Your Easy + Essential Guide to Acne Treatments
Doctor’s Note
As dermatologists, we understand the struggles of dealing with acne. In addition to the physical discomfort of the acne itself, this condition can take an emotional toll on patients by increasing feelings of self-consciousness. For patients, it's often hard to know what will help - we hope our online info will help you learn about the causes of acne, over-the-counter treatments, prescription topicals, oral medications, and in-office procedures.
What is Acne?
Acne is a common skin condition that affects people of all ages, but it is most common during the teenage years. It occurs when the pores of your skin become blocked with oil, dead skin cells, and bacteria. This can lead to pimples, blackheads, whiteheads, and sometimes even painful cysts or nodules. Acne can appear on the face, chest, back, and shoulders.
Normally, an oil gland (AKA sebaceous gland) produces oil (AKA sebum), which flows into the hair follicle. The oil then spreads onto the skin surface. In acne, four things go wrong:
1. Oil gland overproduces oil
2. Dead skin cells clump together
3. Bacteria grows
4. Causes inflammation
What Causes Acne?
So why does this happen? There are many causes that drive this cycle, the most common being:
Excess Oil Production: Your skin produces oil to keep it hydrated, but too much oil can clog pores.
Dead Skin Cells: When dead skin cells accumulate, they can mix with oil and clog pores.
Bacteria: The bacteria Propionibacterium acnes can grow in clogged pores, leading to inflammation and pimples.
Hormones: Hormonal changes, especially during puberty, can increase oil production and cause acne.
Genetics: Blame Mom and Dad.
Diet: Controversial, though some studies indicate that certain foods, like dairy products and high-sugar foods, can trigger or worsen acne in some people.
Medications: Certain meds (hormones, steroids, lithium, etc)
What Makes Acne Worse?
Several factors can exacerbate acne:
Touching Your Face: Constantly touching your face can transfer bacteria and oil from your hands to your skin.
Using Harsh Skincare Products: Products with strong chemicals can irritate your skin and worsen acne.
Stress: Stress can increase hormone levels, leading to more oil production and breakouts.
Diet: Foods high in sugar and dairy can trigger acne in some people.
Not Removing Makeup: Sleeping with makeup on can clog your pores and cause breakouts.
Sweat and Friction: Sweat and tight clothing can irritate your skin and cause acne, especially on your back and chest.
Poor Sleep: Makes everything worse!
Stress: Makes everything worse!
Oftentimes, patients with acne find it difficult to pinpoint their exact trigger. If you don't know what is flaring you, it is important to keep a daily journal to record the day's foods/stressors/events to look back and find a commonality in your triggers. Download a daily printable journal below!
What Makes Acne Better?
On the other hand, certain practices can help improve acne:
Gentle Skincare Routine: Using mild, non-comedogenic products that won’t clog pores.
Healthy Diet: Eating a balanced diet with plenty of fruits, vegetables, and whole grains.
Staying Hydrated: Drinking plenty of water to keep your skin hydrated.
Managing Stress: Practicing relaxation techniques like yoga or meditation to reduce stress.
Regular Exercise: Exercising can help reduce stress and improve blood circulation to your skin.
Acne Treatment Overview
Acne comes in different types, and each type has its own best treatments. For blackheads and whiteheads, which are the mildest forms of acne, over-the-counter products like salicylic acid and retinoids work well. Mild acne, which includes a few small pimples, can be treated with over-the-counter benzoyl peroxide and retinoids.
When acne becomes a bit more noticeable and persistent, like in mild to moderate acne, prescription treatments might be needed. These include topical antibiotics and topical retinoids that a doctor can prescribe. For moderate acne, which includes more pimples and possibly some pain, prescription treatments such as oral antibiotics, birth control pills (for women), spironolactone (also for women), or Accutane may be necessary.
Severe acne is the most serious form and often includes deep, painful cysts or nodules. For this type, a strong prescription medication like Accutane is usually recommended by a dermatologist. Each type of acne has specific treatments that can help clear the skin and prevent further breakouts.
Best Products for Acne
Comedonal acne, including blackheads and whiteheads, can be effectively treated with products containing salicylic acid and retinoids. Salicylic acid is excellent for unclogging pores and exfoliating the skin, while retinoids help increase cell turnover and keep pores clear.
Salicylic Acid
Great for comedonal acne (AKA blackheads and whiteheads). Helps exfoliate the skin and unclog pores. Found in cleansers, toners, and spot treatments. If your skin is very sensitive, choose a salicylic acid cleanser. If you can tolerate it, a leave-on toner works better. Generally the Paula’s Choice BHA toner is one of our favorites and not likely to irritate.
Retinoids
Great for all types of acne! Derived from vitamin A, retinoids help prevent clogged pores and promote cell turnover. Available in creams and gels.
Azelaic Acid
Azelaic acid helps treat acne by unclogging pores, reducing inflammation, and killing acne-causing bacteria. It also promotes cell turnover, which smooths the skin’s texture and reduces the occurrence of blackheads and whiteheads.
Benzoyl Peroxide
Reduces bacteria and helps clear pores. Available in cleansers, gels, and creams.
Best Prescriptions for Acne
If your acne is deeper or not controlled by the above products, it's best to see your dermatologist. Sometimes, prescription medication (whether it's topical or oral) is necessary to clear more stubborn acne. Here is a look at some of the more common prescriptions.
Topical Antibiotics
- Help reduce bacteria and inflammation
- Well-tolerated
- Comes in lotion (more moisturizing), gel (better for oily skin), and wipes (convenient for use after a workout)
- Rx: clindamycin + erythromycin
Spironolactone
- Helps to stabilize hormones for women with hormonal acne
Topical Retinoids
- Unclog pores and reduce inflammation
- Use at night
- May cause irritation
- OTC: Differin and Retinol
- Rx: Tretinoin, Tazorac, Aklief
Birth Control Pills
- Can help regulate hormones that cause acne in females
- Ex: Yaz, Estrostep, Ortho-Tricyclin
Antibiotic + BPO
- Pharmaceutical companies get creative and combine topicals to make an easy 2-in-1 cream
- Rx: Duac (Benzoyl Peroxide + Clindamycin), Benzaclin (Benzoyl Peroxide + Clindamycin)
Oral Antibiotics
- Reduce bacteria and inflammation from the inside. Typically used for moderate to severe acne
- Ex: Doxycycline, minocycline, Bactrim
Retinoid + BPO
- Pharmaceutical companies get creative and combine topicals to make an easy 2-in-1 cream. - Rx: Epiduo + Epiduo Forte (Benzoyl Peroxide + Adapalene)
Accutane
- For severe acne that has not responded to other treatments
- Many side effects, most commonly dryness
- Bloodwork, pregnancy tests, frequent follow-up required
Best Procedures for Acne
In addition to products and prescriptions, certain procedures can help treat acne and reduce scars.
Peels
Type: Topical acid application
Use: Exfoliates skin, unclogs pores
Mechanism: Removes top skin layers
Side Effects: Redness, peeling, sensitivity
Laser + Light
Type: Aviclear AKA “Laser Accutane”
Laser: Targets bacteria and reduces oil production, helping to clear acne and improve scars.
Light: Uses blue or red light to reduce bacteria and inflammation in the skin.
Steroid Injections
Type: Corticosteroid injection
Use: Treats large, painful cysts
Mechanism: Reduces inflammation rapidly
Side Effects: Skin thinning, discoloration
Okay, those treatments are for active acne... what if we don't have active acne? What if we have old red/brown/white spots left over? Are there treatments for that? Of course!!
Acne Marks vs Acne Scars
After acne, your skin can be left with different kinds of marks: PIE, PIH, and scars. PIE, or Post-Inflammatory Erythema, appears as red or pink spots caused by damage to tiny blood vessels. PIH, or Post-Inflammatory Hyperpigmentation, shows up as dark brown or black spots due to increased melanin, which is the skin’s pigment. Acne scars, however, are different because they change the skin's texture, creating dents or raised areas. While PIE and PIH usually fade over time, scars are more permanent and might need treatments like microneedling or laser therapy to improve.
Red Spots
AKA: “Post Inflammatory Erythema”
Appearance: Red spots after pimple resolves
Cause: Damage to blood vessels
Skin Type: Fairer skin tones
Treatment: PDL laser, Azelaic acid, Niacinamide
Scar? NOT A SCAR; will resolve with time
Dark Spots
AKA: “Post Inflammatory Hyperpigmentation”
Appearance: Dark spots after pimple resolves
Cause: Damage to melanocyte cells
Skin Type: Darker skin tones
Treatment: Sunscreen, Retinol, Hydroquinone, Peels, Azelaic acid, Niacinamide
Scar? NOT A SCAR; will resolve with time
Acne Scars
Appearance: Sunken or raised skin after pimple resolves
Cause: Damage to collagen
Skin Type: All
Treatment: Lasers, Fillers, Microneedling
Scar? SCAR. This will NOT resolve with time; procedures are needed to reduce appearance.
Acne FAQs
Can mold cause acne?
Mold itself doesn’t directly cause acne, but exposure to mold can trigger skin irritation and inflammation, which may worsen acne in some individuals. Maintaining a clean environment can help reduce these triggers.
Does almond milk cause acne?
Almond milk is generally considered acne-friendly as it’s dairy-free. However, some people might experience breakouts due to other ingredients or additives in almond milk. It’s important to monitor how your skin reacts.
Does snail mucin cause acne?
Snail mucin is known for its hydrating and healing properties and is usually safe for acne-prone skin. However, like any product, it can cause breakouts if your skin is sensitive or if it’s mixed with other irritating ingredients.
Can pre-workout cause acne?
Some pre-workout supplements can cause acne, especially those high in caffeine or other stimulants. These ingredients can increase oil production and stress hormones, which may lead to breakouts.
Is Vanicream good for acne?
Vanicream is often recommended for sensitive and acne-prone skin because it’s free of dyes, fragrances, and other common irritants. It provides gentle hydration without clogging pores.
Is beef tallow good for acne?
Beef tallow is rich in fatty acids and can be beneficial for the skin. However, its effects on acne-prone skin can vary. Some people find it nourishing, while others might experience breakouts. It’s best to patch test before using it regularly.
Can ice cream cause acne?
Ice cream can contribute to acne for some individuals due to its high sugar and dairy content. Both sugar and dairy have been linked to increased sebum production and inflammation, which can lead to breakouts.
Can oil cleansing cause acne?
Oil cleansing can be beneficial for many, but it can cause breakouts if the wrong type of oil is used or if the skin isn’t thoroughly cleansed afterward. Non-comedogenic oils are less likely to clog pores and cause acne.
Can pre-workout give you acne?
Yes, pre-workout supplements can contribute to acne, particularly if they contain high levels of caffeine, artificial sweeteners, or other ingredients that may increase oil production and stress levels.
Can snail mucin cause cystic acne?
While snail mucin is generally safe for most skin types, it’s possible that some individuals may experience cystic acne if their skin is particularly sensitive or if the product is used with other potentially irritating ingredients.