Hormonal fluctuations and an imbalance of estrogen and testosterone levels have proven to be a direct cause of acne. For this reason, many experience an onslaught of breakouts during puberty and pregnancy. The brain releases a GnRH hormone when an adolescent begins puberty, which in turn signals the pituitary gland to release two additional androgens. Androgens make the sebaceous glands produce more sebum, causing it to occupy too much space within the pore and preventing the full expulsion of dead skin cells and debris. Fluctuations in hormones also cause many women to experience acne during pregnancy and a worsening of breakouts during menstrual cycles.
Dermatologists aren’t sure why azelaic acid is so effective at clearing up inflammation, but it’s often used as an option for sensitive skin or pregnant patients. Linkner says the ingredient is good at treating malasma, acne, and rosacea. Your dermatologist can prescribe a foam product with azelaic acid, and you can also find beauty products with very small amounts of this active ingredient.
First, let’s talk about what causes acne. Pimples form when the oil and dead skin cells on your skin combine to form a plug that blocks the pores. “As the P. acnes bacteria that naturally live on skin overgrow within this plugged follicle, the area becomes inflamed and this is when you start to see papules, pustules, and cystic lesions,” RealSelf dermatologist Sejal Shah, M.D., tells SELF. The treatments ahead work to exfoliate away dead skin cells, suck up excess oil, stop inflammation, and kill the P. acnes bacteria. There are even a few treatments that target hormonal acne specifically.
Topical treatments on their own may not be enough to give you clear skin, especially in those with complicated, inflammatory cystic acne. There are several acne medication options approved for use by the FDA, but which one is best for you is a question for your dermatologist and/or general practitioner. Baldwin says if you have insurance and you have acne, a prescription may be the best step because "it makes no sense to try to handle the condition yourself or to use over the counter products that are always less effective than prescriptions meds." Here are a few of the acne medications you'll want to ask about:
Castor oil has anti-inflammatory and antibacterial properties that can speed up healing, making it ideal for breakout-prone skin. Though I recommend using it in very small amounts with jojoba oil, hemp seed oil or coconut oil, along with one of the essential oils above, it’s high in unsaturated fatty acids, vitamin E, proteins and minerals, which can help reduce acne-causing bacteria and inflammation associated with breakouts. It can even help heal scars caused by acne.
Retinoids are medications which reduce inflammation, normalize the follicle cell life cycle, and reduce sebum production. They are structurally related to vitamin A. Studies show they are underprescribed by primary care doctors and dermatologists. The retinoids appear to influence the cell life cycle in the follicle lining. This helps prevent the accumulation of skin cells within the hair follicle that can create a blockage. They are a first-line acne treatment, especially for people with dark-colored skin, and are known to lead to faster improvement of postinflammatory hyperpigmentation.
Tea tree oil is renowned for being good for your skin. In addition to this, it also contains anti-bacterial and anti-fungal properties, which makes it highly beneficial for acne treatment. In fact, studies that compare tea tree oil to the acne medication benzoyl peroxide shows it to be just as effective. But please remember to dilute tea tree oil before you use it; otherwise, your skin may get irritated.
Contrary to the marketing promises of “blemish banishers” and “zit zappers,” immediate results are not the trademark of acne treatments — a frustrating truth to anyone suffering through a breakout. And while pimples are personal (your stress-induced spots will look and act differently than your best friend’s breakout), the best acne treatments will include a regimen of products to hit all of acne’s root causes. We tested 43 kits to find the most well-rounded breakout-fighting solutions on the market.
A 2013 study on acne vulgaris in The Nurse Practitioner concurred that a multidimensional approach to acne is usually necessary because most people have a combination of symptoms. Based on the advice of dermatologists and aestheticians, we turned our focus to regimen sets, analyzing the ingredients of more than 40 kits before finding our top picks.
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.