There are plenty of ways to treat acne, from creams, gels, and washes to prescriptions and procedures. But which is best? That depends on what kind of acne you have and how bad it is.
“For most people there are a lot of options,” says Arielle Nagler, MD, assistant professor of dermatology at New York University’s Langone Health. “There are ways to get it under control.”
For mild acne, start with over-the-counter products, which don’t need a prescription. First, wash your face daily. “Studies have shown that regular washing of the face makes a huge difference,” Nagler says. Be gentle; overdoing it can make matters worse.
Acne face washes often contain salicylic acid, which removes oil and clears your pores. If you have sensitive skin, find a foaming face wash or other gentle cleanser labeled sensitive, says Allison Arthur, MD, a dermatologist at Sand Lake Dermatology Center in Orlando, FL.
Look for these other ingredients when you shop:
Adapalene (Differin). This medicine is a retinoid, a group of topical medicines derived from vitamin A. It affects the way skin cells grow and helps prevent clogged pores. It used to be only available by prescription.
Benzoyl peroxide. This treatment is usually sold in gels or lotions. It unclogs pores, dries out pimples, and kills bacteria. It prevents new acne.
Using benzoyl peroxide and adapalene together is a common starting point for acne treatment, Arthur says. Then give it a chance to work.
“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.”
When to See a Dermatologist
You can make a dermatologist appointment any time you want. There’s no such thing as too little acne to see a dermatologist about. “There is very little downside,” Nagler says.
Go right away if you have acne scars, painful nodules -- hard bumps -- or deep cysts. And get in soon if over-the-counter products haven’t worked for more than 3 months or if your self-esteem is worse because of your acne, Arthur says.
At your appointment, your doctor will look at your acne, prescribe medicine to apply to your skin (your doctor may call this “topical,” meaning that it goes on your skin), and maybe also pills to help further.
Tretinoin(Retin-A). This retinoid is more powerful than adapalene. It’s especially useful for comedonal acne (clogged pores and blackheads), Arthur says. It sloughs dead skin cells so they don’t stick together and clog your pore openings. Tazarotene (Avage, Fabior, Tazorac) is another prescription-strength retinoid your doctor could prescribe.
Antibiotics. Types like doxycycline and erythromycin kill bacteria on your skin and cut down on inflammation. That’s particularly good for inflammatory acne, which is when you have tender red bumps and pus-filled whiteheads.
Oral contraceptives. For women, birth control pills can clear up your skin. Pills that contain both estrogen and progestin work, like Ortho Tri-Cyclen and Yaz.
Spironolactone. This medication is another hormonal option for women. Created as a blood pressure pill, it stops your hormones from making too much oil.
Isotretinoin. You might have heard of its first brand name, Accutane. The powerful medication is used for cystic acne or acne that scars.
“It is a serious medicine, and there are quite a few potential side effects so it requires close monitoring, but it has the potential to put the acne into remission,” Arthur says. The medicine could dry your lips, nose, and skin. If a woman taking it got pregnant, it could cause severe birth defects.
Your dermatologist might also recommend therapies like extraction, where she will remove stubborn whiteheads or blackheads. (Don’t try to do this yourself!)
Chemical peels involve applying solutions like salicylic acid or glycolic acid to your face. Photodynamic therapy uses lights and lasers to improve your skin.
“They don’t take the place of a daily skin care regimen,” Arthur says. “Your skin care regimen is like brushing your teeth every day, and going in and getting facials is like getting your teeth cleaned.”
Plan to pamper your skin with extra lotions and creams while you treat your acne, Nagler says. “It’s expected that you’ll have dryness, so you need to try to maximize your moisturizer to compensate so you can use the medications effectively. Don’t give up too soon because you’re going to miss the benefit.”