraceptives have been approved by the U.S. Food and Drug Administration (FDA) to treat acne:
drospirenone and ethinyl estradiol (Yaz)
drospirenone, ethinyl estradiol, and levomefolic acid (Beyaz)
norethindrone acetate and ethinyl estradiol (Estrostep Fe)
norgestimate and ethinyl estradiol (Ortho Tri-Cyclen)
An oral contraceptive may not be the right choice for every individual, including those over 35 years old, those who smoke, and those with a history of blood clots or breast cancer. Talk to your doctor about the potential risks and benefits of using oral contraceptives to control your acne.
Retinoids or Retinols
Retinoids and retinols are substances derived from vitamin A. They slough off dead skin cells to prevent clogged pores and reduce inflammation.These medications, which are available in topical and oral versions, can be used for mild, moderate, and severe acne. Oral retinoids are best suited for more severe acne.
Retinoids and retinols are used in both OTC and prescription topical medications:
Topical retinoids can cause dry skin and redness. These products can also increase your sensitivity to the sun, so it’s key to wear sunscreen during the day.
Isotretinoin (Accutane), an oral retinoid medication approved by the FDA to treat nodular acne (a severe type of acne that causes hard, painful lumps under the skin), is also available by prescription. “It’s a treatment we use for those who don’t respond or can’t tolerate other therapies,” says Dr. Zelickson.
Isotretinoin helps the sebaceous glands in your skin make less oil, which can prevent acne. However, the medication can cause birth defects, so people with female reproductive organs must use birth control during treatment.
Spironolactone
Spironolactone (Aldactone, Carospir) is a diuretic (water pill) traditionally used to treat high blood pressure. But it’s another oral prescription medication option for hormonally driven acne in females. This medication helps lower androgen levels, hormones that tell oil glands to produce sebum, which can clog pores.
This medication can cause birth defects so it must be taken with birth control.
Metformin
Metformin (Glumetza, Eqv-Fortamet) is an oral medication used to treat type 2 diabetes. It’s also commonly used to treat acne in people with polycystic ovary syndrome (PCOS). This condition occurs when high insulin levels cause the ovaries to create excess androgens.Metformin helps acne by lowering testosterone.
Currently, metformin is used to treat acne only in people with PCOS.
Your dermatologist may recommend these common procedures for more severe acne.
Cortisone Injections
To shrink large, painful acne cysts (pus-filled pimples deep under the skin) and nodules, your dermatologist can inject the spot with a steroid medication known as cortisone. A cortisone injection can help decrease inflammation to reduce the nodule or cyst quickly (within 48 to 72 hours), says Zelickson. Cortisone shots can also help reduce the risk of scarring.
Extraction
An acne extraction is an in-office procedure performed by a dermatologist or licensed aesthetician. It involves using sterile instruments to manually remove the debris inside a blackhead or whitehead. However, acne extractions can be costly and typically are recommended only when other treatments aren’t effective.
Incision and Drainage
To remove a large, painful acne cyst or nodule, your dermatologist may recommend incision and drainage. This procedure involves opening up the blemish with a surgical tool and removing the inner contents. For your safety and to avoid scarring, it’s important that this procedure is performed by a dermatologist.
Chemical Peels
A chemical peel is an in-office treatment that involves applying a chemical solution to your skin. The solution sloughs off the top layers of the skin to help prevent acne from forming.
If you have mild to moderate acne (mostly whiteheads and blackheads), a chemical peel may be a good option for you. However, it won’t work for cystic and nodular acne, says S. Tyler Hollmig, MD, director of laser and cosmetic dermatology at the Dell Medical School at the University of Texas in Austin.
Several chemical solutions are used in chemical peels:
Carbolic acid (phenol)
Glycolic acid
Lactic acid
Salicylic acid
Trichloroacetic acid
Each chemical solution has different effects. Consult a dermatologist about the best solution for you, especially if you have a darker skin tone. Darker skin is vulnerable to patches of discoloration (also known as hyperpigmentation).
Laser- or Light-Based Treatments
Laser treatments may help acne by reducing inflammation and bacteria involved in acne, says Dr. Hollmig.
Lasers use targeted light to heat up and destroy sebaceous glands, he explains. “It’s a helpful tool, but it doesn’t cure all acne,” Hollmig says. Options include AviClear and Accure. Treatment requires multiple rounds to be effective. AviClear, for example, requires three 30-minute treatments every four to six weeks.
In addition, he recommends a pulsed dye laser to some patients. This laser destroys dilated blood vessels, so it’s traditionally used to treat vascular skin diseases and redness. It works on acne by targeting hemoglobin (a protein in red blood cells) in the skin, reducing inflammation, and eliminating acne bacteria. Pulsed dye laser treatments can be a good option for red, inflamed acne lesions, Dr. He says.
Note that at-home red light and blue light masks and handheld devices like wands, popular for reducing the signs of aging, may also help with breakouts. “There’s some evidence they can help some patients with acne by reducing inflammation, one component of acne,” says Hollmig. These LED light devices can be purchased to use at home.
If you have acne, some lifestyle changes can make a difference for your skin.
Adjust your diet. Evidence suggests that certain foods may contribute to acne. Limit sweets, sugary drinks, white bread, dairy, and fast food.
Practice healthy skin-care habits. Keep your skin clean by removing makeup before bed, not touching your face, and using noncomedogenic cosmetics and skin-care products, which are designed to not clog pores.
Maintain a healthy lifestyle. Manage stress, quit smoking, and prioritize adequate sleep. Regular exercise may also help.
Acne can cause or contribute to mental health conditions such as anxiety and depression.
Research suggests that acne and the associated psychological effects have a significant impact on lowering self-esteem and quality of life, and that females with acne have significantly greater anxiety and depression than males.
Acne affects the mental health of people of all races and ethnicities. However, people of color are less likely to see a dermatologist or be treated with more powerful treatment options, such as oral medications, according to research.
“I recommend acne patients with skin of color work with a dermatologist who has experience treating patients of all ethnicities and skin types, and has an understanding of the potential complications of both the acne itself and acne treatments in skin of color,” says He.
For example, some acne treatments increase the risk of postinflammatory hyperpigmentation (which occurs when injury or inflammation causes areas of skin to darken over time), and acne is also more likely to cause abnormal scarring in skin of color, she adds.
“I encourage skin of color patients to be active participants in their own care by asking their dermatologists questions about their acne treatment plan, including potential risks and side effects that may uniquely or disproportionately affect darker skin types,” He says.
Acne has physical and psychological impacts for people of all skin tones, ages, and genders. “For patients who may be struggling with these issues, seeking guidance from a mental professional such as a therapist or psychiatrist should not only be destigmatized but should be actively encouraged,” says He.
Acne is a common skin condition that can be treated with topical and oral medications, in-office procedures, and lifestyle changes. Connect with a board-certified dermatologist to discuss the best treatments for your skin.