This inflammatory cascade typically leads to the formation of inflammatory acne lesions, including papules, infected pustules, or nodules.[1] If the inflammatory reaction is severe, the follicle can break into the deeper layers of the dermis and subcutaneous tissue and cause the formation of deep nodules.[1][66][67] Involvement of AP-1 in the aforementioned inflammatory cascade leads to activation of matrix metalloproteinases, which contribute to local tissue destruction and scar formation.[44]

Dermabrasion is an effective therapeutic procedure for reducing the appearance of superficial atrophic scars of the boxcar and rolling varieties.[31] Ice-pick scars do not respond well to treatment with dermabrasion due to their depth.[31] The procedure is painful and has many potential side effects such as skin sensitivity to sunlight, redness, and decreased pigmentation of the skin.[31] Dermabrasion has fallen out of favor with the introduction of laser resurfacing.[31] Unlike dermabrasion, there is no evidence that microdermabrasion is an effective treatment for acne.[8]
Acne scars are caused by inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris.[30] The scar is created by abnormal healing following this dermal inflammation.[31] Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris.[30] Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or loss at the site of the acne lesion.[32]
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.
Acne doesn’t discriminate based on age, race or gender. Between 40-50 million Americans have acne and know the daily struggle of living with this painful skin condition. 20% of them are adults. The other 80% are young people between the ages of 12 and 24, and one-quarter of these young people will suffer permanent scars on their skin from it. That means that 10 million young people will have permanent acne scarring.
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.
But the side effects of targeted breakout cream treatments aren’t always worth it. “So many products instruct consumers to use benzoyl peroxide spot treat red bumps and pustules. I don’t recommend it,” says Dr. Lawrence Green, board-certified dermatologist and assistant clinical professor of dermatology at George Washington University. Such high concentrations of benzoyl peroxide cause added irritation and inflammation to already sensitive skin, so with this in mind, we cut kits that included spot treatments.
Considerations: Benzoyl peroxide is able to produce complete clearing of acne only when used in an adequate dosage and within a properly applied benzoyl peroxide regimen. Some dryness, redness, and itchiness is to be expected in the first few weeks of use.6 Scientists call this initial period the "hardening effect" of benzoyl peroxide. About 1-3% of people are allergic to benzoyl peroxide and experience an inflammation of the skin or severe crusting.3This should not be confused with the "hardening effect" of benzoyl peroxide. Benzoyl peroxide, like any other peroxide, can bleach hair and fabric.1
Those with dry skin can experience flaking and skin that feels tight. Dehydration is one cause of dry skin, so be sure to drink plenty of fluids. Also stay away from alcohol and caffeine, which can draw fluid from your body. Exfoliating daily with a product that is non-abrasive will help with skin cell turnover without erasing your skin’s natural oils. Look for moisturizers that contain hyaluronic acid (also listed as sodium hyaluronate in the ingredients list), glycerin, and algae, which is a marine component that can attract water and send it to your skin cells. Emollients like camellia oil and squalene are great to smooth and hydrate your skin.
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.
^ 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.
^ White, Stephen D.; Bordeau, Patrick B.; Blumstein, Philippe; Ibisch, Catherine; GuaguÈre, Eric; Denerolle, Philippe; Carlotti, Didier N.; Scott, Katherine V. (1 September 1997). "Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96)". Veterinary Dermatology. 8 (3): 157–164. doi:10.1046/j.1365-3164.1997.d01-16.x. ISSN 1365-3164.
The Pore Normalizing Cleanser is designed just to cleanse, not treat, which is a good thing: The Nurse Practitioner study emphasizes the importance of washing with mild cleansers in conjunction with topical acne medications to combat or avoid excessive skin irritation. This one is water-based and fragrance-free, and uses sodium laureth sulfate (as opposed to its harsh cousin sodium lauryl sulfate) to eliminate any chance for irritation.
Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. Potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects. In fact, isotretinoin carries such serious risk of side effects that all people receiving isotretinoin must participate in a Food and Drug Administration-approved risk management program.
The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use oral prescription medications for acne.
Tretinoin: As we said above, tretinoin (common brand name: Retin-A) is a synthetic retinoid, but it is stronger than some of the other options, and its cousin, isotretinoin, is even stronger. Isotretinoin, better known as Accutane, is an oral synthetic retinoid typically only prescribed for very severe cases of cystic acne because it can cause intense side effects and is a powerful teratogen, meaning it causes birth defects. However, after taking isotretinoin for several months, many people never need to do any serious acne treatment again, so for some, it is well worth the side effects.

Even though scientists know how pimples and blackheads are formed, they are still not sure what causes you to have a body full of blemishes and the guy sitting next to you not to have a single spot on his face? It’s probably related to hereditary factors. If your parents dealt with acne when they were younger, you’re more likely to struggle with acne, too.


If you have non-inflamed acne, it means you have a lot of blackheads and whiteheads, but not a lot of redness and swelling. Most common acne face washes can work well for you. If you have inflamed acne, you want to make sure you buy a facial cleanser that has the ingredients to reduce inflammation, swelling, and redness. But you also want to be careful not to buy or use anything that can cause irritation, dry skin and thus, more redness and swelling.
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.[12] 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.[41] 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).[42][43]
Combined oral contraceptives. Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine estrogen and progestin (Ortho Tri-Cyclen, Yaz, others). You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help.

But the side effects of targeted breakout cream treatments aren’t always worth it. “So many products instruct consumers to use benzoyl peroxide spot treat red bumps and pustules. I don’t recommend it,” says Dr. Lawrence Green, board-certified dermatologist and assistant clinical professor of dermatology at George Washington University. Such high concentrations of benzoyl peroxide cause added irritation and inflammation to already sensitive skin, so with this in mind, we cut kits that included spot treatments.
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.
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.
“Sometimes I see people try over-the-counter products just for a couple of weeks, they get frustrated, they say it’s not working, and they discontinue them,” Arthur says. “But it really does take a while to see the effectiveness. So unless you’re having a problem with the medication, like it’s causing severe irritation or dryness, it’s recommended to give it at least 2-3 months before switching to something else.”

Considerations: THERE IS AN EXTREMELY HIGH RISK THAT A DEFORMED INFANT CAN RESULT IF PREGNANCY OCCURS WHILE TAKING ACCUTANE IN ANY AMOUNT AND EVEN FOR SHORT PERIODS OF TIME. FEMALES WHO ARE PREGNANT OR WHO MAY BECOME PREGNANT WHILE UNDERGOING TREATMENT SHOULD NOT TAKE ACCUTANE. There are many other warnings as well.1-3 Side effects of Accutane are many, some of which include dry and cracked lips, dry skin, dry nose and mouth, mild to moderate muscle or joint aches.1-2,4-7

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]
What's Going On: If it's big, red, and painful, you're probably experiencing cystic acne, one of the more severe types. "Cystic pimples are caused by genetics and hormonal stimulation of oil glands," says Zeichner. Not only are they large, but they're also notoriously tough to treat. They often recur in the same place, because even if you manage to get rid of one, it can keep filling up with oil again and again, like an immortal pimple.

The recognition and characterization of acne progressed in 1776 when Josef Plenck (an Austrian physician) published a book that proposed the novel concept of classifying skin diseases by their elementary (initial) lesions.[163] In 1808 the English dermatologist Robert Willan refined Plenck's work by providing the first detailed descriptions of several skin disorders using a morphologic terminology that remains in use today.[163] Thomas Bateman continued and expanded on Robert Willan's work as his student and provided the first descriptions and illustrations of acne accepted as accurate by modern dermatologists.[163] Erasmus Wilson, in 1842, was the first to make the distinction between acne vulgaris and rosacea.[164] The first professional medical monograph dedicated entirely to acne was written by Lucius Duncan Bulkley and published in New York in 1885.[165][166]


Acne inversa (L. invertō, "upside down") and acne rosacea (rosa, "rose-colored" + -āceus, "forming") are not true forms of acne and respectively refer to the skin conditions hidradenitis suppurativa (HS) and rosacea.[25][26][27] Although HS shares certain common features with acne vulgaris, such as a tendency to clog skin follicles with skin cell debris, the condition otherwise lacks the defining features of acne and is therefore considered a distinct skin disorder.[25]

Acne scars are caused by inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris.[30] The scar is created by abnormal healing following this dermal inflammation.[31] Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris.[30] Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or loss at the site of the acne lesion.[32]

Comedones (blackheads and whiteheads) must be present to diagnose acne. In their absence, an appearance similar to that of acne would suggest a different skin disorder.[27] Microcomedones (the precursor to blackheads and whiteheads) are not visible to the naked eye when inspecting the skin and can only be seen with a microscope.[27] There are many features that may indicate a person's acne vulgaris is sensitive to hormonal influences. Historical and physical clues that may suggest hormone-sensitive acne include onset between ages 20 and 30; worsening the week before a woman's period; acne lesions predominantly over the jawline and chin; and inflammatory/nodular acne lesions.[1]
How to Handle It: Speaking of touching, don't! Picking it, squeezing it, or poking at it will only worsen the situation. These may disappear on their own after a few days. Otherwise, Zeichner suggests visiting your dermatologist for a shot of cortisone, which will reduce inflammation and shrink it in just 24 to 48 hours. But if a last-minute appointment isn't in the cards, play mad scientist. First, ice the area, and then apply salicylic acid gel, benzoyl peroxide gel, and 1 percent hydrocortisone cream. The combo will calm skin, kill bacteria, and draw out excess oil from the pimple — all things necessary to take this down, says Zeichner.
Thanks to its special MicroClear technology, Neutrogena Oil-Free Acne and Redness Facial Cleanser helps boost the delivery of active ingredient salicylic acid, in order to help reduce the appearance of acne. The inclusion of aloe and chamomile help to calm irritation while visibly reducing facial redness, a source of emotional stress for many acne sufferers.
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]
The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use oral prescription medications for acne.
Antibiotics for acne, both topical and oral, used to be the top prescriptions for getting clear skin, but research has revealed that they aren’t the best option for most people today due to something called antibacterial resistance. This is where bacteria mutate, become immune to certain antibiotics, then reproduce offspring that are also immune, creating entire colonies of bacteria that can’t be killed by certain antibiotics.
Even though scientists know how pimples and blackheads are formed, they are still not sure what causes you to have a body full of blemishes and the guy sitting next to you not to have a single spot on his face? It’s probably related to hereditary factors. If your parents dealt with acne when they were younger, you’re more likely to struggle with acne, too.
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.
If you have non-inflamed acne, it means you have a lot of blackheads and whiteheads, but not a lot of redness and swelling. Most common acne face washes can work well for you. If you have inflamed acne, you want to make sure you buy a facial cleanser that has the ingredients to reduce inflammation, swelling, and redness. But you also want to be careful not to buy or use anything that can cause irritation, dry skin and thus, more redness and swelling.
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.
The severity of acne vulgaris (Gr. ἀκµή, "point" + L. vulgaris, "common")[23] can be classified as mild, moderate, or severe as this helps to determine an appropriate treatment regimen.[19] Mild acne is classically defined by the presence of clogged skin follicles (known as comedones) limited to the face with occasional inflammatory lesions.[19] Moderate severity acne is said to occur when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and are found on the trunk of the body.[19] Severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions and involvement of the trunk is extensive.[19][24]
Skincare is an extra challenge for those with sensitive skin because certain ingredients might cause irritation or inflammation. Spending too much time out in the wind and sun can also increase reactions. You can have oily, dry or combination skin and still have sensitive skin, too. For both skincare products and cosmetics, try out only one product at a time to see what effects it will have on your skin. The best way to start out is by patch-testing the product on your inner forearm. If you see no negative impact, you can apply it to the area behind your ear before trying it on your face. There are many products on the market now that advertise as effective for sensitive skin, but testing them is the only way to determine which is best for your skin.
If you’re used to seeing advertisements for acne treatments using five or six different products to clear up blemishes, you might be surprised that a simple three-step kit is our top pick. In fact, we favored Paula’s Choice for its simplicity. This twice-daily, three-step kit — which includes a cleanser, an anti-redness exfoliant, and a leave-on treatment — is concise without cutting corners.
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.
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.”
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