Oftentimes, our first instinct when we encounter bumps, pimples and other blemishes on our skin is to touch it. But if you’ve been dealing with acne for a while, you’ve probably learned by now that these practices only make acne and skin problems worse. For starters, our hands come into contact with more bacteria, pathogens and contaminants than any other part of our bodies. Even when we try to wash our hands often, there is only so much of that we can avoid putting on our faces every time we reach out to touch it. So, there’s the fact that we could be adding harmful bacteria our facial skin to begin with. But it doesn’t end there.
Side effects include increased skin photosensitivity, dryness, redness and occasional peeling.[81] Sunscreen use is often advised during treatment, to prevent sunburn. Lower concentrations of benzoyl peroxide are just as effective as higher concentrations in treating acne but are associated with fewer side effects.[80][82] Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial antibiotic resistance.[81]

This top-of-line cleanser is one that really works amazingly for normal, combination and oily skin types. It’s a foaming face wash with 3% sulfur that makes your skin visibly clearer without drying it out. It removes blemishes, unclogs pores, draws out impurities all while calming redness and reducing excess sebum production. The sulfur in it helps to prevent future breakouts and tames even the worst acne breakouts.
What's Going On: You might be all too familiar with these, which tend to make their debut when you’re in high school. "Blackheads, like whiteheads, are blocked pores," says Zeichner. What gives them their namesake color, though, is the oil. It's already dark, but blackheads also have a larger opening at the surface than whiteheads do, meaning air can enter and oxidize that oil sitting inside the pore, turning it even darker.
Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren't recommended.

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.
That’s why, no matter how uncomfortable your skin may feel while plagued with acne, you must resist the urge to touch your skin. If the irritating sensations become unbearable, there are other methods of treating your skin, such as cooling it with ice packs or aloe vera gel. You can even use medicated creams designed to soothe irritated skin – given that your dermatologist says it’s okay.
Genetics can also affect how your immune system works. When confronted with bacteria, your skin might erupt in painful red lumps called pustules while someone else might just get a blackhead. Or maybe your friend has sensitive skin that breaks out more often than yours does. Your family history has a lot to do with the type of skin you have and how it looks and feels.
How to Handle It: Think of these as bigger, pissed-off whiteheads. Your best bet, says Zeichner, is to stock up on benzoyl peroxide, which kills the bacteria. A spot treatment like Murad Acne Spot Fast Fix ($22) should do the trick. Also, try not to pop them — as tempting as that may be. Since they're inflamed, they're more likely to scar if you go the DIY route.
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]
Although there is not enough research to determine if certain foods cause breakouts, there are certain changes you can make to your diet to help prevent them. For breakfast, switching to plain oatmeal that has only been sweetened with fresh fruit can help prevent excessive androgen production. When you eat fish, opt for salmon, which is high in omega-3s. One omega-3 called DHA is an anti-inflammatory. Snacking on sunflower seeds can give you more vitamin E in your diet. Vitamin E helps the immune system fight off bacteria before inflammation and cysts occur. Finally, make sure you stay hydrated by drinking plenty of water each day. Your body needs almost half a gallon each day.
Beyond making sure the system contains safe combinations of ingredients, a system can also treat all aspects of acne. By picking and choosing individual products, you may miss an important step. Plus, treatment systems contain ingredients like glycolic acid that help smooth acne scars, something you might not think about when you are shopping for products. Did you know probiotics help reduce inflammation? Or that kojic acid and arbutin can lighten brown spots? When it comes to treating acne, you should leave the mixing to professionals. You still can try out a variety of systems to find the one that works best for you.
Retinoids – Recommended for people with moderate to severe acne, retinoids can unclog your pores, allowing for your other medicated acne treatments to penetrate deeper. They can reduce your potential for outbreaks and the formation of acne scarring2. You can also use a retinoid cream directly as a treatment after your face cleanse, or even take it in the form of a retinoid pill to treat oil/sebum production and to treat inflammation and acne-causing bacteria.

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]

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.

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.[44][64][65] Activation of TLR2 and TLR4 by P. acnes leads to increased secretion of IL-1α, IL-8, and TNF-α.[44] Release of these inflammatory signals attracts various immune cells to the hair follicle including neutrophils, macrophages, and Th1 cells.[44] IL-1α stimulates increased skin cell activity and reproduction, which in turn fuels comedo development.[44] Furthermore, sebaceous gland cells produce more antimicrobial peptides, such as HBD1 and HBD2, in response to binding of TLR2 and TLR4.[44]

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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.
One of the most gentle face cleansers we selected is this one from Paula’s Choice. It won’t dehydrate sensitive skin because it has just 0.5% salicylic acid. But it still contains enough to unclog pores and exfoliate dead skin. You’ll hardly know that it’s working because it’s so pleasant to use. The silky texture glides on and lathers away oil and grime. Furthermore, there are no parabens or artificial fragrances in the formula.
Recommended therapies for first-line use in acne vulgaris treatment include topical retinoids, benzoyl peroxide, and topical or oral antibiotics.[78] Procedures such as light therapy and laser therapy are not considered to be first-line treatments and typically have an adjunctive role due to their high cost and limited evidence of efficacy.[77] Medications for acne work by targeting the early stages of comedo formation and are generally ineffective for visible skin lesions; improvement in the appearance of acne is typically expected between six and eight weeks after starting therapy.[1]
Clascoterone is a topical antiandrogen which has demonstrated effectiveness in the treatment of acne in both males and females and is currently in the late stages of clinical development.[120][121][122][123] It has shown no systemic absorption or associated antiandrogenic side effects.[122][123][124] In a direct head-to-head comparison, clascoterone showed greater effectiveness than topical isotretinoin.[122][123][124] 5α-Reductase inhibitors such as finasteride and dutasteride may be useful for the treatment of acne in both males and females, but have not been thoroughly evaluated for this purpose.[1][125][126][127] In addition, the high risk of birth defects with 5α-reductase inhibitors limits their use in women.[1][126] However, 5α-reductase inhibitors can be combined with birth control pills to prevent pregnancy, and are frequently used to treat excessive hair in women.[125] There is no evidence as of 2010 to support the use of cimetidine or ketoconazole in the treatment of acne.[128]
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