Hair follicles are the tiny structures that grow hair in the scalp. Sebaceous glands produce sebum. On areas where acne develops, sebaceous glands surround the hair follicles. The combination of the sebaceous glands and the hair follicles is the "pilosebaceous unit," where acne pimples and cysts develop. Sebum moisturizes hair and skin. Each hair pushes up through the skin surface along with sebum.
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.

^ Jump up to: a b c Zaenglein, AL; Graber, EM; Thiboutot, DM (2012). "Chapter 80 Acne Vulgaris and Acneiform Eruptions". In Goldsmith, Lowell A.; Katz, Stephen I.; Gilchrest, Barbara A.; Paller, Amy S.; Lefell, David J.; Wolff, Klaus (eds.). Fitzpatrick's Dermatology in General Medicine (8th ed.). New York: McGraw-Hill. pp. 897–917. ISBN 978-0-07-171755-7.
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.

Dear acne, you suck. Seriously, we thought the breakouts would be over soon after AP Calculus. But it’s actually something that affects women and men in their 20s and 30s, and even well past their 50s. It’s just not fair (throws childlike temper tantrum). And if you thought blackheads and whiteheads were annoying, the deep painful pimples that often pop up in adult acne are much more aggravating—and harder to get rid of. So, we talked to dermatologists to find out which acne treatments are the most effective on all types of pimples.


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.


The Daily Skin Clearing Treatment is an all-over 2.5 percent benzoyl peroxide cream that also touts calming bisabolol and allantoin to alleviate the dryness and irritation that can crop up mid-treatment. Anyone frustrated with oil-slick skin will also love this part of the regimen — it creates a satin mattifying effect, instantly transforming shininess into a glow.
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]
The costs and social impact of acne are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over US$2.5 billion each year in direct costs.[13] Similarly, acne vulgaris is responsible for 3.5 million doctor visits each year in the United Kingdom.[19] Sales for the top ten leading acne treatment brands in the US in 2015, have been reported as amounting to $352 million.[175]
If your acne is severe, painful, or refusing to get lost, you may just be beyond what an over-the-counter treatment can do. Not only can a professional set you up with the really powerful stuff, but also Fitz Patrick explains that “working closely with an aesthetician or dermatologist means you can keep tweaking a routine to make it work best for you.”

Light therapy is a treatment method that involves delivering certain specific wavelengths of light to an area of skin affected by acne. Both regular and laser light have been used. When regular light is used immediately following the application of a sensitizing substance to the skin such as aminolevulinic acid or methyl aminolevulinate, the treatment is referred to as photodynamic therapy (PDT).[10][129] PDT has the most supporting evidence of all light therapies.[78] Many different types of nonablative lasers (i.e., lasers that do not vaporize the top layer of the skin but rather induce a physiologic response in the skin from the light) have been used to treat acne, including those that use infrared wavelengths of light. Ablative lasers (such as CO2 and fractional types) have also been used to treat active acne and its scars. When ablative lasers are used, the treatment is often referred to as laser resurfacing because, as mentioned previously, the entire upper layers of the skin are vaporized.[140] Ablative lasers are associated with higher rates of adverse effects compared with nonablative lasers, with examples being postinflammatory hyperpigmentation, persistent facial redness, and persistent pain.[8][141][142] Physiologically, certain wavelengths of light, used with or without accompanying topical chemicals, are thought to kill bacteria and decrease the size and activity of the glands that produce sebum.[129] As of 2012, evidence for various light therapies was insufficient to recommend them for routine use.[8] Disadvantages of light therapy can include its cost, the need for multiple visits, time required to complete the procedure(s), and pain associated with some of the treatment modalities.[10] Various light therapies appear to provide a short-term benefit, but data for long-term outcomes, and for outcomes in those with severe acne, are sparse;[76][143] it may have a role for individuals whose acne has been resistant to topical medications.[10] A 2016 meta-analysis was unable to conclude whether light therapies were more beneficial than placebo or no treatment, nor how long potential benefits lasted.[144] Typical side effects include skin peeling, temporary reddening of the skin, swelling, and postinflammatory hyperpigmentation.[10]
Considerations: Ask your doctor before using any other products on your skin while using erythromycin, as it may be too irritating. This includes other prescriptions, over-the-counter medicines (including those listed on this site), and harsh or abrasive cleansers, perfumes, or make-up.2 People report burning as the most frequent side effect, and also peeling, dryness, itching, redness, and oiliness, among others.2
Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity.[137] In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus.[137] Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B).[137] Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel.[46][137] Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm.[137] Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester.[137] Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy.[138] In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters.[137] Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X).[137] Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects.[1] Finasteride is not recommended as it is highly teratogenic.[1]
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.”
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.
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.
Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity.[137] In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus.[137] Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B).[137] Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel.[46][137] Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm.[137] Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester.[137] Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy.[138] In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters.[137] Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X).[137] Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects.[1] Finasteride is not recommended as it is highly teratogenic.[1]
Retinoids: Retinoids are substances that are derived from vitamin A, which includes retinol, but also includes synthetic versions of retinol with activated retinoic acid which tends to be more effective in treating acne. Retinoic acid has been shown to reduce sebum production8 and regulate skin cell production9, which together can greatly reduce acne. These synthetic retinoids include adapalene, tretinoin, isotretinoin, and others. Although these synthetic options are more reliably effective, they also tend to have more side effects, like burning, itching, and dryness. Unlike retinol, which is available over-the-counter, nearly all synthetic retinoids are prescription-only. One of the main exceptions is Differin, which is a brand that sells a topical gel containing adapalene, a mild synthetic retinoid, over-the-counter.
Accutane (isotretinoin) has a mixed reputation, but among dermatologists it’s the finisher for patients with severe acne. “If you have an acne patient that doesn’t respond to anything, [Accutane] can really be a game changer,” board-certified dermatologist Adam Friedman tells SELF. Accutane is an oral retinoid, and it has all the same benefits of a topical retinol but is even more effective.
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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.
“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.”

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
Neutrogena is one of the best drugstore beauty brands, hands-down, and you can't go wrong with this simple acne wash for acne-stricken skin. It's an Allure Magazine Reader Choice Awards winner, as well. Readers love it because the salicylic acid gel is gentle and soothing — spiked with aloe and chamomile. It also dries out breakouts without drying out sensitive, irritable skin, according to Allure.

Many different treatments exist for acne. These include alpha hydroxy acid, anti-androgen medications, antibiotics, antiseborrheic medications, azelaic acid, benzoyl peroxide, hormonal treatments, keratolytic soaps, nicotinamide, retinoids, and salicylic acid.[75] They are believed to work in at least four different ways, including the following: reducing inflammation, hormonal manipulation, killing P. acnes, and normalizing skin cell shedding and sebum production in the pore to prevent blockage.[76] Common treatments include topical therapies such as antibiotics, benzoyl peroxide, and retinoids, and systemic therapies including antibiotics, hormonal agents, and oral retinoids.[19][77]
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]
Topical and oral preparations of nicotinamide (the amide form of vitamin B3) have been suggested as alternative medical treatments.[134] It is thought to improve acne due to its anti-inflammatory properties, its ability to suppress sebum production, and by promoting wound healing.[134] 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.[135] The purported efficacy of zinc is attributed to its capacity to reduce inflammation and sebum production, and inhibit P. acnes.[135] Antihistamines may improve symptoms among those already taking isotretinoin due to their anti-inflammatory properties and their ability to suppress sebum production.[136]
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.
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.
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