How Acne Is Treated

There are many acne treatment options available to get your acne breakouts under control. They could be topical (medications you put on your skin), systemic (prescription oral medications), or procedural (treatments done at a spa or dermatology office). The appropriate course of treatment is determined by the type and stage of your acne.

This article discusses the types of acne treatment. This includes over-the-counter therapies, prescriptions, procedures, and home remedies.

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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. What's important is that 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. Slowly add more if needed.

Overall, OTC products are a good choice for mild acne and blackheads. 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 healthcare provider may recommend 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. These acne treatments come in many different forms. This includes light water-based gels and creamy lotions to toner-like solutions and medicated pads.

Topical treatments available by prescription include:

  • Azelaic acid is believed to reduce acne bacteria, increases the shedding of skin cells, and helps prevent hyperpigmentation when used as a cream or gel.
  • Benzoyl peroxide products are available in 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 or small flesh-colored bumps.
  • 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 inside the body. 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. However, they may benefit women who break out around the time of their monthly cycle or 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.

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 by 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, the dark spots left after acne heals. It can be performed by an esthetician.

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

  • Corticosteroid injections: This procedure is performed by a practitioner 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 healthcare provider to drain stubborn lesions.

Phototherapy is a procedure that was initially developed for treating skin cancer and actinic keratosis, a precancerous skin growth. 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 skincare 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 skincare products for acne-prone skin and offer advice on daily skincare. 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 healthcare provider. You can also find them at day spas or skin spas.

Complementary and 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 with 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). This 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. This will help 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. This 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 dietary changes suggested follow general dietary guidelines for good health. This includes 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. 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.

Summary

Finding the right acne treatment depends on the type and stage of your acne. For mild cases, over-the-counter topical medications are a good option. For moderate to severe acne, your healthcare provider may recommend a prescription, either a topical or oral medication.

Some procedural treatments can be helpful for acne as well. These include acne treatment facials, microdermabrasion, and corticosteroid injections. There is also some evidence that skincare products with tea tree oil may help with acne, but more research is needed.

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.

Frequently Asked Questions

  • What over-the-counter acne treatments work?

    Over-the-counter (OTC) topical products including benzoyl peroxide, azelaic acid, or salicylic acid all may be helpful. Studies have shown that 2.5% benzoyl peroxide gels or creams are just as effective as 5% and 10% formulations and less likely to cause skin irritation. By contrast, higher concentrations of azelaic or salicylic acid (up to 5% and 15% respectively) seem to be more effective.

  • How is cystic acne treated?

    Cystic acne is treated in much the same way as “regular” acne, although it may benefit from Aczone (topical dapsone 5%) to relieve inflammation.

    Since cystic acne is more common in women and is influenced by hormonal fluctuations, combination birth control pills may be an option for those who want to use them for contraception.

    Aldactone (spironolactone) is often used in women who don’t respond to oral antibiotics. Isotretinoin or local steroid injections may be appropriate for severe cases.

  • Is oral isotretinoin an option for my acne?

    Isotretinoin is typically used for severe cystic acne due to its possible side effects. But it can also be used for moderate acne if other treatment options fail or if acne is causing scarring and emotional distress.

  • What is the best treatment for acne scars?

    There are many options, depending on the severity of scarring and your skin type, including:

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9 Sources
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