How Acne Is Treated

There are many acne treatment options available to get your acne breakouts under control. Acne treatments can be divided into three categories: topical (medications you put on your skin, either over-the-counter products or prescriptions), systemic (prescription oral medications), and procedural (treatments done at a spa or dermatology office). The appropriate course of treatment is determined by the type and stage of your acne.

Over-the-Counter (OTC) Therapies

Over-the-counter acne treatments are those products you can get at a drugstore, grocery store, skin spa, or cosmetics store. Many OTC products claim to be good for breakout-prone skin. The trick to finding one that actually works is taking a look at the active ingredients.

The most effective OTC acne treatment products contain at least one of these ingredients:

  • Salicylic acid (0.5% to 2%): Salicylic acid works as an exfoliant, helping your skin shed dead skin cells more effectively. It works best for non-inflamed outbreaks and for blackheads. It also helps other acne-fighting ingredients penetrate the skin better, so it is a good addition to a variety of preparations.
  • Benzoyl peroxide (2.5% to 10%): Benzoyl peroxide is the active ingredient in products such as Clearasil and Proactiv, as well as in prescription acne medications. It works by introducing oxygen into the pores, which kills the bacteria that are associated with acne. It also helps clear the follicle of dead skin cells, which can prevent breakouts.
  • Sulfur: Sulfur reduces skin oiliness, helps the skin slough away cells more effectively to prevent blocked pores, and is anti-microbial. It is good for mild to moderate acne, including moderate inflammatory acne, but isn't effective for severe acne or cystic breakouts. It tends to be gentler on the skin.
  • Glycolic acid: Glycolic acid is a water-soluble alpha hydroxy acid (AHA) that works to speed up cell turnover and exfoliate the skin. It also stimulates the skin to make more collagen, which reduces aging effects. However, it makes your skin sensitive to the sun.

It doesn't matter much what type of product you use, whether it be a cleanser, toner, cleansing pads, or a lotion, so long as it contains a proven acne treatment ingredient. You can also choose several OTC products and put them together to create your own blemish-fighting skincare routine.

OTC acne products could cause excessive dryness, peeling, and redness. If you have sensitive skin, you may wish to start with a single acne treatment product, and slowly add more if needed.

Overall, OTC products are a good choice for mild acne and blackheads, but moderate and severe outbreaks will likely require prescription medications.

Prescriptions

For acne that isn't getting better after three months with over-the-counter products, your doctor may recommend treatment with stronger topical prescription medications. In more severe breakouts, oral prescription medication may be recommended.

Topical Medications

Prescription topical medications can be used to treat mild breakouts, severe acne, and everything in between. Topical acne treatments come in many different forms, from light water-based gels and creamy lotions to toner-like solutions and medicated pads.

Topical treatments available by prescription include:

  • Azelaic acid: Believed to reduce acne bacteria, azelaic acid increases shedding of skin cells and helps prevent hyperpigmentation when used as a cream or gel.
  • Benzoyl peroxide (prescription strength)
  • Topical retinoids are made from synthetic vitamin A and include Retin-A Micro (tretinoin), Tazorac (tazarotene), and the retinoid-like compound adapalene (which goes by the brand name Differin). They rapidly exfoliate the skin, keeping your pores unclogged and preventing comedones.
  • Topical antibiotics target the skin bacteria that are associated with acne. Clindamycin and erythromycin are the most common ones used.
  • Combination acne medications combine an antibiotic with another of the topical agents.

Oral Medications

Oral acne medications work internally. These medications are typically prescribed for severe breakouts or cystic acne. They're also used for less severe types of acne when topical treatments aren't giving good enough results.

Oral acne treatments are available by prescription only and include:

  • Oral antibiotics: These might be used, but for no longer than three to six months. Because of the rise of resistant bacteria, the American Academy of Dermatology says that treatment with a single antibiotic should be avoided.
  • Isotretinoin: This drug, like topical retinoids, is made from a synthetic form of vitamin A. It is considered the most effective for severe acne. However, it is essential that you do not become pregnant while taking it as it can cause severe birth defects. There are several brands of isotretinoin (e.g., Absorica, Zenatane), but you may be most familiar with one that went off the market in 2009: Accutane.
  • Hormonal treatments: Options such as birth control pills and CaroSpir (spironolactone) are not first-line treatments for acne, but they may benefit women who consistently break out around the time of their monthly cycle or who have hormonal disorders that trigger acne.

With the exception of isotretinoin, you'll probably use an oral medication in conjunction with another topical acne treatment.

If you're pregnant, acne must be treated carefully. Certain medications like isotretinoin and Retin-A (tretinoin), for example, should never be used while pregnant or if you think you could be pregnant.

Surgeries and Specialist-Driven Procedures

Procedural treatments are therapies performed by a dermatologist, healthcare practitioner, or esthetician in the office or salon. They can be used to treat mild to severe acne, depending on the procedure.

Some professional acne treatment procedures performed my estheticians may not be covered by health insurance, so you should check with your plan provider. Some you may want to try include:

  • Comedo extractions: Estheticians perform this treatment to clear out clogged pores with precision extraction.
  • Acne treatment facials: The goal of this treatment is to clear your pores so you have fewer breakouts.
  • Chemical peels: These procedures exfoliate the skin to clear the pores. A light chemical peel can be done by an esthetician, while a deeper peel requires a dermatologist.
  • Microdermabrasion: This procedure uses a machine to rapidly remove the outermost layer of the skin, freeing the pores. It may help with mild acne and post-acne hyperpigmentation. It can be performed by an esthetician.

These procedures are done by a physician and are likely to be covered by many insurance plans:

  • Corticosteroid injections: This procedure is performed by a physician to treat large, inflamed acne cysts. There is a risk you will get a pitting scar, however.
  • Acne surgery: Blemish excision might be performed by a physician to drain stubborn lesions.

Phototherapy is a procedure that was initially developed for treating skin cancer and actinic keratosis. It is performed by specially-trained physicians and their staff. As its effectiveness for acne is still being explored, it may not be covered by insurance.

Procedural therapies aren't meant to be used as the sole acne treatment. Instead, consider these add-ons to help boost your current acne treatment medication.

Seeing a Dermatologist

A dermatologist is a medical doctor who specializes in the science of the skin, its treatment, and diseases. Having a professional's help is a great asset in the fight against acne. Your dermatologist can offer many acne treatment options, as well as advice and support.

Seeing an Esthetician

An esthetician, or skin care therapist, specializes in the treatment and beautification of the skin. Estheticians are not medical doctors; rather they perform cosmetic treatments of the skin, such as facials. They can recommend skin care products for acne-prone skin and offer advice on daily skin care. Estheticians can also perform deep cleansing treatments to help ward off comedones.

Dermatology offices and medi-spas may employ estheticians to offer supportive therapy under the supervision of the doctor, or you can find them at day spas or skin spas.

Complementary Alternative Medicine (CAM)

There are a few alternative treatments that may hold some promise, although more research needs to be done.

Tea tree oil is obtained from the leaves of the Melaleuca alternifolia plant. It has traditionally been used for skin infections and wounds. It has anti-inflammatory and antimicrobial properties, which may help reduce the bacteria responsible for acne breakouts. Ongoing studies have been building evidence that tea tree oil reduces breakouts in those who have mild to moderate acne when used topically.

Note that studies of tea tree oil for acne are done with a 5% gel (or similarly diluted strength of product) which is washed off after 20 minutes. If you buy tea tree oil at a health food store, you must dilute it in a carrier oil to a 5% strength to avoid redness, itchiness, blistering, and drying of the skin. Alternatively, you can opt for a skincare product that contains tea tree oil.

Home Remedies and Lifestyle

Building good skincare habits from childhood can help kids and teens (as well as adults) prevent or reduce outbreaks. By age 9 and throughout the years ahead, people should clean their faces each night with a gentle cleanser (such as Dove or Neutrogena). All products used should be mild and should be applied gently without scrubbing. An oil-free moisturizer should be used if soap is drying the skin.

It's also important to never pick at or "pop" pimples. While you may think you are draining the lesion, this simply forces the bacteria deeper into the skin to cause more inflammation and can result in infection and even scarring. It's never too late to break yourself of this habit.

Making certain dietary changes, like switching to low-glycemic index carbohydrates or reducing dairy, might lessen acne severity for some people. Some of the changes suggested follow general dietary guidelines for good health, such as eating more whole grains rather than sugar and refined carbohydrates. Be aware that the scientific evidence for any step away from a generally healthy diet, such as eliminating dairy, is not conclusive. Especially for children and teens, it is important to provide a balanced diet for growth.

You may be drawn to natural treatments or home remedies to try to clear your skin, but the reality is that most just don't work. There's no scientific evidence to show, for example, that things like garlic, apple cider vinegar, Milk of Magnesia (magnesium hydroxide), or other home remedies clear acne. In some cases, they can actually cause contact dermatitis and make your skin look and feel worse.

A Word From Verywell

Acne is a complicated problem—one that is still not fully understood. It can be hard to treat and is not a condition that goes away overnight. On the contrary, many people will go through several treatments and regimens before they find one that works for them. Try not to get discouraged. Just starting treatment can help you feel more in control of your skin. Your dermatologist can help you devise a treatment plan that will work for you. Take that first step.

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Article Sources

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