- Over-the-counter acne products and natural remedies can effectively treat mild acne
- Inflammatory, cystic, nodular and severe forms of acne require prescription medications
- Proper skin care can work alongside acne medication to treat current outbreaks and help prevent future outbreaks
Acne is one of the most common skin conditions among adolescents and adults, and varies in severity. It can present as noninflammatory acne (whiteheads and blackheads) or as inflammatory acne (papules, pustules and cysts). There are a wide range of effective acne treatments to choose from, and this choice will depend on your specific needs.
What Are Your Treatment Options?
An effective acne treatment will depend on specific factors such as underlying cause, frequency of breakouts and severity of blemishes.
These options include over-the-counter and prescription medications that help prevent excess sebum production, exfoliate clogged hair follicles or control hormonal fluctuations.
Risks and side effects
The risks and side effects associated with acne medications vary widely. Those caused by topical medications directly affect the skin. Among the most common of these are stinging or burning when the medication is applied as well as skin irritation, dryness, redness, peeling and itching that develops over time.
Oral acne medications such as antibiotics have systemic (body-wide) side effects, such as digestive issues. Medications for treating hormonal acne, such as oral contraceptives, can affect the menstrual cycle and cause breast tenderness.
Several acne medications are unsafe during pregnancy. The most notable is isotretinoin, an oral retinoid known to cause severe birth defects. People who take this drug must take precautions to avoid pregnancy.
There’s little you can do about the root causes of acne, such as genetics and hormonal changes. However, there are practical measures you can take if you’re prone to breakouts to help prevent them, reduce their severity and minimize their appearance.
Making some changes to your daily habits can often be the most natural, safest form of treatment.
- Stress management – stress triggers the release of hormones called catecholamines that may contribute to acne by inducing oil production; consider exercise, medication, and fun activities to keep stress in check
- Proper skin care – avoid excess oil build-up and clogged pores; wash your face regularly using an acne-targeted cleanser, avoid picking at blemishes and use skin care products that will not block pores (noncomedogenic)
- Trim excess weight – there is evidence to suggest a possible link between obesity and acne, in particular, inflammatory acne in adolescents
- Healthy diet – foods believed to contribute to high rates of obesity have also been linked to adult acne, including those with a high glycemic load, large amounts of sugar and some dairy products
- Probiotics – skin is teeming with billions of bacteria that help protect the skin from infection; you can help keep these “good” microbes healthy by eating fermented foods such as yogurt and kimchi
Over-the-Counter Topical Acne Treatments
Over the counter (OTC) topical acne products are available in a variety of formulations, including ointments, gels and creams that are especially effective in treating individual lesions, and toners, facial cleansers and body washes that can treat larger areas of skin. OTC medications can effectively target noninflammatory acne blackheads, whiteheads and mild-to-moderate pimples.
This widely-used acne medication exfoliates skin, dries up excess oil, clears debris from hair follicles and destroys Cutibacterium acnes, the bacteria that causes acne by delivering oxygen into the pores.
Benzoyl peroxide is highly effective. In a review of more than 120 studies of benzoyl peroxide for acne treatment, it was found to work as well for some people as adapalene (a retinoid-like medication) and the antibiotic, clindamycin.
For acne that doesn’t respond to OTC benzoyl peroxide, a prescription-strength formulation can be used alone or in combination with other acne medications.
Retinols are derivatives of vitamin A and are the active ingredient in many anti-aging products as well as acne treatments. They also have anti-inflammatory properties. As an acne medication, retinols clear pores by exfoliating dead skin cells and dissolving clogged pores.
Because they aren’t as strong as other vitamin A-based acne medications, retinols are most effective for mild-to-moderate acne. Retinol products are available OTC and are primarily marketed as anti-aging treatments.
Salicylic acid works primarily by breaking up the bonds between corneocytes (dead skin cells). This allows them to slough off more easily and not accumulate in hair follicles. It is also effective in reducing excess sebum on the skin and has anti-inflammatory properties.
Salicylic acid has been found to work well for clearing blackheads and mild inflammatory acne in a variety of formulations. It is typically combined with other acne medications and can also be used in chemical peels as an acne treatment.
Prescription Acne Treatments
If an OTC product isn’t providing satisfactory results or you have a type of acne that can’t be treated with a nonprescription medication, such as hormonal acne, your dermatologist can prescribe medication for you.
Options include stronger formulations of certain topical acne medications as well as oral retinoids, antibiotics and hormonal treatments.
Prescription-strength topical medications
Prescription-strength versions of benzoyl peroxide include salicylic and azelaic acid. Each works in the same way as its nonprescription counterpart, but more aggressively. Prescription-strength salicylic acid is also available as a chemical peel.
Retinoids are derived from vitamin A and work in much the same way as retinols do but are stronger. They may cause stronger side effects such as skin irritation and sensitivity.
Two retinoids are prescribed for acne: tretinoin, (Retin A and Avita) and tazarotene (Tazorac or Fabior).
Prescription antibiotics are stronger than topical antibiotics and help treat severe acne by killing bacteria. However, because they’re taken orally, they can have systemic (body-wide) side effects, notably nausea, vomiting and other digestive problems.
Oral antibiotics may also contribute to antibiotic resistance. To help prevent this, dermatologists often prescribe them along with topical benzoyl peroxide or a retinoid and limit their use to 3 months.
There are two types of prescription medications that work by addressing acne caused by increases in male hormones (androgens).
Oral contraceptives—specifically combination birth control pills—contain both estrogen and progestin. Brand names of those approved by the Food and Drug Administration for acne are Yaz, Ortho Tri-Cyclen and Estrostep.
Spironolactone is a high blood pressure medication and a diuretic that may also help treat hormonal acne by lowering androgen levels. It’s been found to be highly effective in decreasing the severity of acne on the face, chest and back of females. It’s available under the brand names Aldactone and Carospir.
Isotretinoin (Accutane) is an oral retinoid (meaning it is derived from vitamin A) that is prescribed to treat severe nodular acne. It does so by shrinking sebaceous glands and preventing the overproduction of oil.
Isotretinoin causes severe birth defects. People who take this medication must agree to use two forms of birth control and have regular pregnancy checks.
Professional Acne Treatments
Alternatives to medication for noninflammatory acne are treatments performed by a dermatologist or other skin care professional. Two common ones are microdermabrasion and chemical peels.
Microdermabrasion uses a diamond-tipped instrument or spray of fine particles to exfoliate dead cells and other debris from the top layer of skin. This gentle form of exfoliation also reduces the amount of oil on the skin.
A chemical peel uses an acid to loosen dead cells on the surface of the skin and remove them along with excess oil. Among the several acids used in chemical peels for acne are glycolic, salicylic and lactic acid.
Some peels are milder than others. Your dermatologist will determine which strength will best treat your acne based on its severity.
Homemade and Natural Acne Treatments
If you have very mild acne or just the occasional pimple or two, you may be able to successfully manage it without medication.
You can apply a warm compress to a pimple to loosen the plug and gently extract the debris with clean fingers,
There are also a number of natural ingredients that may help treat acne as well. Manuka honey, apple cider vinegar and tea tree oil have all been found to have antibacterial properties that can help kill bacteria.
You might also discuss taking certain vitamins or supplements with your dermatologist, such as vitamin C or fish oil for inflammation.
What to do if your acne doesn’t clear
If you’re treating mild acne with OTC products, it may take some trial and error to find the skin care product or combination of products that work specifically for you.
Besides experimenting with different ingredients, you might also try different formulations; ensure you are using each product according to the directions on the label for best results.
When to see a doctor
If your acne is not improving or if you see it worsening, make an appointment with your doctor to discuss a course of action.
You also should see a doctor if you develop blemishes that are inflamed, hard to the touch, filled with pus or are large and deep. These are likely cysts or nodules that will need prescription medication to heal.
Skin care routine to manage acne-prone skin
You can boost the effects of your acne treatment by following a good skin care regimen.
A routine that pairs twice-daily cleansing, use of a moisturizer with an SPF of 30 and a prescription acne medication can effectively control acne.
Your dermatologist can suggest or prescribe cleansers, noncomedogenic lotions, moisturizers and sunscreens as well as other skin care products based on your skin type and the severity of your acne.
Treatments for acne scarring
Scarring is sometimes an unavoidable complication of acne, especially cystic or nodular acne. Acne scars cannot be completely removed, but treatment can reduce their appearance.
There are different types of acne scars as well with a variety of targeted treatments. That said, among the treatments used for acne scars are laser treatment, chemical peels, dermabrasion, subcision and needling. Sometimes multiple treatments or a combination of treatments are most effective,
Acne is a common skin condition among adolescents and adults. It occurs when dead skin cells and excess oil accumulate in hair follicles, causing various types of blemishes that can become infected with naturally occuring bacteria on the skin.
OTC and home remedies may be effective treatments for mild to moderate acne by exfoliating skin and helping to dry up oil. More severe acne and inflammatory acne usually require prescription-strength products.
Severe acne may also be treated with medications such as oral contraceptives and spironolactone to address hormonal fluctuations responsible for the overproduction of oil, antibiotics to kill bacteria and, for very severe nodular acne, isotretinoin.
If you are experiencing acne for the first time or if your acne worsens, see your doctor or dermatologist to develop a treatment plan.
- Leyden, J., Stein-Gold, L., & Weiss, J. (2017). Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and therapy, 7(3), 293–304. https://doi.org/10.1007/s13555-017-0185-2
- Walsh, T. R., Efthimiou, J., & Dréno, B. (2016). Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. The Lancet. Infectious diseases, 16(3), e23–e33. https://doi.org/10.1016/S1473-3099(15)00527-7
- Trivedi, M. K., Shinkai, K., & Murase, J. E. (2017). A Review of hormone-based therapies to treat adult acne vulgaris in women. International journal of women’s dermatology, 3(1), 44–52. https://doi.org/10.1016/j.ijwd.2017.02.018
- Charny, J. W., Choi, J. K., & James, W. D. (2017). Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. International journal of women’s dermatology, 3(2), 111–115. https://doi.org/10.1016/j.ijwd.2016.12.002
- Albuquerque, R. G., Rocha, M. A., Bagatin, E., Tufik, S., & Andersen, M. L. (2014). Could adult female acne be associated with modern life?. Archives of dermatological research, 306(8), 683–688. https://doi.org/10.1007/s00403-014-1482-6
- Borrel, V., Thomas, P., Catovic, C., Racine, P. J., Konto-Ghiorghi, Y., Lefeuvre, L., Duclairoir-Poc, C., Zouboulis, C. C., & Feuilloley, M. (2019). Acne and Stress: Impact of Catecholamines on Cutibacterium acnes. Frontiers in medicine, 6, 155. https://doi.org/10.3389/fmed.2019.00155
- Snast, I., Dalal, A., Twig, G., Astman, N., Kedem, R., Levin, D., Erlich, Y., Leshem, Y. A., Lapidoth, M., Hodak, E., & Levi, A. (2019). Acne and obesity: A nationwide study of 600,404 adolescents. Journal of the American Academy of Dermatology, 81(3), 723–729. https://doi.org/10.1016/j.jaad.2019.04.009
- Yang, Z., Zhang, Y., Lazic Mosler, E., Hu, J., Li, H., Zhang, Y., Liu, J., & Zhang, Q. (2020). Topical benzoyl peroxide for acne. The Cochrane database of systematic reviews, 3(3), CD011154. https://doi.org/10.1002/14651858.CD011154.pub2
- Zheng, Y., Wan, M., Chen, H., Ye, C., Zhao, Y., Yi, J., Xia, Y., & Lai, W. (2013). Clinical evidence on the efficacy and safety of an antioxidant optimized 1.5% salicylic acid (SA) cream in the treatment of facial acne: an open, baseline-controlled clinical study. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI), 19(2), 125–130. https://doi.org/10.1111/srt.12022
- Tan, M. H., Spencer, J. M., Pires, L. M., Ajmeri, J., & Skover, G. (2001). The evaluation of aluminum oxide crystal microdermabrasion for photodamage. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 27(11), 943–949. https://doi.org/10.1046/j.1524-4725.2001.01120.x
- Enshaieh, S., Jooya, A., Siadat, A. H., & Iraji, F. (2007). The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study. Indian journal of dermatology, venereology and leprology, 73(1), 22–25. https://doi.org/10.4103/0378-6323.30646
- Jung, J. Y., Kwon, H. H., Hong, J. S., Yoon, J. Y., Park, M. S., Jang, M. Y., & Suh, D. H. (2014). Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial. Acta dermato-venereologica, 94(5), 521–525. https://doi.org/10.2340/00015555-1802
- Gozali, M. V., & Zhou, B. (2015). Effective treatments of atrophic acne scars. The Journal of clinical and aesthetic dermatology, 8(5), 33–40. https://pubmed.ncbi.nlm.nih.gov/26029333/
- Lu, J., Cong, T., Wen, X., Li, X., Du, D., He, G., & Jiang, X. (2019). Salicylic acid treats acne vulgaris by suppressing AMPK/SREBP1 pathway in sebocytes. Experimental dermatology, 28(7), 786–794. https://doi.org/10.1111/exd.13934
- Sas, K., & Reich, A. (2019). High Body Mass Index is a Risk Factor for Acne Severity in Adolescents: A Preliminary Report. Acta dermatovenerologica Croatica : ADC, 27(2), 81–85. https://pubmed.ncbi.nlm.nih.gov/31351501/
- Veith, W. B., & Silverberg, N. B. (2011). The association of acne vulgaris with diet. Cutis, 88(2), 84–91. https://pubmed.ncbi.nlm.nih.gov/21916275/