Alternative and integrative medicine approaches used in the treatment of acne include fish oil, brewer's yeast, probiotics, oral zinc and topical tea tree oil. More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and traditional Chinese medicine. Talk with your doctor about the pros and cons of specific treatments before you try them.

Everything you need to know about cystic acne Cystic acne is an uncommon and severe form of acne. The skin condition results from blocked pores in the skin that cause infection and inflammation. Treatment often requires the help of a specialist doctor who can prescribe potent drugs. Read on to learn about symptoms, causes, diagnosis, and prevention. Read now

Side effects include increased skin photosensitivity, dryness, redness and occasional peeling.[81] Sunscreen use is often advised during treatment, to prevent sunburn. Lower concentrations of benzoyl peroxide are just as effective as higher concentrations in treating acne but are associated with fewer side effects.[80][82] Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial antibiotic resistance.[81]
Have you tried treating your acne with no luck? You might simply be using the wrong product for the type you have. Whether you have periodic breakouts or more stubborn cystic acne, there's a solution. We asked Dr. Neal Schultz, an NYC dermatologist, to share the best treatments for every type of acne. Read on for his expert product recommendations, along with some editor favorites, that'll give you clear skin in no time.
Retinoids are medications which reduce inflammation, normalize the follicle cell life cycle, and reduce sebum production.[45][83] They are structurally related to vitamin A.[83] Studies show they are underprescribed by primary care doctors and dermatologists.[15] 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,[1] especially for people with dark-colored skin, and are known to lead to faster improvement of postinflammatory hyperpigmentation.[36]
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.

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.
Exercise regularly. Exercising does a number of things to help reduce your acne. It releases endorphins which lower stress levels and therefore reduce oil-production and also makes you sweat which cleans out dead skin cells. Try exercising on a daily basis for a minimum of thirty minutes to help reduce your acne not only on your face, but also on your chest, shoulders, and back; which is where the term "bacne" comes from.

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]
“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.”
Risk factors for the development of acne, other than genetics, have not been conclusively identified. Possible secondary contributors include hormones, infections, diet and stress. Studies investigating the impact of smoking on the incidence and severity of acne have been inconclusive.[2][38][39] Sunlight and cleanliness are not associated with acne.[14]
Combination therapy—using medications of different classes together, each with a different mechanism of action—has been demonstrated to be a more efficacious approach to acne treatment than monotherapy.[10][47] The use of topical benzoyl peroxide and antibiotics together has been shown to be more effective than antibiotics alone.[10] Similarly, using a topical retinoid with an antibiotic clears acne lesions faster than the use of antibiotics alone.[10] Frequently used combinations include the following: antibiotic and benzoyl peroxide, antibiotic and topical retinoid, or topical retinoid and benzoyl peroxide.[47] The pairing of benzoyl peroxide with a retinoid is preferred over the combination of a topical antibiotic with a retinoid since both regimens are effective but benzoyl peroxide does not lead to antibiotic resistance.[10]
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Because baby acne typically disappears on its own within several months, no medical treatment is usually recommended. If your baby's acne lingers for much longer, your baby's doctor may recommend a medicated cream or other treatment. Don't try any over-the-counter medications without checking with your baby's doctor first. Some of these products may be damaging to a baby's delicate skin.

^ White, Stephen D.; Bordeau, Patrick B.; Blumstein, Philippe; Ibisch, Catherine; GuaguÈre, Eric; Denerolle, Philippe; Carlotti, Didier N.; Scott, Katherine V. (1 September 1997). "Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96)". Veterinary Dermatology. 8 (3): 157–164. doi:10.1046/j.1365-3164.1997.d01-16.x. ISSN 1365-3164.
C. acnes also provokes skin inflammation by altering the fatty composition of oily sebum.[45] Oxidation of the lipid squalene by C. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels.[45] Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4).[45] LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein.[45] PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells.[45] The inflammatory properties of C. 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.[45] These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.[45]
Spironolactone is an androgen blocker. It can be used to treat hormonal acne in women (only) by reducing the production of androgens (male hormones) in a woman's body, which can then reduce oil production in the skin. If you're wondering how to get rid of acne overnight, keep in mind that aldactone can take up to three months to start taking effect.
Another once-daily gel your dermatologist might prescribe for acne is Aczone 7.5 percent. The active ingredient, dapsone, is both antimicrobial and anti-inflammatory, and it’s proven to help with blackheads, whiteheads, and deeper painful pimples. Oftentimes, Aczone is used alongside other acne treatments. And like many of those other remedies, Aczone can cause skin to dry out.

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.


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.[35] By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time.[35] 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.[35] The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone.[35] 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.[35] 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.[35] 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.[35] 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.[35]

Acne scars are caused by inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris.[31] The scar is created by abnormal healing following this dermal inflammation.[32] Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris.[31] 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.[33]


^ Jump up to: a b c Zaenglein, AL; Graber, EM; Thiboutot, DM (2012). "Chapter 80 Acne Vulgaris and Acneiform Eruptions". In Goldsmith, Lowell A.; Katz, Stephen I.; Gilchrest, Barbara A.; Paller, Amy S.; Lefell, David J.; Wolff, Klaus (eds.). Fitzpatrick's Dermatology in General Medicine (8th ed.). New York: McGraw-Hill. pp. 897–917. ISBN 978-0-07-171755-7.

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.[35] By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time.[35] 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.[35] The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone.[35] 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.[35] 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.[35] 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.[35] 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.[35]
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]

Spot treatments are designed to give problem pimples a mega-dose of concentrated benzoyl peroxide — in a couple of regimens, like the Proactiv Teen Kit, the spot treatment had nearly three times the benzoyl peroxide as its all-over treatment. The logic: If benzoyl peroxide can be irritating to the skin in high concentrations, limiting its intensity to just the pimple itself could save the rest of your healthy skin.
Cystic Acne: The most severe type of acne, cystic acne requires dermatological care and prescription acne medication to treat. Even the best acne products available over the counter are no match for this painful condition in which the area of the outbreak becomes inflamed, but not infected. Cystic acne can result in permanent scarring. However, it's important to know that all acne lesions can scar. Scarring is related to size, amount of inflammation, genetics and delay in therapy.
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]
Ablative lasers deliver an intense wavelength of light to the skin, removing thin outer layers of the skin (epidermis). In addition, collagen production is stimulated in the underlying layer (the dermis). Patients are typically numbed with local anesthetic and the ablation is done as an outpatient procedure. CO2 and erbium are the ablative lasers most often used for acne scar treatment.

Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It's even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.
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