Acne

Acne is a skin concern that affects almost everyone, regardless of age, race, or gender. Separate fact from fiction in this breakdown of what acne is; what triggers it; and the top acne treatments and products, according to dermatologists.

Acne is a skin concern that affects almost everyone, regardless of age, race, or gender. Separate fact from fiction in this breakdown of what acne is; what triggers it; and the top acne treatments and products, according to dermatologists.

Medically reviewed by Andrea Hui Austin, MDDermatologic Surgeon, Board Certified in Dermatology
Written byKaryn RepinskiUpdated on July 2, 2021
RealSelf ensures that an experienced doctor who is trained and certified to safely perform this procedure has reviewed this information for medical accuracy.You can trust RealSelf content to be unbiased and medically accurate. Learn more about our content standards.
Acne 754x484
Acne 754x484

Acne (aka acne vulgaris) is the most common skin concern in the U.S., according to the American Academy of Dermatology. Commonly called pimples, it usually makes its debut in adolescence (an estimated 90% of teens suffer from acne, to some degree), but it can stubbornly stick around beyond the teenage years, and adult acne is common. 

Some women experience this skin condition for the first time as adults, often during pregnancy or menopause, when hormones called androgens boost sebum production, which results in oily skin. 

Noninflammatory acne, which develops when a pore (aka a follicle) gets clogged with oil (sebum) and dead skin cells, is also known as comedonal acne. There are two types:

  • Blackheads are clogged pores that remain open, so the trapped oil is oxidized by air and appears black. Blackheads aren’t caused by dirt, so don’t try to scrub them away—that will just irritate your skin.
  • Whiteheads are clogged, closed pores. When left untreated, they can lead to inflammatory acne.

Inflammatory acne develops when the bacteria that normally lives on top of your skin gets trapped in the pore and the area becomes infected, red, and swollen. 

Varieties of inflammatory acne include: 

  • Papules: small, tender bumps that occur when oil, bacteria, and dead cells push deeper into the skin, causing inflammation
  • Pustules: pus-filled papules, often with a yellow center
  • Nodules: large, solid, painful lumps that form beneath the skin’s surface
  • Cysts: deep, painful, pus-filled lumps embedded beneath the surface of the skin; cystic acne is the most severe type

Areas with the largest, most active oil glands—the forehead, nose, and chin, commonly called the T-zone—are most likely to develop acne, but it can also develop on the neck, back, shoulders, and chest. (Butt acne is actually an irritation of the hair follicles, known as folliculitis.)

There are three main factors that contribute to breakouts.

  • Excess oil. Sebum is a natural skin moisturizer, but the sebaceous glands can pump out too much oil. When dead skin cells clump and start to form a plug, excess oil builds up behind it. 
  • Clogged pores. When a pore becomes blocked with oil, dead skin cells, or makeup, blackheads and whiteheads form. 
  • Bacteria. The bacteria P. acnes normally live in the skin’s oil glands. But as the bacteria feed on excess oil, they multiply and inflame the pore. Eventually, the pore may rupture—which leads to pustules, papules, nodules, and cysts. Inflammatory acne needs medication, often topical or oral antibiotics, to calm the inflammation and clear the bacteria. 
  • Hormones. Changes in hormones can play a major role in acne too. “Starting around puberty, hormone levels are fluctuating and the body is responding in many ways, including acne,” says Dr. Abbott. Hormones such as androgens stimulate the production of oil and cause dead skin cells to become “sticky,” making them more likely to block pores.  In women, cyclical hormone fluctuations around the time of their periods can lead to monthly acne flares—particularly, painful red bumps along the jawline. This is why doctors may prescribe birth control pills as an acne treatment. They can help calm down hormonal changes that trigger acne, leading to clearer skin all month long. If you have acne and irregular menstrual cycles, consider having your hormone levels checked. “Polycystic ovary syndrome [PCOS] can cause excess hormone production that leads to irregular cycles, excess hair on the face and body, and acne,” says L.A. dermatologist Dr. A. David Rahimi

Since each type of acne responds best to different medications and treatments, it’s best treated by a board-certified dermatologist and with a customized combination of therapies. 

Keep in mind that it can take three to six months to see the full effects of any acne treatment. “My patients are almost always better in one month, but it’s not the maximum effect at that time,” says Dr. Rebecca Baxt, a Paramus, New Jersey, dermatologic surgeon.

These are the treatments dermatologists and RealSelf members say work best to get rid of acne.

Retin-A (Page Image)Retin-A

nonsurgical

Accutane (Page Image)Accutane

nonsurgical

Salicylic Peel (Page Image)Salicylic Peel

nonsurgical

Worth It Rating100%93%93%82%79%86%
Average Cost$75$575Not yet available$300$400$100
DowntimeNo downtimeNo downtime1 week of downtimeNo downtimeUp to 1 week of downtimeNo downtime
Anesthesia No anesthesiaNo anesthesiaNo anesthesiaNo anesthesiaNo anesthesia
  • Retin-A, the most widely known brand of tretinoin, a retinoid derived from vitamin A, is one of the key treatments for acne with proven results. “Retinoids stop blackheads and whiteheads from forming on your skin. These are the first ‘lesions’ of acne, which can bring on other forms of acne, such as red bumps [cysts] and pus bumps,” says Dr. Austin.  Tretinoin (other common brands include Refissa, Atralin, and Renova) is the most well-known topical retinoid for acne. Applied in a small amount at bedtime, it helps keep pores clear and unclogged by speeding up skin cell turnover.  “Acne gets better as the upper dead skin cells slough off more rapidly, new skin cells push off the dead layers, and excess oil is reduced,” says Minneapolis plastic surgeon Dr. Richard Tholen. Related: 7 Things You Need to Know Before Starting Retin-A Your skin may look worse before it gets better. “You can have some irritation, redness, and dryness that can cause slight swelling in the pores, which can lead to trapped sebum and the occasional outbreak or stray pimple—but only for a while as your skin acclimates.”  There are other prescription retinoids, including adapalene (Differin), tazarotene (Tazorac, Avage), and trifarotene (Aklief). Approved by the U.S. Food and Drug Administration (FDA) in late 2019, Aklief is the first new retinoid to be available in two decades. Both Aklief and Altreno, a form of tretinoin approved in early 2019, are less likely to cause the side effects usually associated with retinoids.  Find doctors who offer Retin-A
  • Accutane (isotretinoin) is considered the only medication that has the potential to get rid of acne. “All other medications work just to keep acne under control,” says Dr. Michael Greenberg, a dermatologist in Elk Grove Village, Illinois.  “In addition to greatly decreasing acne lesions, isotretinoin has remarkable durability, usually resulting in clearance for years,” says NYC dermatologist Dr. Bobby Buka. The medication course can take four to six months, depending on how many milligrams you take each day.  The higher your dose, the more side effects you may experience. The most common side effect is dryness. “Very severe acne sufferers may notice a temporary worsening of their acne prior to overall improvement, but usually, it’s a steady improvement from day one,” reports Dr. Buka, who says patients usually see the most notable results after two or three months.  Related: 7 Things You Should Never Do While Taking Accutane Isotretinoin can cause birth defects, so women of child-bearing age need to take special precautions (including undergoing regular pregnancy tests) when using the drug. Verification through a pregnancy monitoring registry, called iPledge, is a mandatory part of your monthly visit with your dermatologist, whether you are male or female. Find doctors who offer Accutane
  • Salicylic peels help treat acne and dullness by speeding up cell turnover, removing the surface layer of dead skin cells, and boosting collagen.  Like other chemical peels, salicylic peels typically require a series of four to six weekly or biweekly treatments. Many dermatologists prefer salicylic acid for acne because it penetrates into the pores and dissolves oil better than other options. It’s also anti-inflammatory.  Glycolic peels are another in-office option for treating acne. However, one split-face study on women with mild to moderate inflammatory acne showed that while both salicylic and glycolic peels were effective in reducing acne lesions, salicylic acid peels had longer-lasting results and fewer side effects.  Find doctors who offer salicylic peels
  • Light-emitting diode (LED) light therapy may be your best bet, if a chemical solution isn’t your thing for combatting acne. During this in-office procedure, a dermatologist or aesthetician uses blue light to target oil glands (to make them less active) and kill acne-causing bacteria. They may also use red light to reduce inflammation. The treatment can heal current pimples and prevent future breakouts. You’ll see the biggest benefit from a series of six to eight weekly LED light therapy sessions. After that, your initial results should last from six months to a year. Annual follow-up sessions will help maintain them. Find doctors who offer LED light therapy
  • Photodynamic therapy is similar to LED light therapy, with a key difference: your provider starts by applying a topical drug, to make the skin more photosensitive, then exposes it to blue or red light that “turns on” the drug. The treatment kills P. acnes bacteria and helps shrink oil glands. Other than a little redness and swelling, there’s no downtime with PDT. The treatment is considered effective for treating mild to severe acne, and it may help reduce acne scarring by stimulating collagen production and the growth of new blood vessels.  Find doctors who offer photodynamic therapy
  • Spironolactone can be used to block the action of the body’s hormones on the oil glands, making it ideal for treating acne that’s aggravated by hormonal fluctuations. Spironolactone (“spiro” for short) isn’t FDA-approved for acne, but there is research suggesting that long-term use (up to eight years, in one study) is safe.  Dosage for the drug ranges from 25 mg to 200 mg daily, but it’s common to be prescribed a lower dose that’s then boosted after a month. Even at a low dosage, women often see some improvement.   Spironolactone shouldn’t be taken if you’re pregnant or trying to get pregnant, due to concerns about birth defects.  Find doctors who offer spironolactone

  • Antibiotics. Topical antibiotics like clindamycin and erythromycin can reduce the amount of P. acnes bacteria on the skin and lessen the inflammation they cause.  However, sometimes topical options don’t cut it. That’s when oral antibiotics, like minocycline or doxycycline, which circulate throughout the body and into the sebaceous glands, can really be helpful, says Dr. Abbott. Oral antibiotics should be used for the shortest time possible, usually three to four months. This allows other topicals, such as retinoids, to start working to unclog your pores. Both topical and oral antibiotics are often prescribed with benzoyl peroxide, another commonly used topical antiseptic, to reduce the likelihood of developing antibiotic resistance. 
  • Birth control pills. Oral contraception that contains both estrogen and progesterone helps regulate hormone levels so you don’t have a dramatic rise in the male hormones (androgens) that trigger sebum production. (Progesterone-dominant birth control pills tend to make acne worse.)  Research has found that estrogen-containing oral contraceptive pills are effective at treating blackheads, whiteheads, pimples, nodules, and cysts. It’s proven so effective that some oral contraceptives, including Beyaz, Estrostep FE, Ortho Tri-Cyclen, and Yaz, have been FDA-approved for treating acne.  The Pill is generally safe for women, but some shouldn’t take it. Many dermatologists don’t prescribe oral contraception, so speak to your OB-GYN to see if it’s a good treatment option for you. Other types of hormonal contraception that also contain estrogen and progesterone, such as patches, implants, and vaginal rings, may also be an option. 
  • Sebacia. Cleared by the FDA in 2018, Sebacia is an in-office acne treatment that uses inert gold microparticles to destroy the sebaceous glands that produce pore-clogging sebum. During the treatment, gold microparticles are absorbed into the oil glands and then targeted by a laser. The laser heats up the particles—which, in turn, effectively destroys the oil glands. Once these glands have been destroyed, acne outbreaks are reduced, pores appear smaller, and greasiness is diminished. Results from this treatment take about 10 to 12 weeks to become apparent, and it’s recommended for patients to undergo three treatments, for the optimal outcome.

When working to diminish your acne, it’s best to start with a visit to a dermatologist, who can recommend the best skin-care options for you.

Many acne treatments dry your skin, so using an oil-free, noncomedogenic (meaning it won’t clog pores) moisturizer or lotion allows your skin to better tolerate them. Sunscreen is also critical because dry, sensitive skin is even more prone to harmful UV rays, especially if you’re using a retinoid.

The two best pimple-fighting ingredients that you can currently buy over the counter are salicylic acid and benzoyl peroxide. Both ingredients act as an exfoliant, to help remove dead skin cells and sebum from pores. Benzoyl peroxide also kills acne-causing bacteria on contact, which helps to prevent breakouts from occurring in the first place.

Alpha hydroxy acids, like glycolic acid and lactic acid, also have exfoliant properties, so they're good options for those experiencing flare-ups.

Finally, retinol, a weaker form of prescription retinoids, is found in over-the-counter (OTC) acne products. Differin is also available OTC in a topical gel, and RealSelf favorite Obagi360 Retinol 1.0 ($74) contains 1.0% encapsulated retinol, to clear out skin congestion.

Related: 14 Skin-Care Ingredients for Busting Cystic Acne

Updated July 2, 2021

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