First, let’s talk about what causes acne. Pimples form when the oil and dead skin cells on your skin combine to form a plug that blocks the pores. “As the P. acnes bacteria that naturally live on skin overgrow within this plugged follicle, the area becomes inflamed and this is when you start to see papules, pustules, and cystic lesions,” RealSelf dermatologist Sejal Shah, M.D., tells SELF. The treatments ahead work to exfoliate away dead skin cells, suck up excess oil, stop inflammation, and kill the P. acnes bacteria. There are even a few treatments that target hormonal acne specifically.
But the side effects of targeted breakout cream treatments aren’t always worth it. “So many products instruct consumers to use benzoyl peroxide spot treat red bumps and pustules. I don’t recommend it,” says Dr. Lawrence Green, board-certified dermatologist and assistant clinical professor of dermatology at George Washington University. Such high concentrations of benzoyl peroxide cause added irritation and inflammation to already sensitive skin, so with this in mind, we cut kits that included spot treatments.
Keep in mind that even if some products market themselves toward severe acne breakouts, all the kits we looked at are definitely designed for mild to moderate acne. Not sure if you fit on that scale? You’re not alone! When you’re in the middle of a breakout, all acne seems severe, so it can be difficult to self-diagnose your symptoms. We talked to dermatologists and cosmetic chemists to better understand the differences between the various types of acne (see below).
The best acne treatment system will include a cleanser, exfoliant and a treatment product that can be used daily. The idea is to have a product that cleans and clears clogged pores, kills bacteria, exfoliates to remove dead cells and spot treats trouble spots to combat stubborn blemishes and reduces inflammation and redness. For those with oily skin, a toner may be useful. For those with black heads, deep cleansing pore strips will help. If you have dry skin, foaming face wash would be something you want to avoid. The point is, a carefully tailored system is the best approach to an effective acne treatment.
It is widely suspected that the anaerobic bacterial species Propionibacterium acnes (P. acnes) contributes to the development of acne, but its exact role is not well understood. There are specific sub-strains of P. acnes associated with normal skin, and moderate or severe inflammatory acne. It is unclear whether these undesirable strains evolve on-site or are acquired, or possibly both depending on the person. These strains have the capability of changing, perpetuating, or adapting to the abnormal cycle of inflammation, oil production, and inadequate sloughing of dead skin cells from acne pores. Infection with the parasitic mite Demodex is associated with the development of acne. It is unclear whether eradication of the mite improves acne.
Topical and oral preparations of nicotinamide (the amide form of vitamin B3) have been suggested as alternative medical treatments. It is thought to improve acne due to its anti-inflammatory properties, its ability to suppress sebum production, and by promoting wound healing. Topical and oral preparations of zinc have similarly been proposed as effective treatments for acne; evidence to support their use for this purpose is limited. The purported efficacy of zinc is attributed to its capacity to reduce inflammation and sebum production, and inhibit P. acnes. Antihistamines may improve symptoms among those already taking isotretinoin due to their anti-inflammatory properties and their ability to suppress sebum production.
Exposed Skin Care: Exposed Skin Care products include benzoyl peroxide, salicylic acid, and azelaic acid (see below for more details), all at low concentrations that are safe for all skin types. Plus they also incorporate powerful natural ingredients, like tea tree oil, vitamin E, and green tea extract. Before jumping straight to the strongest (and harshest) prescription treatment available, we highly recommend giving this gentle but effective brand a try for a few weeks. If it doesn’t work, you can always send your empty product bottles back to the company and they will reimburse you in full.
Although there is not enough research to determine if certain foods cause breakouts, there are certain changes you can make to your diet to help prevent them. For breakfast, switching to plain oatmeal that has only been sweetened with fresh fruit can help prevent excessive androgen production. When you eat fish, opt for salmon, which is high in omega-3s. One omega-3 called DHA is an anti-inflammatory. Snacking on sunflower seeds can give you more vitamin E in your diet. Vitamin E helps the immune system fight off bacteria before inflammation and cysts occur. Finally, make sure you stay hydrated by drinking plenty of water each day. Your body needs almost half a gallon each day.
Whether it’s just or not, you are judged by your appearance: the clothes you wear, your hairstyle, your body language. And if you have acne, life can be more difficult for you. You may feel uncomfortable in social settings. You may lose your confidence. It could destroy intimacy with someone you care about. If your poor self-esteem affects your job performance, then having acne could even have a negative impact on your income and career advancement. There’s no such thing as ‘growing out of acne’. It’s an issue that needs to be taken seriously. The only way to fight acne is by treating it. And to fight acne head-on, you need to find the best acne treatment for you.
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Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties. It opens obstructed skin pores and promotes shedding of epithelial skin cells. Salicylic acid is known to be less effective than retinoid therapy. Dry skin is the most commonly seen side effect with topical application, though darkening of the skin has been observed in individuals with darker skin types.
What it does: Benzoyl peroxide is the only known substance which can bring oxygen under the skin surface. Since bacteria cannot survive in the presence of oxygen, when used in an adequate dosage, benzoyl peroxide eradicates 99.9% of these bacteria almost immediately. It also exerts a mild drying and peeling effect, which is thought to help prevent breakouts.1-6 Benzoyl peroxide also helps lessen inflammation.7-9 2.5% benzoyl peroxide is just as effective as higher concentrations with less side effects.6,10
What it is: Originally under the brand name "Accutane" but now available only in generic form, isotretinoin is a derivative of vitamin A taken in pill form for 15-20 weeks. Doctors normally prescribe it for people with "severe nodular acne" that does not respond to other treatments. Nodules are inflammatory lesions with a diameter of 5mm or more. A single course of 15-20 weeks has been shown to result in complete clearing and long-term remission of acne in many people.1-2 Learn more on the Accutane page of acne.org.
Resorcinol – Almost always found coupled with sulfur, this ingredient breaks down hardened, rough or scaly skin, while disinfecting and fighting infections5. This ingredient is often used topically to treat pain and itching stemming from small injuries like scrapes and cuts, burns, bug bites, sunburn, poison ivy and more. It’s also used to treat skin conditions like eczema, seborrhea, psoriasis, warts, corns and other disorders. It is generally found in strengths of up to 2%.
Aside from the obvious fact that a good face wash can help heal acne and pimple-prone skin, your choice of facial cleanser really matters when you’re trying to get rid of acne. For starters, the wrong face washes can cause acne, or at least, make yours a lot worse. Throughout the day, your skin does come into contact with a lot of dirt and grime, and it also secretes sebum – an oily, waxy, fatty substance that keeps your skin waterproof and lubricated. Oily skin is the result of an excessive amount of sebum secretion, and most soaps are designed to remove that oil from your skin. However, your skin actually needs some of that sebum to function normally. Without it, you end up with dry skin that tightens to create clogged pores and, ultimately, acne.
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Any acne treatment is a weeks-long experiment that you’re conducting with your skin. Acne is slow to heal, and in some cases, it can get worse before it gets better (nearly every benzoyl peroxide product we looked at emphasized the likeliness of irritating acne further, and starting off with a lighter application). April W. Armstrong, a doctor at the University of California Davis Health System, recommends waiting at least one month before you deem a product ineffective.
Some people use natural treatments like tea tree oil (works like benzoyl peroxide, but slower) or alpha hydroxy acids (remove dead skin and unclog pores) for their acne care. Not much is known about how well many of these treatments work and their long-term safety. Many natural ingredients are added to acne lotions and creams. Talk to your doctor to see if they’re right for you.
Combination therapy—using medications of different classes together, each with a different mechanism of action—has been demonstrated to be a more efficacious approach to acne treatment than monotherapy. The use of topical benzoyl peroxide and antibiotics together has been shown to be more effective than antibiotics alone. Similarly, using a topical retinoid with an antibiotic clears acne lesions faster than the use of antibiotics alone. Frequently used combinations include the following: antibiotic and benzoyl peroxide, antibiotic and topical retinoid, or topical retinoid and benzoyl peroxide. The pairing of benzoyl peroxide with a retinoid is preferred over the combination of a topical antibiotic with a retinoid since both regimens are effective but benzoyl peroxide does not lead to antibiotic resistance.
Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.