Azelaic acid has been shown to be effective for mild to moderate acne when applied topically at a 20% concentration.[66][129] Treatment twice daily for six months is necessary, and is as effective as topical benzoyl peroxide 5%, isotretinoin 0.05%, and erythromycin 2%.[130] Azelaic acid is thought to be an effective acne treatment due to its ability to reduce skin cell accumulation in the follicle, and its antibacterial and anti-inflammatory properties.[66] It has a slight skin-lightening effect due to its ability to inhibit melanin synthesis, and is therefore useful in treating of individuals with acne who are also affected by postinflammatory hyperpigmentation.[1] Azelaic acid may cause skin irritation but is otherwise very safe.[131] It is less effective and more expensive than retinoids.[1]
Spironolactone has relatively minor side effects, like low appetite, weakness, or cramping, but there’s one major exception: spironolactone comes with a black box warning about its cancer-causing effects. The FDA is required to include this label based on a study conducted in the 1950s that found carcinogenic properties in the spironolactone given to rats in an experiment. However, the dose of spironolactone used in this study was nearly 500 times higher than the dose currently prescribed, and no studies since have found anything carcinogenic about spironolactone. Because of this, most dermatologists feel comfortable prescribing spironolactone for acne. Still, it’s something to be aware of before you take it. Additionally, those with low blood pressure or kidney conditions are likely not good candidates for spironolactone and may want to explore other acne treatment options.
Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation that develop deep inside hair follicles produce cystlike lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren't usually involved in acne.
Medical conditions that commonly cause a high-androgen state, such as polycystic ovary syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors, can cause acne in affected individuals.[44][45] Conversely, people who lack androgenic hormones or are insensitive to the effects of androgens rarely have acne.[44] An increase in androgen and oily sebum synthesis may be seen during pregnancy.[45][46] Acne can be a side effect of testosterone replacement therapy or of anabolic steroid use.[1][47] Over-the-counter bodybuilding and dietary supplements are commonly found to contain illegally added anabolic steroids.[1][48]
Benzoyl Peroxide – A strong compound that kills the bacteria that causes acne1. It also gets rid of excess oil and the build-up of dead skin cells which clog your pores. This ingredient is exceptionally strong, and it can cause some side effects like redness, dry skin, burning or stinging and scaling. You’ll only find it in products at 2.5% to 10% strength. However, dermatologists recommend that adults stick to a low-dose of benzoyl peroxide, at around 3% for minimal irritation and to avoid bleaching your skin, hair or clothing.
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Acne vulgaris and its resultant scars have been associated with significant social and academic difficulties that can last into adulthood, including difficulties obtaining employment.[30][177] Until the 1930s, it was largely seen as a trivial problem among middle-class girls – a trivial problem, because, unlike smallpox and tuberculosis, no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it.[165] During the Great Depression, dermatologists discovered that young men with acne had difficulty obtaining jobs, and during World War II, some soldiers in tropical climates developed such severe and widespread tropical acne on their bodies that they were declared medically unfit for duty.[165]
Risk factors for the development of acne, other than genetics, have not been conclusively identified. Possible secondary contributors include hormones, infections, diet and stress. Studies investigating the impact of smoking on the incidence and severity of acne have been inconclusive.[2][37][38] Sunlight and cleanliness are not associated with acne.[14]
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).[10] Additional sebum-lowering medications being researched include topical antiandrogens and peroxisome proliferator-activated receptor modulators.[10] 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.[10]
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We suggest avoiding spot treatments. “Benzoyl peroxide, when placed on red spots, can actually cause more irritation and inflammation to the area. It’s best used to prevent red bumps and pustules, and applied all over the area you want to treat,” said Townsend, who was also quick to naysay a spot-treat-only approach: “Acne affects all of the pores. If someone is going to spot treat against my advice, I still suggest they spot treat one day and treat the whole face the next.”

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.

First, it’s a cleansing oil, not the typical gel wash or liquid. Next, it has a potent blend of salicylic, glycolic, and lactic acid for superior exfoliation. Third, it contains natural ingredients that repair damage to the skin and get rid of acne. For example, soapwort extract dissolves oil without the need for drying sulfates. Then, vitamin B and lavender combine to reduce oil secretion and inflammation. Finally, watercress is full of antioxidant vitamins that heal damage caused by the sun.
This dermatologist-tested formula is a foaming face wash that works incredibly fast. It can make skin visibly clearer in as little as 12 hours. It’s made with 2% salicylic acid, Acceladerm Technology™, and PHAs, polyhydroxy acids that open pores, improve skin moisturization and calms the skin. It unblocks pores, kills bacteria and calms and soothes the skin. This Clearasil product is guaranteed to be so good that if it doesn’t work for you, they have a 30-day money-back guarantee that you can take them up on.
Complementary therapies have been investigated for treating people with acne.[150] Low-quality evidence suggests topical application of tea tree oil or bee venom may reduce the total number of skin lesions in those with acne.[150] Tea tree oil is thought to be approximately as effective as benzoyl peroxide or salicylic acid, but has been associated with allergic contact dermatitis.[1] Proposed mechanisms for tea tree oil's anti-acne effects include antibacterial action against P. acnes, and anti-inflammatory properties.[65] Numerous other plant-derived therapies have been observed to have positive effects against acne (e.g., basil oil and oligosaccharides from seaweed); however, few studies have been performed, and most have been of lower methodological quality.[151] There is a lack of high-quality evidence for the use of acupuncture, herbal medicine, or cupping therapy for acne.[150]

Considerations: Despite the frequent referencing of an initial flare of acne when starting is tretinoin, there is no scientific evidence to back this up. You should not expect an initial worsening of acne.3-4 Exposure to sunlight should be minimized as you may be more sensitive to its rays. Ask your doctor before using other medication on the skin, especially anything containing sulfur, resorcinol, or salicylic acid, as the combination may be too irritating. Abrasive soaps and cleansers should be used with caution for the same reason. Side effects can include skin irritation, swelling, lightening or darkening of the skin, an increase in acne sores, excessive redness, and crusted or blistered skin.
According to Dr. Bailey, the best facial cleansers for acne should have at least one of these key ingredients: salicylic acid, glycolic acid or benzoyl peroxide. Cleansers with these ingredients can penetrate your pores and eliminate pore-clogging impurities—like dead skin cells, makeup, excess oil and bacteria—that irritate skin and make acne worse.

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Personalized service:We may provide you with customized services in store based on your earlier purchases with us, and information regarding your clothing/shopping preferences that you have voluntarily shared with our staff. We aim to provide this service in all countries where we have our own stores, including but not limited to Sweden, Norway, Denmark, Germany, France, Italy, the United Kingdom, Australia, the United States, Japan and South Korea.
Hypertrophic scars are uncommon, and are characterized by increased collagen content after the abnormal healing response.[31] They are described as firm and raised from the skin.[31][33] Hypertrophic scars remain within the original margins of the wound, whereas keloid scars can form scar tissue outside of these borders.[31] Keloid scars from acne occur more often in men and people with darker skin, and usually occur on the trunk of the body.[31]

Genetics is thought to be the primary cause of acne in 80% of cases.[2] The role of diet and cigarette smoking is unclear, and neither cleanliness nor exposure to sunlight appear to play a part.[2][13][14] In both sexes, hormones called androgens appear to be part of the underlying mechanism, by causing increased production of sebum.[5] Another frequent factor is excessive growth of the bacterium Propionibacterium acnes, which is normally present on the skin.[5]
Tea Tree Oil – Another anti-bacterial ingredient that is common in over-the-counter treatments, tea tree oil combats acne-causing bacteria. While the FDA hasn’t officially approved it for acne treatment, some dermatologists say it’s almost as effective as benzoyl peroxide for clearing skin, although it doesn’t work quite as fast. It can be used for spot treatment as well.

Acne removal: Your dermatologist may perform a procedure called “drainage and extraction” to remove a large acne cyst. This procedure helps when the cyst does not respond to medicine. It also helps ease the pain and the chance that the cyst will leave a scar. If you absolutely have to get rid of a cyst quickly, your dermatologist may inject the cyst with medicine.

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