The idea behind using antibiotics for acne is that they can help reduce the number of p. acnes on the skin and relieve an acute case of severe acne. After the person stops taking the antibiotics, the hope is that the reduced numbers of p. acnes will prevent the pimples or cysts from getting out of hand again. However, in reality, most people simply end up taking the antibiotics much longer than they should, and the acne almost always comes back. That’s because, according to The Lancet: Infectious Diseases, over 50 percent of p. acnes strains are resistant to antibiotics7. If your doctor tries to prescribe you antibiotics for your acne, we recommend asking about other courses of action.
Before you can find the best acne treatment for you, you have to know what type of skin you have. It’s also good to understand how your skin reacts to different weather conditions and foods that you may eat. Most people don’t realize that the skin is your body’s largest organ. It’s complex and is designed to encase and protect your body and all of your vital organs.
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.
The third phase of the life cycle of acne is inflammation. At this point, your body’s immune system may deal with the problem, but if it doesn’t, different bacteria can move into the pore. Detecting an enemy bacterial invader, your body responds by emitting white blood cells to the infected area. In some cases, the white blood cells have a difficult time fighting the bacteria, and some die, contributing to the oily buildup and creating pus.
A major mechanism of acne-related skin inflammation is mediated by P. acnes's ability to bind and activate a class of immune system receptors known as toll-like receptors (TLRs), especially TLR2 and TLR4. Activation of TLR2 and TLR4 by P. acnes leads to increased secretion of IL-1α, IL-8, and TNF-α. Release of these inflammatory signals attracts various immune cells to the hair follicle including neutrophils, macrophages, and Th1 cells. IL-1α stimulates increased skin cell activity and reproduction, which in turn fuels comedo development. Furthermore, sebaceous gland cells produce more antimicrobial peptides, such as HBD1 and HBD2, in response to binding of TLR2 and TLR4.
“You unfortunately cannot determine the strength of a product strictly by the percentage of its active ingredients because how well a product works depends on how well its inactive ingredients help it penetrate the skin,” explains Dr. Green. “In other words, a 2 percent benzoyl peroxide may be more effective than another brand’s 5 percent benzoyl peroxide because there are other ingredients helping out.”
Once you hit your 30s, there's a good chance you'll still occasionally battle the same breakouts you've had since your teen years at the same time you're trying to stave off the fine lines that come with age. But you don't have to choose between a facial cleanser that only fights dull, aging skin or clears up zits. Plenty of products fight both—you just need to know what to look for.
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.
Dermatologists aren’t sure why azelaic acid is so effective at clearing up inflammation, but it’s often used as an option for sensitive skin or pregnant patients. Linkner says the ingredient is good at treating malasma, acne, and rosacea. Your dermatologist can prescribe a foam product with azelaic acid, and you can also find beauty products with very small amounts of this active ingredient.
For years the French have have opted for super moisturizing cold creams. You simply massage this in and then wipe off with a tissue or a warm washcloth and you're left with super soft skin. It removes makeup without leaving skin feeling "tight." Plus, because you aren't using water to rinse the face, you might be saving your skin from the drying effects of water.
Ask any dermatologist for advice on how you can reduce the chances of breakouts, and they’re most likely going to mention taking probiotics as one of their top tips. This facial cleanser, infused with tea tree oil, willow bark and yogurt, targets irritation-causing bacteria while controlling oil production. It also features a biocomplex of vitamins A, C and E, coenzyme Q10 and antioxidants that diminish wrinkles and other visible signs of aging.
^ Hay, RJ; Johns, NE; Williams, HC; Bolliger, IW; Dellavalle, RP; Margolis, DJ; Marks, R; Naldi, L; Weinstock, MA; Wulf, SK; Michaud, C; Murray, C; Naghavi, M (October 2013). "The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions". The Journal of Investigative Dermatology. 134 (6): 1527–34. doi:10.1038/jid.2013.446. PMID 24166134.
Considerations: Side effects are generally mild and short lived. Most common, in 1-5% of people are itching, burning, stinging, and tingling. Other side effects were reported in less than 1% of people. There have been a few reports from darker skinned people of lightening of the skin. Azelaic acid has not been well studied in people with dark complexions.1
A lot of people have an urge to rub, squeeze or scratch the blemishes on their skin, and who can really blame them? Pimples can hurt, throb and itch, all the while being a sore sight to see. It’s only natural that we seek to remove these blemishes in any way possible, but some methods of removal are more harmful than others. When it comes to rubbing, squeezing and scratching your pimples, it can only make your skin worse.
Chemical peels can be used to reduce the appearance of acne scars. Mild peels include those using glycolic acid, lactic acid, salicylic acid, Jessner's solution, or a lower concentrations (20%) of trichloroacetic acid. These peels only affect the epidermal layer of the skin and can be useful in the treatment of superficial acne scars as well as skin pigmentation changes from inflammatory acne. Higher concentrations of trichloroacetic acid (30–40%) are considered to be medium-strength peels and affect skin as deep as the papillary dermis. Formulations of trichloroacetic acid concentrated to 50% or more are considered to be deep chemical peels. Medium-strength and deep-strength chemical peels are more effective for deeper atrophic scars, but are more likely to cause side effects such as skin pigmentation changes, infection, and small white superficial cysts known as milia.
It's a common misconception that those with oily skin shouldn't moisturize. Be sure you're treating your entire face to a full routine and not solely relying on spot treatments to battle your breakouts. If your acne comes with a side of oil, this is your best bet for a daily moisturizer. It contains panadoxine, a vitamin B6 derivative that improves skin’s overall healthy balance by visually minimizing pore size and shine.
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).
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.
Although there is no one single cure for acne, we based our reviews first on what doctors are saying about these products and their ingredients. Then we did some digging into all the reviews. We ruled out those products that had primarily negative responses. After all that, we consulted natural product experts to see which system they felt were the best acne treatment.
The side effects depend on the type of treatment you use. Generally, for topical, over-the-counter creams, you can watch out for stinging, redness, irritation and peeling — these side effects usually don’t go any deeper than the skin. Others, like oral antibiotics or hormonal medications, could come with new sets of complications, so we suggest talking to your doctor before pursuing the treatment.
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Atrophic acne scars have lost collagen from the healing response and are the most common type of acne scar (account for approximately 75% of all acne scars). They may be further classified as ice-pick scars, boxcar scars, and rolling scars. Ice-pick scars are narrow (less than 2 mm across), deep scars that extend into the dermis. Boxcar scars are round or ovoid indented scars with sharp borders and vary in size from 1.5–4 mm across. Rolling scars are wider than icepick and boxcar scars (4–5 mm across) and have a wave-like pattern of depth in the skin.
Many doctors treat whiteheads, blackheads, or pimples, with either a prescription for an antibiotic or prescription strength benzoyl peroxide or both. These treatments are harsh for mild to moderate problems. If you have an exceptionally deep skin infection causing nodules or cysts, you should be given a referral to a dermatologist. This is also true if you have an aggressive form of acne that causes blemishes to grow together all over your upper body (acne conglobata). You will probably need laser therapy or surgical reconstruction procedures if you have this rare condition.
Warning: Sulfur smells like rotten eggs. But it is an effective ingredient at drying up pus-filled pimples and whiteheads (you’ve gotta take the good with the bad). It works by sucking up the oil. Sulfur is typically mixed with other active ingredients to get the most efficacy and fragrances to mask the strong scent. You can often find it in masks and spot treatments.
Efforts to better understand the mechanisms of sebum production are underway. The aim of this research is to develop medications that target and interfere with the hormones that are known to increase sebum production (e.g., IGF-1 and alpha-melanocyte-stimulating hormone). Additional sebum-lowering medications being researched include topical antiandrogens and peroxisome proliferator-activated receptor modulators. Another avenue of early-stage research has focused on how to best use laser and light therapy to selectively destroy sebum-producing glands in the skin's hair follicles in order to reduce sebum production and improve acne appearance.
The best acne medication differs from person to person based on their skin care needs. For some, a gentle over-the-counter option is the best way to reduce acne, while for others, stronger prescription medication is necessary. Regardless of your acne needs, there is an acne medication available for you. The best way to find the right acne treatment is with patience, and sometimes with the assistance of a dermatologist. This guide will cover the basics of acne medication, from benzoyl peroxide to Accutane.
The Effaclar Medicated Cleanser from La Roche-Posay is made especially for users with oily skin. The 2% salicylic acid concentration slows down sebum production without completely stripping the skin of its natural oil. Therefore, it won’t dry out your face, but it does reduce shine. And the key ingredient, zinc pidolate, soaks up excess oil and removes impurities.
Pustules, as their name suggests, are filled with pus. They usually have a white or yellow center surrounded by extremely inflamed skin that is pink or red. The pus isn’t just bacteria and skin cells—it contains some dead white blood cells that were trying to fight the bacteria, too. Squeezing these can cause the skin around them to darken and scar.