Hormonal activity, such as occurs during menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in sex hormones called androgens causes the skin follicle glands to grow larger and make more oily sebum. Several hormones have been linked to acne, including the androgens testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA); high levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) have also been associated with worsened acne. Both androgens and IGF-1 seem to be essential for acne to occur, as acne does not develop in individuals with complete androgen insensitivity syndrome (CAIS) or Laron syndrome (insensitivity to GH, resulting in very low IGF-1 levels).
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.
With the right formula, acne is simple to treat. The key is being gentle with your skin because inflammation will cause more acne – always. That’s why the best acne treatment systems in 2019 include as many natural ingredients as possible to offset the drying effect of the (necessary) scientific, stronger components, combining the best science and nature has to offer.
PanOxyl Acne Foaming Wash: This product is marketed for facial acne, but we recommend using on pesky body acne instead. PanOxyl uses benzoyl peroxide, a highly effective acne-fighting ingredient that we’ll describe more just below, but at a concentration that is much too high to be used on your face. Most PanOxyl products contain 10% benzoyl peroxide, which will likely cause peeling and burning on your face, but could be the perfect solution for back or butt acne.
Unfortunately, the vast majority of acne products are formulated incorrectly and/or made with cheap ingredients. Even dermatologists get it wrong and you shouldn’t assume that a treatment system is good for you just because dermatologists or celebrities say so online. They are most likely paid for their testimonial. Instead, make an effort to find out what the actual users of the products are saying. Amazon is a great place to start.
In most cases, acne products need to be used for at least 30 days before you can begin to ascertain its efficacy. Some skin and acne types may see noticeable results in a few days and end up totally clear in just a few weeks. Others may take several weeks to see the slightest change, or need to have their regimen adjusted as their skin adapts. Treating acne can often be a months-long process.
If even a trace of sodium lauryl sulfate is left on the skin for more than an hour, however, the upper layer of living skin cells is irritated and dies. Tiny flakes of skin make the texture of the skin look uneven, and they can clog pores. The scent of sodium lauryl sulfate also causes your nose and tongue to be less sensitive to sweet tastes and their associated odors, so you will crave sugar.
This is a low foaming formula that doesn’t produce much lather or foam which, for some, may be quite drying. It’s non-comedogenic and moisturizing, without being oily, leaving skin feeling soft and smooth. As the name suggests, it’s the best normal and oily skin types, and for some with combination skin. Due to its low-foaming nature, it doesn’t strip skin of natural oils, promoting skin health and healthy cell growth and protection. However, it may not be good for people with sensitive skin types.
Simple alcohols like isopropyl alcohol, SD alcohol, and denatured alcohol are everywhere in acne treatment because they trick you into thinking they’re working: Splash some on and any oil on your face instantly vaporizes. However, these ingredients destroy the skin’s barrier, called the acid mantle. When your acid mantle is damaged, you’re actually more susceptible to breakouts, enlarged pores, and inflammation. To make matters worse, evaporating all the oil on your face can actually set your sebaceous glands into overdrive, leaving your skin oilier than ever. If any product included a simple alcohol high up in its ingredients list, we nixed its whole kit.
This AHA 10% Skin Perfecting Cleanser is an incredible combination of Glycolic Acid and natural ingredients like rosehip oil, chamomile, seaweed extract, grapefruit seed oil and more. It doesn’t just tackle blackheads, whiteheads, and blemishes, but also smoothes out fine lines and wrinkles. If you want a high-quality product, with real and lasting results, Misumi has got you covered.
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How to Handle It: Your best bet is benzoyl peroxide. "Benzoyl peroxide can kill acne-causing bacteria and reduce inflammation," says Zeichner. Try a cream like the La Roche-Posay Effaclar Duo Dual-Action Acne Treatment ($37), which also exfoliates with lipo-hydroxy acid. Be aware that it can seriously dry out skin so moisturize well after you use it.
Perhaps one of the most popular cleansers for combination skin care on the market today, Boscia's purifying cleansing gel works best for oily to normal skin types. It works by gently cleansing skin without stripping it and adding harsh elements to the skin. It can be a tad drying, so it works best on women with more oily spots than dry spots. You can also use it to cleanse your oily T-zone, but keep it away from your dry spots, where you may want to moisturize more.
P. acnes also provokes skin inflammation by altering the fatty composition of oily sebum. Oxidation of the lipid squalene by P. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels. Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4). LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein. PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells. The inflammatory properties of P. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase. These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.
“Acne cleansers with these ingredients will gradually unclog pores, reduce the size of existing blackheads and slow or stop the formation of new ones,” she says. “Benzoyl peroxide is also the best ingredient for treating the acne-causing bacteria called p. acnes. In fact, study after study continues to show that benzoyl peroxide is more effective than prescription topical antibiotics at treating p. acnes.”
Just as there are no bells and whistles with Purpose above, there are none with this baby-mild product that renowned dermatologists swear by. So why is this $10 cleanser such a must-have? It's creamy, simple and isn't loaded with chemicals or perfumes that can irritate the skin. Cetaphil products are revered in the industry and their cleanser is one of the best drugstore buys out there. Period.
When whiteheads and blackheads become infected with bacteria, called Propionibacterium acnes, it leads to inflammatory acne. Regular bacteria is found in most whiteheads and blackheads, but P. acnes is attracted to the closed, oily environment. This bacteria makes acne more difficult to treat. The four different pimple types that characterize inflammatory acne are papules, pustules, nodules and cysts.
Your pimples need TLC, too. The study on acne vulgaris found that, in an attempt to dry out acne lesions, patients often use too many products or apply excessive amounts to problem areas, resulting in further irritation and over drying of the skin. Vigorous scrubbing and using harsh exfoliants can make acne worse by rupturing whiteheads and blackheads, turning them into painful red ones. And remember: no matter how satisfying it is, picking and popping your zits will also increase inflammation and opportunity for infection.
According to Dr. Bailey, it’s not enough to have a facial cleanser designed for acne-prone skin. Half the battle is properly washing your face. Here’s what she recommends: “First, wet your face with warm water, then lather your cleanser over all of your facial skin. Depending on your skin type, you can use your fingers, an exfoliating cloth or a sonic skin-cleansing brush system. Rinse well with warm water to remove the lather entirely. Some of the important acne cleanser ingredients will stay behind, but the cleanser’s foaming agents, as well as built-up oil, dead cells, products and bacteria, will be rinsed off of your skin.”
You will see the results from the top performers in the comparison chart. Although any of these treatment systems can safely and effectively help reduce blemishes, Exposed Skin Care stands above the rest as the best acne treatment system. All the products are safe and regulated by the FDA, but Exposed Skin Care also works for a variety of skin types, including sensitive skin. The thing we like most about Exposed Skin Care is the 6-month money back guarantee. Many blemish products expect you to use them for six to eight weeks before you see results and then only provide you with a 1-month guarantee. If you purchase individual products in the store, you are stuck with them, since many do not come with any guarantees. Exposed Skin Care allows you to give their product a fair trial before you decide if it is working for your skin.