What it is: You may have heard of tretinoin in reference to "Retin-A" wrinkle treatments. Tretinoin is retinoic acid and vitamin A acid combined, and comes in various strengths in creams, gels, and liquids for topical use on the skin. It is used to treat acne and also to treat sun damaged skin or wrinkles and is usually applied once per day.1Learn more from the U.S. National Library of Medicine.
If a pore is open, it’s called a blackhead or “open comedo”. Because of the opening, contact with the air oxidizes the dead skin cells inside the pore. The air contact turns the melanin inside them darker in color, similar to the way a peeled banana left exposed to the air will darken. This is how the blackhead forms. The color of a blackhead is not because of dirt. It’s a mixture of air and the skin pigment called melanin.
All acne is not, actually, created equal. This makes perfect sense, seeing as there are so many factors — i.e. hygiene, hormones, and genetics — that can both lead to and exacerbate your breakouts. But knowledge is power, and just knowing that there are different types, and that each kind requires its own plan of attack, puts you ahead of the clear-skin curve. Once you figure out what you're working with, it gets far easier to treat. Here, your ultimate guide to identifying, and then taking down, every type of acne out there, according to dermatologists. Find out how to identify and deal with the different kinds of acne, including blackheads, whiteheads, blind pimples, and cystic zits.
Feverfew – Commonly known as wild chamomile, feverfew is a plant that has been used for generations. It was once called “parthenium” by the ancient Greeks and is used to treat various ailments and disease. When it comes to your skin, feverfew is anti-inflammatory7, reducing and preventing redness and swelling. It’s also high in anti-oxidants and can be consumed orally in the form of tea for added benefits, like healing your skin from the inside out.
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.
Aside from adding bacteria to your skin, these forms of contact can irritate the skin, adding to the appearance of redness and causing increased inflammation. In the event that your pimples get ruptured during this process, the oil and bacteria that was trapped inside could spread to the surrounding skin on your face, which causes acne to spread. So, not only will rubbing, squeezing and scratching leave your acne-ridden skin further irritated, it will increase the amount of acne you will have to deal with.
Some acne cleansers and face soaps have added ingredients to fight acne and improve the skin's appearance. Medicated cleansers contain acne-fighting ingredients like salicylic acid, sodium sulfacetamide, or benzoyl peroxide, which can help clear up skin while cleaning it. Salicylic acid helps clear blocked pores and reduces swelling and redness. Benzoyl peroxide exfoliates the skin and kills bacteria. Sodium sulfacetamide interferes with the growth of bacteria.
The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle.[1] In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle.[10] However, increased production of oily sebum in those with acne causes the dead skin cells to stick together.[10] The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone.[10] This is further exacerbated by the biofilm created by P. acnes within the hair follicle.[44] If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo).[1][10][19] In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).[1][10]
Genetics play a big part in who gets acne and how severely, but each blemish can be blamed on some combination of sebum production, a bacteria called Propionibacterium acnes (P. acnes), plugged follicles, and inflammation. Finding a good treatment is really about finding the right combination of ingredients to troubleshoot each of those issues. Some factors that might worsen acne include hormones, certain medications, diet and stress.

Azelaic acid is a natural acid that is derived from various grains like wheat and barley. It helps reduce acne by preventing skin cell buildup, killing p. acnes bacteria, and reducing inflammation4. This means it can help reduce all kinds of acne, from blackheads to pimples. Blackheads and whiteheads form when dead skin cells combine with sebum, the oil our skin naturally produces and get clogged in a pore. To get rid of this kind of acne, it helps to regulate your skin cell production and exfoliate your skin to remove excess dead skin cells. Azelaic acid is a great way to do both of these things, while also decreasing inflammation and killing bacteria. When the skin is inflamed, it swells slightly, causing the pores to constrict. This traps dead skin cells and sebum inside, leading to blackheads and whiteheads, and if bacteria get trapped as well, then pimples can also form.
Although combined oral contraceptives are a more popular treatment with women, men can use them as well, as they may also experience hormonal fluctuations. The only downside is that birth control pills tend to produce feminizing features in the person taking them, such as reduced hair growth or enlarged breast tissue. To get a prescription for a combined oral contraceptive, you can talk to your family doctor, a dermatologist, or an OB/GYN, or visit your local Planned Parenthood.

Spot treatments are designed to give problem pimples a mega-dose of concentrated benzoyl peroxide — in a couple of regimens, like the Proactiv Teen Kit, the spot treatment had nearly three times the benzoyl peroxide as its all-over treatment. The logic: If benzoyl peroxide can be irritating to the skin in high concentrations, limiting its intensity to just the pimple itself could save the rest of your healthy skin.
In women, acne can be improved with the use of any combined birth control pill.[89] These medications contain an estrogen and a progestin.[90] They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduced acne severity.[10][91] Although oral estrogens can decrease IGF-1 levels in some situations and this might be expected to additionally contribute to improvement in acne symptoms,[92][93] combined birth control pills appear to have no effect on IGF-1 levels in fertile women.[90][94] However, cyproterone acetate-containing birth control pills have been reported to decrease total and free IGF-1 levels.[95] Combinations containing third- or fourth-generation progestins including desogestrel, dienogest, drospirenone, or norgestimate, as well as birth control pills containing cyproterone acetate or chlormadinone acetate, are preferred for women with acne due to their stronger antiandrogenic effects.[96][97][98] Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills.[91] A 2014 review found that antibiotics by mouth appear to be somewhat more effective than birth control pills at decreasing the number of inflammatory acne lesions at three months.[99] However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions.[99] The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance.[99]

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