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 eight and twelve weeks after starting therapy.[15]
Oral antibiotics are recommended for no longer than three months as antibiotic courses exceeding this duration are associated with the development of antibiotic resistance and show no clear benefit over shorter courses.[87] Furthermore, if long-term oral antibiotics beyond three months are thought to be necessary, it is recommended that benzoyl peroxide and/or a retinoid be used at the same time to limit the risk of C. acnes developing antibiotic resistance.[87]
The approach to acne treatment underwent significant changes during the twentieth century. Retinoids were introduced as a medical treatment for acne in 1943.[83] Benzoyl peroxide was first proposed as a treatment in 1958 and has been routinely used for this purpose since the 1960s.[168] Acne treatment was modified in the 1950s with the introduction of oral tetracycline antibiotics (such as minocycline). These reinforced the idea amongst dermatologists that bacterial growth on the skin plays an important role in causing acne.[164] Subsequently, in the 1970s tretinoin (original trade name Retin A) was found to be an effective treatment.[169] The development of oral isotretinoin (sold as Accutane and Roaccutane) followed in 1980.[170] After its introduction in the United States it was recognized as a medication highly likely to cause birth defects if taken during pregnancy. In the United States, more than 2,000 women became pregnant while taking isotretinoin between 1982 and 2003, with most pregnancies ending in abortion or miscarriage. About 160 babies were born with birth defects.[171][172]
What is a pimple in the first place? A pimple is a small comedone, pustule or papule that forms a skin lesion; the more technical term is acne vulgaris. There are numerous causes, but regardless of the cause, pimples develop when the sebaceous glands (oil glands) get clogged and infected from bacteria. This is why pimples swell up and become red, pus-filled lesions on the surface, and just under the surface, of the skin. (2)
This at-home skin peel available at Sephora tightens pores, reduces oil, helps retexturize skin and diminishes dark spots. It's paraben and sulfate free, non-comedogenic and isn't tested on animals. Use this peel each week as part of your clear skin regimen to help even out skin tone and gently remove unhealthy top skin layers, revealing new, healthier skin underneath. 
Warning: Sulfur smells like rotten eggs. But it is an effective ingredient at drying up pus-filled pimples and whiteheads (you’ve gotta take the good with the bad). It works by sucking up the oil. Sulfur is typically mixed with other active ingredients to get the most efficacy and fragrances to mask the strong scent. You can often find it in masks and spot treatments.
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.[16] 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][17] Early and aggressive treatment of acne is advocated by some in the medical community to decrease the overall long-term impact to individuals.[4]

Post-inflammatory hyperpigmentation is not an acne scar, but a red, pink, brown or tan skin discoloration where acne has previously flared up. It'll usually disappear on its own in a year or so. Many skin lightening products claim to help reduce the visibility of these acne "scars." Their active ingredient, hydroquinone, works to slow melanin production and can reduce dark brown marks, but melanin isn't the cause of red and pink acne discolorations. A better option is to use the best foundation for acne prone skin you can find to hide the marks until they naturally fade away.
There are two big guns used to take down acne, and they're both great at doing entirely different things. Salicylic acid is a beta hydroxy acid that comes from willow bark and works primarily as an exfoliator, breaking down fatty acids like sebum so your pores don’t clog. (Glycolic acid works similarly but is less effective.) These acids are effective on comedones — whiteheads, blackheads, and other non-red bumps.

Baby acne generally lasts longer with breast-fed babies, since the same residual, oil-triggering hormones that the baby was exposed to in the uterus can come through the mother's milk, too. As a result, it often begins clearing up as your baby is weened off of breast-milk. It may even clear up sooner if your baby's oil glands have matured enough to handle the hormones before then.
Not only can the sun prolong PIE appearance, it can lead to premature aging including sun spots, fine lines, and wrinkles. UV damage is DNA damage. Sunscreen is an anti-aging must for all ages young and old--preventing future skin cancer. It is the fountain of youth in a bottle. Prevention is better than treatment. There is no such thing as safe tanning, as tanning is the result of sun damage.
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Microneedling is a procedure in which an instrument with multiple rows of tiny needles is rolled over the skin to elicit a wound healing response and stimulate collagen production to reduce the appearance of atrophic acne scars in people with darker skin color.[140] Notable adverse effects of microneedling include postinflammatory hyperpigmentation and tram track scarring (described as discrete slightly raised scars in a linear distribution similar to a tram track). The latter is thought to be primarily attributable to improper technique by the practitioner, including the use of excessive pressure or inappropriately large needles.[140][147]
Coconut oil is all the rage, with uses ranging from hair conditioning to cooking. But some swear by it as a natural acne treatment. To use coconut oil as an acne treatment, you can include it as part of a healthy diet. The fatty acids like lauric acid and caprylic acid are metabolized into antibacterial agents in the body. Or, you can apply a very small amount and rub directly onto your skin after cleansing for an extra hydrating boost.
Processed Foods: Ingredients found in processed and junk food such as chips, breakfast cereals and white bread are acne-inducing villains. Preservatives and additives can trigger hormonal fluctuations, and greasy fast food leads to inflammation all over your body – including your face. Refined grains are quickly broken down and turned into sugar, which creates a terrible effect on skin by aggravating acne.

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.

Globally, acne affects approximately 650 million people, or about 9.4% of the population, as of 2010.[158] It affects nearly 90% of people in Western societies during their teenage years, but can occur before adolescence and may persist into adulthood.[19][20][23] While acne that first develops between the ages of 21 and 25 is uncommon, it affects 54% of women and 40% of men older than 25 years of age,[47][159] and has a lifetime prevalence of 85%.[47] About 20% of those affected have moderate or severe cases.[2] It is slightly more common in females than males (9.8% versus 9.0%).[158] In those over 40 years old, 1% of males and 5% of females still have problems.[20]

Keep in mind that even if some products market themselves toward severe acne breakouts, all the kits we looked at are definitely designed for mild to moderate acne. Not sure if you fit on that scale? You’re not alone! When you’re in the middle of a breakout, all acne seems severe, so it can be difficult to self-diagnose your symptoms. We talked to dermatologists and cosmetic chemists to better understand the differences between the various types of acne (see below).

When we sleep, healing happens, and at the same time, it’s a great time to apply a home remedy and let it get it to work on eliminating toxins that can cause acne. The Psychiatric Clinics of North America reports that stress is a factor affecting all organs. Though it’s easy to forget, the skin is an organ. In fact, it’s your largest organ! Getting plenty of rest can help reduce acne-associated stress. (9) 
Acne vulgaris and its resultant scars have been associated with significant social and academic difficulties that can last into adulthood, including difficulties obtaining employment.[31][178] Until the 1930s, it was largely seen as a trivial problem among middle-class girls – a trivial problem, because, unlike smallpox and tuberculosis, no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it.[166] During the Great Depression, dermatologists discovered that young men with acne had difficulty obtaining jobs, and during World War II, some soldiers in tropical climates developed such severe and widespread tropical acne on their bodies that they were declared medically unfit for duty.[166]
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.
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Washing your face with regular soap isn't enough to make acne better. The best face wash for acne is effective at removing oil and dirt, but still gentle enough to use regularly without overdrying your skin. Look for topical acne medication ingredients salicylic acid and/or benzoyl peroxide in your face wash and use gentle, nonabrasive cleansing techniques.
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.
Your pimples need TLC, too. The study on acne vulgaris found that, in an attempt to dry out acne lesions, patients often use too many products or apply excessive amounts to problem areas, resulting in further irritation and over drying of the skin. Vigorous scrubbing and using harsh exfoliants can make acne worse by rupturing whiteheads and blackheads, turning them into painful red ones. And remember: no matter how satisfying it is, picking and popping your zits will also increase inflammation and opportunity for infection.
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“You unfortunately cannot determine the strength of a product strictly by the percentage of its active ingredients because how well a product works depends on how well its inactive ingredients help it penetrate the skin,” explains Dr. Green. “In other words, a 2 percent benzoyl peroxide may be more effective than another brand’s 5 percent benzoyl peroxide because there are other ingredients helping out.”

This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.


A BHA product often cited includes salicylic acid, it must be between a pH between 3 and 4 to work. A BHA works to slough (to get rid of) off dead skin cells and encourage new skin growth. As a result, you may experience dry skin and scaliness around your acne, but this will dissipate over time as your skin begins to regenerate faster. Use this in a cleanser or spot treatment daily on the acne-affected areas of your skin.[6]
The use of antimicrobial peptides against C. acnes is under investigation as a treatment for acne to overcoming antibiotic resistance.[10] In 2007, the first genome sequencing of a C. acnes bacteriophage (PA6) was reported. The authors proposed applying this research toward development of bacteriophage therapy as an acne treatment in order to overcome the problems associated with long-term antibiotic therapy such as bacterial resistance.[179] Oral and topical probiotics are also being evaluated as treatments for acne.[180] Probiotics have been hypothesized to have therapeutic effects for those affected by acne due to their ability to decrease skin inflammation and improve skin moisture by increasing the skin's ceramide content.[180] As of 2014, studies examining the effects of probiotics on acne in humans were limited.[180]

Sometimes birth control alone isn’t enough to really make a difference in hormonal acne. That’s when your doctor might recommend adding in an androgen blocker such as Spironalactone. Spiro (as it’s called) minimizes the amount of androgen hormones in circulation by blocking the receptors that bind with testosterone. When these pills are taken at the same time as an oral contraceptive, 90 percent of women see an improvement in breakouts, according to Linkner. The drug is sometimes prescribed to women with PCOS (polycystic ovarian syndrome) to relieve androgen-related symptoms like excessive hair growth, hypertension, oily skin, and acne.

Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.
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