Acne is the most common skin problem in the United States, affecting up to 50 million people. It often appears as an outbreak of pimples on your face. But it can also show up on your chest, neck, back, or shoulders.
While you can cover a rash on your chest or arm with clothes, it's hard to hide bumps and blemishes on your face. Plus, they can be painful. They can affect your mood and make you self-conscious.
What Causes Acne?
Acne happens when a skin pore gets clogged with oil and dead skin cells. It can affect people of all ages. The main trigger for acne is fluctuating hormones, specifically the male hormone testosterone. (Women do have some levels of testosterone.) When teenagers hit puberty, their hormones start surging — and often, so does acne.
The hormonal fluctuations that cause acne are most common during the teen years, but they can also affect adults. Women may have hormonal swings during their menstrual cycle, pregnancy, and menopause that result in acne breakouts.
Acne can also be a side effect of certain medications, such as anticonvulsants and steroids. Some people may be more prone to getting acne because of their genes. One study found that 50% of adults with acne had a parent, sibling, or child with acne.
What Are the Different Types of Acne?
Acne can appear on your face, forehead, chest, upper back, or shoulders. There are several types of acne, including:
- Blackheads (plugged pores with a black top)
- Whiteheads (plugged pores with a white top)
- Pimples or pustules (bumps filled with pus)
- Pastules (small bumps that are darker than your skin tone)
- Nodules (large, painful lumps under your skin)
- Cystic lesions (painful lumps under your skin filled with fluid)
Does What You Eat Make Acne Worse?
A generation or so ago, it was thought that eating too many sweet or greasy foods caused acne. Now, doctors know much more about why breakouts happen and how to treat them.
There is some evidence that certain diets may have an effect on acne, says Macrene Alexiades-Armenakas, MD, PhD, an assistant clinical professor of dermatology at Yale School of Medicine. Some studies, such as one published in the Journal of the American Academy of Dermatology, have suggested that consuming a lot of dairy products raises the risk of getting acne because of the hormones in milk, cheese, and yogurt. But later studies have not confirmed this.
Still, other studies of acne's link to nutrition have shown that a diet with a high glycemic index, such as white breads, waffles, and other carbs, worsens acne.
What Are the Treatments for Acne?
The occasional pimple can be covered up. If you use over-the-counter cover-up creams and cosmetics, choose water-based products. Even if you can't get rid of acne outbreaks, standard treatment can offer relief.
The best treatments slow down sebum production, limit bacterial growth, and help shed skin cells to unclog pores. Also, a newer treatment works by blocking male hormones in the skin. Because many therapies can have side effects, any patient with acne should use caution when trying a new treatment. People whose acne affects their self-esteem, causes scarring, or is severe and long-lasting should see a skin doctor (dermatologist) for proper care.
Nonprescription Treatment for Acne
Here are some ways you can treat your acne without a prescription:
Soap and water. Gentle cleansing of the face with soap and water, no more than two times a day, can help with acne. However, this does not clear up acne that is already present. Scrubbing too hard can injure your skin and cause other skin problems.
Cleansers. There are many cleansers and soaps advertised for treating acne. They often contain benzoyl peroxide, glycolic acid, salicylic acid, or sulfur.
Benzoyl peroxide. For mild acne, you may try (or your doctor may recommend) treatment with a nonprescription drug that contains benzoyl peroxide. It's believed that this compound works by destroying the acne-related bacteria. It usually takes at least four weeks to work, and it must be used continuously to keep acne at bay. Like many over-the-counter and prescription products, it does not affect sebum production or the way the skin follicle cells are shed, and when you stop using it, the acne comes back. It is available in many forms: creams, lotions, washes, foams, cleansing pads, and gels. Benzoyl peroxide can cause dry skin and can bleach fabrics, so take care when applying it. Consider wearing an old T-shirt to bed if you are applying it to your back or chest overnight.
Salicylic acid. Salicylic acid helps fix the abnormal shedding of skin cells. For milder acne, salicylic acid helps unclog pores to resolve and prevent lesions. It does not have any effect on sebum production and does not kill bacteria. It must be used continuously, just like benzoyl peroxide, because its effects stop when you stop using it — pores clog up, and the acne returns. Salicylic acid is available in many acne products, including lotions, creams, and pads.
Sulfur. In combination with other substances such as alcohol, sodium sulfacetamide (a prescription medication), and salicylic acid, sulfur is a component of many over-the-counter acne medications. Usually, it isn't used by itself because of its unpleasant odor and temporary skin discoloration. Sulfur helps prevent pores from being clogged and slows the growth of bacteria. But it has only a marginal benefit in most cases.
Topical retinol gel or creams. Retinol works to keep pimples from being able to form. It affects the growth of cells, speeding up cell turnover to unblock pores. Your acne may appear to get worse before it gets better because it will work on the pimples that have already started forming beneath your skin. It must be used continuously and may take 8-12 weeks to get results. Retinoids used to be available only in a prescription strength. Differin Gel is the only topical retinoid approved as an over-the-counter treatment for acne.
Alcohol and acetone. Alcohol is a mild antibacterial agent, and acetone can remove oils from the surface of the skin. These substances are combined in some over-the-counter acne drugs. These agents dry out the skin, have little or no effect on acne, and are generally not recommended by doctors.
Herbal, organic, and "natural" medications. There are many herbal, organic, and natural products marketed to treat or prevent acne. It's not proven if these agents work well, and they are unlikely to have much benefit.
Note: When pus-filled pimples are ready to break, apply a hot towel for a few minutes to help with the natural bursting process. Inflamed pimples should be opened only by a nurse or doctor using surgical tools and following antiseptic practices. Squeezing pimples yourself may lead to further inflammation and even cause permanent scars.
Prescription Treatments for Acne
Here are some treatments that your doctor may prescribe for acne:
Antibiotics. Antibiotics may be used on top of the skin (topical) or taken orally (systemic). Antibiotics work by clearing the skin of acne-causing bacteria and easing inflammation. There are several topical products available in creams, gels, solutions, pads, foams, and lotions. Topical antibiotics can't reach deep-seated skin very well, whereas systemic antibiotics travel throughout the body and reach the oil (sebaceous) glands. Systemic antibiotics often cause more side effects than topicals, but they can be used for more severe kinds of acne. Usually, topical antibiotics aren't recommended alone as an acne treatment, as they can raise the risk for antibiotic resistance in skin bacteria. But using benzoyl peroxide with a topical antibiotic may lower the chances of developing antibiotic resistance.
Topical clindamycin (Cleocin T, Clinda-Derm) and erythromycin (Akne-Mycin, ATS, Erycette, Erygel, Ilotycin) are antibiotics that are also anti-inflammatory drugs and work well against many bacteria. They should always be combined with benzoyl peroxide or a topical retinoid and applied directly to the skin. Oral erythromycin is also available, but you may become resistant to its effects, limiting its usefulness.
Other oral antiinflammatory antibiotics often used are doxycycline, minocycline, and tetracycline, all of which work quite well in many cases of acne.
Antibiotics do not address the other factors causing acne and may take several weeks or months to clear it up. Antibiotics are often used along with other drugs that "unclog" follicles. Many oral antibiotics for acne should not be used during pregnancy.
Retinoids or vitamin A derivatives. These drugs are available as topical or oral drugs. Topical retinoids clear up moderate-to-severe acne by affecting the way the skin grows and sheds. They can be used along with other acne products, such as benzoyl peroxide and oral antibiotics. Topical retinoids don't have the severe side effects of oral retinoids, but they aren't recommended for pregnant or nursing women. Side effects of topical retinoids include redness, dryness, and itchy skin.
For severe cystic acne, isotretinoin (Absorica, Accutane, Amnesteem, Claravis, Sotret, Zenatane) is the most effective therapy. This drug is the only drug that addresses all three causes of acne. It can often even clear severe acne that hasn't responded to other treatments. But the product can have side effects. It can cause severe birth defects and must never be taken by a woman who is pregnant or who is not using contraception. In addition, it shouldn't be taken by a woman who is nursing. Some studies suggest its use has been associated with an increased risk of depression, suicide, and inflammatory bowel disease. Talk to your doctor about the potential risks of this drug.
Other side effects are dry skin and lips, muscle and joint pain, headache, higher triglyceride levels (a type of cholesterol), higher liver enzymes, decline in night vision, and, rarely, temporary hair shedding. For most people taking these drugs, side effects are tolerable and not a reason to end therapy before the acne clears up.
Azelaic acid. Another topical is azelaic acid, which comes in a gel, cream, or foam and has antibacterial and anti-inflammatory properties. It is more commonly used for another type of condition called rosacea, but it may help mild acne.
Dapsone. It is a topical gel that is antibacterial and anti-inflammatory.
Oral contraceptives. Birth control pills contain female hormones that work by lowering the effects of male hormones (such as testosterone) on acne. Their use is limited to female patients. The maximum benefit of oral contraceptives on acne occurs in three to four months. Side effects include nausea, spotting, breast tenderness, and blood clots.
Spironolactone (aldactone). Spironolactone is an oral drug that can block the action of the body's hormones on the skin's oil glands. This medication is not FDA-approved for acne, but it is especially helpful for women who have acne that worsens around the time of menstruation and menopause.
Clascoterone (Winlevi). A newly approved topical treatment for moderate to severe acne, clascoterone is considered an alternative to spironolactone. It targets the hormones that cause acne. Just how it works is not quite understood, but it has been found to reduce acne in both males and females over the age of 12.
Another common drug your doctor may try is triamcinolone, a type of corticosteroid solution that is injected directly into acne nodules.
Acne Scar Treatments
Some adults carry scars from acne. Some strong surgical treatments, such as dermabrasion, certain lasers, and chemical peels, can help improve them by removing scarred skin and showing fresh skin underneath. Dermatologists may also use the following:
- Microneedling to boost collagen and lessen the appearance of scars
- Subcision, where a needle is used under the scars to break them up
- Fillers, which are injections under the scars to lift them to the surrounding skin surface
Dermatologists may use more superficial peels, such as glycolic or salicylic acid, to help loosen whiteheads and blackheads and decrease pimples.
Microdermabrasion has little effect on acne itself but works well in combination with lasers. Before considering any treatment, it is important to discuss the procedures, necessary precautions, and likely results with a doctor.
Be Good to Your Skin
Wash the area two times a day. Use a gentle cleanser, not soap. Don't scrub too hard.
Try cleansing wipes. These already have cleanser in them. They are easy to use and can be thrown away after.
Other skin tips:
- Don't use too much topical acne medicine; apply just enough to cover problem areas.
- Many acne medicines (benzoyl peroxide, salicylic acid, and tretinoin) make your skin more sensitive to the sun.
- Don't use oily makeup, sunscreen, or hair products.
- Don't pick at or squeeze your pimples.
- Keep your hair, hands, and phone off your face.
For men, shaving can irritate the skin, worsening acne. Try an electric razor, or be very careful with a blade.
Will Your Acne Ever Go Away?
Most often, acne will go away on its own at the end of puberty, but some people still struggle with acne in adulthood. Almost all acne can be successfully treated, however. It's a matter of finding the right acne treatment for you.
Takeaways
If you have acne, you're definitely not alone. Up to 50 million people in the U.S. deal with it. The biggest trigger? Hormones. Hence, acne often shows up during puberty, but it can also flare during periods, pregnancy, or menopause. Genetics, certain medications, and even stress on your system can play a role.
Acne is treatable. There are lots of options, from over-the-counter products such as benzoyl peroxide and salicylic acid to prescription treatments such as antibiotics, retinoids, hormonal therapy, and even isotretinoin for severe cases. The catch? Nothing works overnight. It can take weeks (sometimes months), and your skin might even look worse before it improves.
Acne Treatment FAQs
How do you 100% remove acne?
Skin doctors (dermatologists) consider oral isotretinoin the only treatment that can almost completely clear severe or hard-to-treat acne and keep it away long term. Approximately 85% of people who use it see permanent clearing.
What acne treatments are safe during pregnancy?
Generally, if you want to treat acne during your pregnancy, it helps to get expert advice from your obstetrician or a dermatologist before using any acne treatment.
If you are already taking acne treatments, doctors will tell you to stop taking isotretinoin, tazarotene, and spironolactone, as these can cause birth defects.
Experts also suggest stopping other meds such as adapalene while you are pregnant. Antibiotics you apply to your skin, like clindamycin, are thought to be safe. Researchers also haven't seen any possible birth defects with oral antibiotics such as cefadroxil. But you should still check with your doctor.
How do you tell if acne is hormonal or bacterial?
Hormonal acne is linked to changes in your hormonal levels (such as during puberty, pregnancy, and menstruation). You'll likely see acne like this on your face or jawline. Bacterial acne is triggered by dirt or bacteria. You'll usually see this kind of acne in oily skin areas like your nose, chin, or forehead.
