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In women, acne can be improved with the use of any combined birth control pill.[89] These medications contain an estrogen and a progestin.[90] They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduced acne severity.[10][91] First-generation progestins such as norethindrone and norgestrel have androgenic properties and can worsen acne.[15] Although oral estrogens can decrease IGF-1 levels in some situations and this might be expected to additionally contribute to improvement in acne symptoms,[92][93] combined birth control pills appear to have no effect on IGF-1 levels in fertile women.[90][94] However, cyproterone acetate-containing birth control pills have been reported to decrease total and free IGF-1 levels.[95] Combinations containing third- or fourth-generation progestins including desogestrel, dienogest, drospirenone, or norgestimate, as well as birth control pills containing cyproterone acetate or chlormadinone acetate, are preferred for women with acne due to their stronger antiandrogenic effects.[96][97][98] Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills.[91] A 2014 review found that antibiotics by mouth appear to be somewhat more effective than birth control pills at decreasing the number of inflammatory acne lesions at three months.[99] However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions.[99] The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance.[99]

This inflammatory cascade typically leads to the formation of inflammatory acne lesions, including papules, infected pustules, or nodules.[1] If the inflammatory reaction is severe, the follicle can break into the deeper layers of the dermis and subcutaneous tissue and cause the formation of deep nodules.[1][66][67] Involvement of AP-1 in the aforementioned inflammatory cascade leads to activation of matrix metalloproteinases, which contribute to local tissue destruction and scar formation.[45]
The path to clear skin is often one of trial and error; you might need to try several acne remedies before you find the right treatment for the types of acne affecting your skin. Before trying acne medication, you may prefer to give different natural acne treatment options a chance. While there's no research supporting the effective use of natural acne treatments, here are two popular options that you may want to try.
Frankincense oil is a personal favorite for me and my wife, Chelsea. Containing antibacterial and anti-inflammatory properties, it’s amazing for almost all skin types and perfect for acne-prone skin. Frankincense invites new cell growth, which can help reduce the appearance of scars. It also helps prevent or eliminate bacteria, part of what can cause acne in the first place.

Some people swear by the disinfecting power of tea tree oil for acne treatment. It can be applied either full strength or slightly diluted with water directly onto pimples. Use a small amount on a clean cotton swab or cotton pad and dab on the affected areas immediately after cleansing. Because tea tree oil can be drying, you might choose to use both tea tree oil and coconut oil for acne as part of your clear skin regimen.
Hormonal acne is exactly what it sounds like: breakouts that are tied to fluctuations in hormones. If your skin flares up at the same time each month, tends to occur in the same spot (chin, cheeks, jawline), and is characterized by pimples that are deep and cystic, your acne might be hormonal. Hormonal acne is usually due to a sensitivity to androgens, which are a specific type of hormone. With respect to acne, the androgen in charge is testosterone. Testosterone (and estrogen) are produced and needed by both sexes, but women are sensitive to extraneous amounts since it’s unnecessary for their typical functioning. The excess androgen has to go somewhere, and is usually purged via the skin’s androgen receptor cells which creates breakouts. While testosterone remains in the bloodstream, it increases sebum production and can make breakouts worse.
^ Jump up to: a b GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
Postinflammatory hyperpigmentation (PIH) is usually the result of nodular acne lesions. These lesions often leave behind an inflamed darkened mark after the original acne lesion has resolved. This inflammation stimulates specialized pigment-producing skin cells (known as melanocytes) to produce more melanin pigment which leads to the skin's darkened appearance.[35] People with darker skin color are more frequently affected by this condition.[36] Pigmented scar is a common term used for PIH, but is misleading as it suggests the color change is permanent. Often, PIH can be prevented by avoiding any aggravation of the nodule, and can fade with time. However, untreated PIH can last for months, years, or even be permanent if deeper layers of skin are affected.[37] Even minimal skin exposure to the sun's ultraviolet rays can sustain hyperpigmentation.[35] Daily use of SPF 15 or higher sunscreen can minimize such a risk.[37]
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.
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“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.”
If you're looking for suggestions on how to get rid of acne overnight, using toothpaste for acne spot treatment has probably come up. But does it work? Toothpaste contains ingredients like baking soda, alcohol, hydrogen peroxide and menthol that can dry out acne. However, some experts warn that using toothpaste for acne can actually cause over-drying and even skin peeling, so it should be used with caution. Here's how:

Dermabrasion is an effective therapeutic procedure for reducing the appearance of superficial atrophic scars of the boxcar and rolling varieties.[32] Ice-pick scars do not respond well to treatment with dermabrasion due to their depth.[32] The procedure is painful and has many potential side effects such as skin sensitivity to sunlight, redness, and decreased pigmentation of the skin.[32] Dermabrasion has fallen out of favor with the introduction of laser resurfacing.[32] Unlike dermabrasion, there is no evidence that microdermabrasion is an effective treatment for acne.[8]
Frankincense oil is a personal favorite for me and my wife, Chelsea. Containing antibacterial and anti-inflammatory properties, it’s amazing for almost all skin types and perfect for acne-prone skin. Frankincense invites new cell growth, which can help reduce the appearance of scars. It also helps prevent or eliminate bacteria, part of what can cause acne in the first place.
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Many skin conditions can mimic acne vulgaris, and these are collectively known as acneiform eruptions.[28] Such conditions include angiofibromas, epidermal cysts, flat warts, folliculitis, keratosis pilaris, milia, perioral dermatitis, and rosacea, among others.[20][72] Age is one factor which may help distinguish between these disorders. Skin disorders such as perioral dermatitis and keratosis pilaris can appear similar to acne but tend to occur more frequently in childhood, whereas rosacea tends to occur more frequently in older adults.[20] Facial redness triggered by heat or the consumption of alcohol or spicy food is suggestive of rosacea.[73] The presence of comedones helps health professionals differentiate acne from skin disorders that are similar in appearance.[8] Chloracne, due to exposure to certain chemicals, may look very similar to acne vulgaris.[74]
Back acne (sometimes called "bacne") is a potentially embarrassing and sometimes painful condition where clogged hair follicles on the back cause pimples and blackheads. Back acne can be caused by the same factors as other types of acne: diet, hormones, certain medications, genetics or any combination thereof. But when you're considering how to get rid of back acne, also remember that most people have their back covered the majority of the day. The clothing we wear matters, and the way in which we wash the skin on our back is key for clear skin, the whole body over. Learn more about common back acne causes, the best acne products for your body, and how to prevent acne on the back from returning in this section.

Acne is at least in part due to hereditary factors. Those whose parents have a history of acne are likely to struggle with the same condition. Your genetic makeup can determine how to get rid of pimples, how sensitive your skin is, how reactive you are to hormonal fluctuations, how quickly you shed skin cells, how you respond to inflammation, how strong your immune system is to fight off bacteria, how much oil your sebaceous glands produce, and the list goes on and on. All of these determinants can cause acne to develop more easily and determine what’s good for pimples in your complexion.


Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity.[137] In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus.[137] Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B).[137] Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel.[47][137] Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm.[137] Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester.[137] Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy.[138] In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters.[137] Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X).[137] Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects.[1] Finasteride is not recommended as it is highly teratogenic.[1]
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.
Combined oral contraceptives. Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine estrogen and progestin (Ortho Tri-Cyclen, Yaz, others). You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help.
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