When it comes to finding the right acne treatments, there are a million products and they are not all created equal. From acne washes to creams and spot treatments, the options can be overwhelming, making it impossible to know what is really the best acne treatment for you.
Even more frustrating? The fact that we are still dealing with acne. Seriously, we thought the outbreaks would end shortly after AP Calculus. But adult acne is one thing, and it’s actually something that can affect people in their 20s and 30s, and even well beyond their 50s.
And if you thought the black spots and dots white were annoying, deep and painful pimples that often appear in adult acne are much more aggravated and more difficult to remove. We spoke with dermatologists to find out which acne treatments are the most effective on all types of pimples. Read on to learn what causes acne in the first place, plus the best acne treatments and medications worth your hard-earned money.
What Causes Acne?
Pimples form when oil and dead skin cells combine to form a plug that blocks pores. Usually, your skin naturally sheds its dead cells. But if your body produces a lot of sebum (oil), those cells can get stuck in your pores, according to the American Academy of Dermatology (AAD).
Sometimes the bacteria Cutibacterium acne (sometimes called Propionibacteria acnes ) also gets trapped in the pore, where it multiplies. “As the P. acnes bacteria that naturally live on the skin overgrow within this clogged follicle, the area becomes inflamed and that’s when you start to see papules, pustules, and cystic lesions,” said dermatologist Sejal Shah, MD., of the healthcare market. RealSelf tells SELF.
The treatments below work to exfoliate dead skin cells, absorb excess oil, stop inflammation, and kill the C. acnes bacteria. There are even some treatments that specifically target hormonal acne.
There Is No One-Size-Fits-All Solution For Acne.
All the dermatologists we spoke to agreed on this point. Each patient responds to treatments differently and can sometimes get worse before getting better. But finding the right treatment for you is part of personal acne care, and with the help of your dermatologist, you can find an acne treatments regimen that is best for your skin. And yes, it really helps to work with a derm to get it right, especially if your acne is more than occasional or mild.
First, your dermo will examine your skin to determine the severity of your acne to give it a grade (grade 1 is mild; grade 4 is severe) and determine what type (or types) you have, explains the AAD. Then they will see which type of treatment would work best: topical or oral (or both). Here’s the difference between each, according to the AAD:
• Topical acne treatment: This is the most common type of acne treatment. Some work by killing acne-causing bacteria, while others clear acne by reducing oil. Ingredients in topical acne treatments can include retinoids, benzoyl peroxide, antibiotics, or salicylic acid.
• Oral acne treatment: These internally acting medications are prescribed when you have red, swollen pimples (acne cysts and nodules). They can come in different forms, such as antibiotics (which kill bacteria and decrease inflammation), birth control pills (which help with hormonal acne), and isotretinoin (commonly known as Accutane, although that specific brand has been discontinued).
Below are the best acne treatments for occasional, mild, and moderate acne.
1. Salicylic acid
Oh hello, old friend. Salicylic acid is the ideal solution for preteens with pimples. And as you walk down the aisles of the pharmacy, you will find it as the active ingredient in most products labeled “acne wash” or “spot treatment.” Salicylic acid is a beta-hydroxy acid (BHA) that works by dissolving excess oil and gently exfoliating dead skin cells.
Salicylic acid also has anti-inflammatory properties to help with inflamed cystic breakouts that can occur when deep locks in hair follicles break under the skin. Although it’s totally fine to use salicylic acid in a face wash, you may get better results when used as a toner, moisturizer, or leave-in spot treatment because they give you more time to do your job. And keep in mind that salicylic acid can dry out your skin if applied excessively, so it may be wise to choose just one product with the ingredient to use every day.
Products To Try:
- Neutrogena Oil-Free Acne Wash ($ 8, Amazon )
- CosRX BHA Blackhead Power Liquid ($ 24, Dermstore )
- Paula’s Choice Skin Perfecting Liquid Scrub 2% BHA ($ 30, Amazon )
2. Glycolic acid
Glycolic acid is an alpha hydroxy acid (AHA) that gently exfoliates the skin and helps remove dead cells that can clog pores. As with salicylic acid, you can find glycolic in washes, scrubs, moisturizers, and serums at your local pharmacy or beauty store.
Products To Try:
- L’Oréal Paris Revitalift 10% Pure Glycolic Acid ($ 24, Amazon )
- SkinCeuticals Glycolic 10 Renew Overnight ($ 80, Dermstore )
- Neova Serious Glypeel Peel-Off Mask ($ 58, Dermstore )
3. Benzoyl peroxide
Benzoyl peroxide is an antibacterial ingredient and is very effective in killing the C. acnes bacteria that cause breakouts. But benzoyl is not without its drawbacks. Leave-in creams and cleansing treatments can dry out sensitive skin and bleach clothes if you’re not careful. Board-certified dermatologist Eric Meinhardt, MD, previously told SELF that it is best to stick to formulations that have no more than 2% benzoyl peroxide on the list of active ingredients; stronger concentrations are harsher on the skin without being harsher on bacteria.
Products To Try:
- PanOxyl Creamy Acne Wash ($ 12, Amazon )
- La-Roche Posay Effaclar Duo Benzoyl Peroxide Acne Treatment ($ 30, Dermstore )
- Kate Somerville Anti Bac Acne Clearing Lotion ($ 42, Sephora )
4. Lactic acid
Like glycolic acid, lactic acid is an AHA, which means that it works as a chemical exfoliator on the skin. However, it is generally gentler than glycolic acid, making it a good option for people who want to use an acid exfoliator but have more sensitive skin. Lactic acid is also a humectant, which means that it draws water into itself and can be hydrating. So for those with dry or sensitive skin, lactic acid scrubs would work well without being too irritating.
Products To Try:
- Ordinary Lactic Acid 10% + HA 2% ($ 18, Amazon )
- Sunday Riley Good Genes All-in-One Lactic Acid Treatment ($ 85, Sephora )
- Freck Beauty Cactus Water Lactic Acid Cleansing Toner ($ 24, Urban Outfitters )
You’ve probably heard of the anti-aging benefits of retinoid creams, but these forms of the vitamin are also effective in clearing acne. “[Retinoids] cause skin cells to churn at a faster rate, decrease oil production, and help exfoliate the skin,” board-certified dermatologist Rita Linkner, MD, tells SELF. Another benefit: Acne is inflammation, and retinoids are anti-inflammatory.
Shah often recommends over-the-counter retinol or prescription retinoids to her acne-prone patients. “I find that, compared to other treatments, they are beneficial not only for treating acne but also for preventing new acne from forming, as they help prevent early-stage follicle-clogging,” she says. “They can also help with some of the post-acne [problems], like hyperpigmentation.”
But keep in mind that retinoids can be irritating too, and if you have sensitive skin (or a skin condition like psoriasis, eczema, or rosacea), even an over-the-counter option may be too harsh. Therefore, it is important to always start with a low retinol concentration (even as low as 0.01% ) to see how your skin reacts. Your dermatologist may also recommend low-strength over-the-counter retinol or a low-strength version of prescription retinoids, which you may more easily tolerate.
Retinol is also not a quick fix. It takes time to see results (possibly a few months) and it is something you will have to keep using to maintain your benefits.
- CeraVe Resurfacing Retinol Serum ($ 18, Amazon )
- First Aid Beauty FAB Skin Lab Retinol Serum .25% Concentrate ($ 58, Dermstore )
- Drunk Elephant A-Passioni Retinol Cream ($ 74, Sephora )
- Intensive Skin Clarity Treatment PCA .5% Pure Retinol Night ($ 111, Dermstore )
Retinol is not the only OTC retinoid out there, nor is it the mildest. In fact, some experts recommend that people with sensitive skin opt for products that contain retinol (also called retinaldehyde) over traditional retinol. Like retinol, this compound is a natural retinoid that the body converts to retinoic acid. And, as SELF previously explained, some studies have shown it to be as effective as retinol and other retinoids with fewer side effects.
Products To Try:
- MyChelle Dermaceuticals Remarkable Retinal Serum ($ 48, Amazon )
- Avene Retrinal .1 Intensive Cream ($ 69, Amazon )
- Obagi Retivance Skin Rejuvenating Complex ($ 127, Dermstore )
Adapalene, often known by the brand name Differin, is a synthetic retinoid that used to be available only by prescription. But it was recently available without a prescription, making it a great, powerful acne medication that you can access without a prescription. And because it is synthetic, it was formulated to be gentler than other prescription acne medications. For those who have graduated beyond the over-the-counter retinol but aren’t ready for the full intensity of a prescription retinoid, adapalene is a perfect option.
Products To Try:
- Differin Gel ($ 15, Amazon )
- La Roche-Posay Effaclar Adapalene Gel ($ 30, Amazon )
- Acne-Free Adapalene Gel ($ 12, Amazon )
Warning: Sulfur smells like rotten eggs. But it is an effective ingredient for drying pimples and pus-filled pimples (you have to take the good with the bad). It works by sucking in the oil. Sulfur is generally mixed with other active ingredients for the best effectiveness and with fragrances to mask the strong odor. It can often be found in face masks and spot treatments.
Products To Try:
- Murad Clarifying Mask ($ 39, Dermstore )
- Mask detox clarifier for skincare Lancer ($ 75, DermStore )
- Peter Thomas Roth Sulfur Acne Treatment Therapeutic Mask ($ 52, Sephora )
This ingredient, which is a plant-based extract that is often advertised as an alternative to retinol, is not actually a retinoid at all. But in a few limited studies, it showed promise in managing things like skin texture and fine lines, without the side effects we generally associate with retinoids. Today, it can appear in a product on its own or be combined with a low concentration of retinol to help stimulate anti-aging and acne-fighting effects without increasing the risk of side effects.
- Versed Press Restart Gentle Retinol Serum ($ 22, Target )
- Indeed Labs Bakuchiol Reface Pads ($ 20, Ulta)
- The Inkey List Bakuchiol Retinol Alternative Moisturizer ($ 10, Sephora )
And here are the best acne treatments for the most severe acne.
10. Dapsone Gel
Another prescription option that your dermatologist might prescribe for acne is dapsone gel, like the brand-name version Aczone. Dapsone is both antimicrobial and anti-inflammatory and has been shown to help with black spots, the spots whites, and deeper painful pimples. Dapsone is often used in conjunction with other acne treatments. And like many of those other remedies, this can make your skin dry.
11. A Cortisone Injection
Cortisone is a quick fix for acne emergencies, especially large cystic acne bumps. Go to the dermatologist’s office for an injection of this corticosteroid, and the pimple will dramatically subside and possibly even disappear within 24 to 48 hours. The treatment works to slow down inflammation, which makes it better for cystic breakouts and can be really good for fighting hormonal breakouts.
However, if done incorrectly, a cortisone injection can leave a small depression in the skin that lasts for about eight weeks. “It’s a rare side effect that occurs if the cortisone dose is too high,” Linkner explains. “You want to go to someone who knows what he is doing.” Therefore, this method is best saved for those rare emergencies and should not be considered a long-term acne treatment.
12. Birth Control Pills
If you notice that you have breakouts around your period every month, your acne could be related to hormones. “Sensitivity to hormones called androgens manifests itself in the form of cystic acne,” says Linkner. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Contraceptive hormonal combination, which contains the hormones estrogen and progestin, helps maintain hormone balance and clear skin. Ortho Tri-Cyclen, Estrostep, and YAZ are FDA-approved as acne treatments.
Sometimes birth control alone is not enough to really make a difference in hormonal acne. This is when your doctor might recommend adding an androgen blocker like spironolactone. Spiro (as it is often called) minimizes the amount of circulating androgen hormones by blocking the receptors that bind to testosterone. When these pills are taken at the same time as an oral contraceptive, many women see an improvement in flare-ups, according to Linkner. The drug is sometimes prescribed to women with polycystic ovary syndrome ( PCOS ) to relieve androgen-related symptoms such as excessive hair growth, hypertension, oily skin, and acne.
Also known by the brand name Tazorac, this is another powerful prescription retinoid, but it is synthetic. Like other retinoids, it can cause side effects like dryness and irritation, so you should always follow your dermatologist’s instructions on when and how to use it. Interestingly, it can also be used to help control plaque psoriasis and can be combined with other topical medications, such as corticosteroids, to do just that.
Isotretinoin (formerly sold as Accutane) is a particularly strong retinoid. It has a mixed reputation, but among dermatologists, it is the finisher for severe acne patients. “If you have an acne patient who is unresponsive, [isotretinoin] can really be a game-changer,” board-certified dermatologist Adam Friedman, MD, tells SELF. Commonly known as Accutane, although that particular brand was discontinued, isotretinoin is an oral retinoid and has all the benefits of topical retinol, but is even more effective.
It is especially good for cystic acne in women and body acne in men. “Oral vitamin A basically closes the sebaceous glands. If you suppress them for a long enough period, you can cure someone of their acne, and about 50% achieve that cure rate, “says Linkner. A course of isotretinoin can take six to nine months. Sometimes patients need to repeat the course on a higher dose to really clear the acne.
But isotretinoin has mixed reviews for a reason. It makes skin super dry and sensitive, which means it’s important to keep moisturizers and lip balm close while you’re on the treatment. Oh, and don’t even think about plucking your eyebrows (imagine having your skin ripped off).
There is another downside to isotretinoin: it requires a lot of paperwork and office visits. Since isotretinoin can cause birth defects, you should visit your dermatologist’s office once a month for a pregnancy test and an extensive survey with questions about your sex life to show that you are using enough birth control. These precautions are intense, but dermatologists agree that the end results of isotretinoin are like no other. “This is one of the few drugs that I can look [patients] in the eye and guarantee that it will work,” says Friedman.
16. Azelaic Acid
Dermatologists are not sure why azelaic acid is so effective in eliminating inflammation, but it is often used as an option for sensitive skin or pregnant patients. The ingredient is good for treating melasma, acne, and bumps associated with rosacea, Linkner says. Your dermatologist may prescribe products with high concentrations of azelaic acid, and you can find over-the-counter options with lower concentrations of this active ingredient.
Products to try:
- Ordinary 10% Azelaic Acid Suspension ($ 8, Sephora )
- Paula’s Choice 10% Azelaic Acid Booster ($ 36, Amazon )
- REN Ready Steady Glow Daily AHA Toner ($ 38, Sephora )
A dermatologist can prescribe oral antibiotics to help with acne, but it is not usually the first option. While you may see immediate results, the acne will return as soon as you stop taking the antibiotics. And Linkner warns: “While taking them, [you can get] yeast infections, nausea, and upset stomach.”
Bottom line: acne is a pain regardless of your age, but you don’t have to live with it. If over-the-counter treatments don’t work for you, talk to your dermatologist, who can determine the best acne medication for you.