Acne vulgaris is a chronic skin disease of the pilosebaceous unit and develops due to blockages in the skin's hair follicles. These blockages are thought to occur as a result of the following four abnormal processes: a higher than normal amount of oily sebum production (influenced by androgens), excessive deposition of the protein keratin leading to comedo formation, colonization of the follicle by Propionibacterium acnes (P. acnes) bacteria, and the local release of pro-inflammatory chemicals in the skin.[49]
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]
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.”
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.
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For example, if you have acne on dry skin, you need something gentle enough to cleanse and exfoliate but not dehydrate, like a Neutrogena cleanser. If you have oily skin, you’re looking to exfoliate and combat oil production with a product like Cetaphil. If you have combination skin, you need something that can treat your unique skin and balance it out, like Exposed Skin Care.
Some people use natural treatments like tea tree oil (works like benzoyl peroxide, but slower) or alpha hydroxy acids (remove dead skin and unclog pores) for their acne care. Not much is known about how well many of these treatments work and their long-term safety. Many natural ingredients are added to acne lotions and creams. Talk to your doctor to see if they’re right for you.
What it does: Benzoyl peroxide is the only known substance which can bring oxygen under the skin surface. Since bacteria cannot survive in the presence of oxygen, when used in an adequate dosage, benzoyl peroxide eradicates 99.9% of these bacteria almost immediately. It also exerts a mild drying and peeling effect, which is thought to help prevent breakouts.1-6 Benzoyl peroxide also helps lessen inflammation.7-9 2.5% benzoyl peroxide is just as effective as higher concentrations with less side effects.6,10
Topical antibiotics deemed safe during pregnancy include clindamycin, erythromycin, and metronidazole (all category B), due to negligible systemic absorption.[46][137] Nadifloxacin and dapsone (category C) are other topical antibiotics that may be used to treat acne in pregnant women, but have received less study.[46][137] No adverse fetal events have been reported from the topical use of dapsone.[137] If retinoids are used there is a high risk of abnormalities occurring in the developing fetus; women of childbearing age are therefore required to use effective birth control if retinoids are used to treat acne.[19] Oral antibiotics deemed safe for pregnancy (all category B) include azithromycin, cephalosporins, and penicillins.[137] Tetracyclines (category D) are contraindicated during pregnancy as they are known to deposit in developing fetal teeth, resulting in yellow discoloration and thinned tooth enamel.[1][137] Their use during pregnancy has been associated with development of acute fatty liver of pregnancy and is further avoided for this reason.[137]
Having a specific type of skin now doesn’t mean you will be stuck with it the rest of your life. As you get older, your skin can change. It may be oily when you are younger but become dry as you age. Plus, skin can become more or less sensitive over time. It’s always a good idea to retest for your skin type if you notice any changes. We’ve included a guide above to help you recognize what kind of acne you have, what the average causes are, and how to treat it (or at least not aggravate it).

Hydroquinone lightens the skin when applied topically by inhibiting tyrosinase, the enzyme responsible for converting the amino acid tyrosine to the skin pigment melanin, and is used to treat acne-associated postinflammatory hyperpigmentation.[34] By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time.[34] Improvement in skin hyperpigmentation is typically seen within six months when used twice daily. Hydroquinone is ineffective for hyperpigmentation affecting deeper layers of skin such as the dermis.[34] The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone.[34] Its application only to affected areas lowers the risk of lightening the color of normal skin but can lead to a temporary ring of lightened skin around the hyperpigmented area.[34] Hydroquinone is generally well-tolerated; side effects are typically mild (e.g., skin irritation) and occur with use of a higher than the recommended 4% concentration.[34] Most preparations contain the preservative sodium metabisulfite, which has been linked to rare cases of allergic reactions including anaphylaxis and severe asthma exacerbations in susceptible people.[34] In extremely rare cases, repeated improper topical application of high-dose hydroquinone has been associated with an accumulation of homogentisic acid in connective tissues, a condition known as exogenous ochronosis.[34]
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
@ brazen i also get exposed to sunlight a lot and would recommend Cetaphil as it has no photosensitive effects. I use Cetaphil wash and it has really been a great help with my acne. it cleans your skin thoroughly while still being gentle. i would recommend using this with a cleansing brush (clarisonic, luna, spin brush etc) and following with a toner preferably one with witch hazel. these combination of things has worked wonders for my skin. 3 months down the line the improvement has been fantastic. All I’m dealing with now is the scars (Hyperpigmentations).

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]
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]
Dry Skin – Skin that doesn’t produce enough sebum, so it doesn’t retain moisture well and dries out. Dry skin tends to crack, peel, and become itchy, flaky, irritated or inflamed easily. Acne is caused by dead skin cells and bacteria clogging pores, while dryness tightens the pores to clog them further. The best acne face washes should exfoliate your skin, but shouldn’t dry it out further.
You really don’t need to pay more than $25 per month to get the best acne treatment system. Systems priced higher than that are, in our opinion, overpriced. Unless you have serious types of acne that require medical attention, it’s better to stay out of the dermatologists office. It’s inconvenient, expensive, potentially uncomfortable (think side-effects from medication), and no more effective than a good, complete acne treatment system you can use at home. Finally, you can go cheaper and treat your acne with homemade remedies. But the treatment experience and the results are very unlikely to be as good as they are with a treatment system.
Many treatment options for acne are available, including lifestyle changes, medications, and medical procedures. Eating fewer simple carbohydrates such as sugar may help.[7] Treatments applied directly to the affected skin, such as azelaic acid, benzoyl peroxide, and salicylic acid, are commonly used.[8] Antibiotics and retinoids are available in formulations that are applied to the skin and taken by mouth for the treatment of acne.[8] However, resistance to antibiotics may develop as a result of antibiotic therapy.[15] Several types of birth control pills help against acne in women.[8] Isotretinoin pills are usually reserved for severe acne due to greater potential side effects.[8][16] Early and aggressive treatment of acne is advocated by some in the medical community to decrease the overall long-term impact to individuals.[4]
Any acne treatment is a weeks-long experiment that you’re conducting with your skin. Acne is slow to heal, and in some cases, it can get worse before it gets better (nearly every benzoyl peroxide product we looked at emphasized the likeliness of irritating acne further, and starting off with a lighter application). April W. Armstrong, a doctor at the University of California Davis Health System, recommends waiting at least one month before you deem a product ineffective.
The good news about oily skin is that it is less likely to wrinkle, is more supple and doesn’t show its age as soon as other skin types. The bad news is that pores get clogged with oil more frequently. Using a daily gentle exfoliator can balance your skin’s tone and texture and keep pores unplugged. There are also anti-bacterial exfoliators that can speed up healing for breakouts.
Antiandrogens such as cyproterone acetate and spironolactone have been used successfully to treat acne, especially in women with signs of excessive androgen production such as increased hairiness or skin production of sebum, or baldness.[10][46] Spironolactone is an effective treatment for acne in adult women, but unlike combined birth control pills, is not approved by the United States Food and Drug Administration for this purpose.[1][35][100] The medication is primarily used as an aldosterone antagonist and is thought to be a useful acne treatment due to its ability to additionally block the androgen receptor at higher doses.[35] Alone or in combination with a birth control pill, spironolactone has shown a 33 to 85% reduction in acne lesions in women.[91] The effectiveness of spironolactone for acne appears to be dose-dependent.[91] High-dose cyproterone acetate alone has been found to decrease symptoms of acne in women by 75 to 90% within 3 months.[101] It is usually combined with an estrogen to avoid menstrual irregularities and estrogen deficiency.[102] The medication has also been found to be effective in the treatment of acne in males, with one study finding that a high dosage reduced inflammatory acne lesions by 73%.[103][104] However, the side effects of cyproterone acetate in males, such as gynecomastia, sexual dysfunction, and decreased bone mineral density, make its use for acne in this sex impractical in most cases.[103][104][105] Hormonal therapies should not be used to treat acne during pregnancy or lactation as they have been associated with birth disorders such as hypospadias, and feminization of the male babies.[46] In addition, women who are sexually active and who can or may become pregnant should use an effective method of contraception to prevent pregnancy while taking an antiandrogen.[106] Antiandrogens are often combined with birth control pills for this reason, which can result in additive efficacy.[35][107]

Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 1 May 2019), Cerner Multum™ (updated 2 May 2019), Wolters Kluwer™ (updated 1 May 2019) and others.

No single product can contain all of the necessary acne-fighting ingredients, despite what some may claim. Some chemicals shouldn’t be used together, while others work together to totally eradicate acne and all the blemishes that come with it. The best acne treatment systems can do that for you, but because everyone’s skin is unique, what works for one person may not work for another. The key lies in finding the right system, a combination of products, that work best for your unique skin.


Alpha-Hydroxy Acids – These are synthetic acids derived from sugary fruits that remove dead skin cells3 while reducing inflammation. The two common types that can be found in over-the-counter acne treatments are glycolic acid and lactic acid. Another benefit of these acids is that they improve the appearance of your acne scars and make your pores look smaller by stimulating the growth of new, healthy skin.
Acne, also known as acne vulgaris, is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin.[10] It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring.[1][2][11] It primarily affects areas of the skin with a relatively high number of oil glands, including the face, upper part of the chest, and back.[12] The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide.[3][4]
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.
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.
Acne and stress aren’t connected. FALSE. Scientific studies have shown the opposite to be true. Students with acne were examined before and after major exams at school, and their acne got worse when they experienced stress before exams. It is a double-edged sword. Acne can cause stress, but it can also get worse with stress. Stress hormones such as cortisol can overstimulate the oil glands in your skin. And we already know that oil, bacteria and dead skin cells are what really cause acne. So try to keep away from stressors while you try to get your skin healthier.
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.
The trick is to identify a cleanser that offers a deep clean without over-drying the skin, which naturally produces less oil with age, says Jessica Wu, MD, a dermatologist in Los Angeles. "Adult or hormonal acne is different than teen acne—people are often dry on the top layer of skin, and broken out underneath that layer,” Dr. Wu says. “So Proactiv or Clean & Clear won't work as well once you hit your 30s.”
P. acnes also provokes skin inflammation by altering the fatty composition of oily sebum.[44] Oxidation of the lipid squalene by P. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels.[44] Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4).[44] LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein.[44] PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells.[44] The inflammatory properties of P. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase.[44] These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.[44]
With the right formula, acne is simple to treat. The key is being gentle with your skin because inflammation will cause more acne – always. That’s why the best acne treatment systems in 2019 include as many natural ingredients as possible to offset the drying effect of the (necessary) scientific, stronger components, combining the best science and nature has to offer.
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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