The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle.[1] In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle.[10] However, increased production of oily sebum in those with acne causes the dead skin cells to stick together.[10] The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone.[10] This is further exacerbated by the biofilm created by C. acnes within the hair follicle.[45] If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo).[1][10][20] In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).[1][10]
Acne vulgaris is diagnosed based on a medical professional's clinical judgment.[15] The evaluation of a person with suspected acne should include taking a detailed medical history about a family history of acne, a review of medications taken, signs or symptoms of excessive production of androgen hormones, cortisol, and growth hormone.[15] 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.[28] 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.[28] 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]
Like acne on your face, back acne occurs when your pores become blocked with oil and dead skin cells. Exfoliating your back regularly might help remove these dead skin cells and pore-clogging debris before they have a chance to block pores. However, you want to take care not to scrub too hard, especially if you're experiencing an active breakout. Use a soft cloth to gently brush away surface impurities as you shower.
It is widely suspected that the anaerobic bacterial species Cutibacterium acnes (formerly Propionibacterium. acnes) contributes to the development of acne, but its exact role is not well understood.[2] There are specific sub-strains of C. acnes associated with normal skin, and moderate or severe inflammatory acne.[50] It is unclear whether these undesirable strains evolve on-site or are acquired, or possibly both depending on the person. These strains have the capability of changing, perpetuating, or adapting to the abnormal cycle of inflammation, oil production, and inadequate sloughing of dead skin cells from acne pores. Infection with the parasitic mite Demodex is associated with the development of acne.[30][51] It is unclear whether eradication of the mite improves acne.[51]
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]

Similar to the above natural acne remedies, these acne treatments can be inexpensive and worth giving a try. Best of all, these use products you probably already have in your household, like apple cider vinegar and toothpaste. Use home remedies for acne with caution if you have cystic acne, open sores or inflammatory acne, which are best treated with medical supervision.


How to Handle It: Pair two of the best-known acne-fighting ingredients, salicylic acid and benzoyl peroxide, in the week leading up to your period. (If you're feeling bloated, now's the time to do it.) The combo can help prevent hormonal acne from happening in the first place. Zeichner suggests following a salicylic acid wash, like fan-favorite Neutrogena Oil-Free Acne Wash Pink Grapefruit Facial Cleanser ($7), with a benzoyl peroxide spot treatment, such as Murad Acne Spot Fast Fix ($22). If you're still seeing zits, "visit your dermatologist to discuss prescription options, like birth control pills, oral spironolactone — which blocks oil — or topical Aczone 7.5 percent gel," says Zeichner. "It's shown to be particularly effective in adult women without causing irritation." Oral contraceptives level out those hormone fluctuations, keeping your oil production normal and your skin clear.
Similar to the above natural acne remedies, these acne treatments can be inexpensive and worth giving a try. Best of all, these use products you probably already have in your household, like apple cider vinegar and toothpaste. Use home remedies for acne with caution if you have cystic acne, open sores or inflammatory acne, which are best treated with medical supervision.

Use a toner after cleansing. After you wash your face, exfoliate, or apply a face mask, apply a toner to the entirety of your face. Toners work to tighten pores making it less likely that dirt and oil will become trapped in them. Buy acne toners at a local drugstore, or use witch hazel or apple cider vinegar dabbed on with a cotton ball. Don’t rinse toners after application - allow them to stay on your skin.
Frequently used topical retinoids include adapalene, isotretinoin, retinol, tazarotene, and tretinoin.[47] They often cause an initial flare-up of acne and facial flushing, and can cause significant skin irritation. Generally speaking, retinoids increase the skin's sensitivity to sunlight and are therefore recommended for use at night.[1] Tretinoin is the least expensive of the topical retinoids and is the most irritating to the skin, whereas adapalene is the least irritating to the skin but costs significantly more.[1][84] Most formulations of tretinoin cannot be applied at the same time as benzoyl peroxide.[15] Tazarotene is the most effective and expensive topical retinoid, but is not as well-tolerated.[1][84] Retinol is a form of vitamin A that has similar but milder effects, and is used in many over-the-counter moisturizers and other topical products.
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When it comes to how to remove pimples, there are generally three different treatment routes. Some can be performed in conjunction with one another, while others require exclusive usage (as in the case of strong prescription medications). If you’re in need of a skincare solution to clarify your complexion and an answer for how to get rid of pimples, consider the benefits and drawbacks of these various options:
Do a Google search for "how to get rid of acne fast" and you'll see plenty of websites telling you to eat better for clear skin. But are there really foods that cause acne, or is that an old wives' tale? Dermatologist Hilary Baldwin, MD, of the Acne Treatment and Research Centre in Morristown, New Jersey, says the answer isn't really simple at all. "The simple answer is, we don't know. So far studies have suggested that high-glycemic index diets (those with lots of white foods like potatoes, pasta, bread, rice and sweets), as well as diets high in skim-milk dairy products and whey protein supplements might be associated with worsening of existing acne but are less likely to cause acne," Baldwin says.

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.
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