Dear acne, you suck. Seriously, we thought the breakouts would be over soon after AP Calculus. But it’s actually something that affects women and men in their 20s and 30s, and even well past their 50s. It’s just not fair (throws childlike temper tantrum). And if you thought blackheads and whiteheads were annoying, the deep painful pimples that often pop up in adult acne are much more aggravating—and harder to get rid of. So, we talked to dermatologists to find out which acne treatments are the most effective on all types of pimples.
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.
All the dermatologists we talked to agreed that there is no one-size-fits-all solution to acne. Every patient responds to treatments differently, and sometimes it can get worse before it gets better. But with the help of your dermatologist, you can find an acne treatment regimen that works for you. And, yes, we do stress how helpful it is to work with a derm to get it right.
For occasional to moderate acne, you can shop some key ingredients in the beauty aisle to help handle breakouts.
1. Salicylic acid
Oh, hello old friend. Salicylic acid is the go-to fix for pimply preteens. And cruising through the aisles at the drugstore, you’ll find it as the active ingredient on the majority of products labeled “acne wash” or “spot treatment.” Salicylic acid is a beta-hydroxy acid that works by dissolving excess oil and gently exfoliating away dead skin cells. Salicylic also has anti-inflammatory properties to help with inflamed cystic breakouts that can occur when blockages deep in the hair follicles rupture beneath the skin. It’s best to apply this ingredient as a toner, moisturizer, or leave-on spot treatment instead of a face wash to give it time to do its work. And keep in mind, salicylic acid can dry out the skin if over-applied, so maybe choose only one product with the ingredient to use every day.
2. Glycolic acid
Glycolic acid is an alpha hydroxy acid that exfoliates the skin, helping to get rid of the dead skin cells that can clog pores. Just like salicylic acid, you can find glycolic in washes, peels, moisturizers, and serums at your local beauty store or drugstore.
3. Benzoyl peroxide
Benzoyl peroxide is an antibacterial ingredient, and it’s very effective at killing the P. acnes bacteria that causes breakouts. But benzoyl isn’t without its downsides. The leave-on creams and cleansing treatments can dry out sensitive skin types and bleach clothing if you aren’t careful. Board-certified dermatologist Eric Meinhardt, M.D., previously told SELF that it's best to stick to formulations that have no more than 2 percent of benzoyl peroxide listed on the active ingredients chart; stronger concentrations are harder on your skin without being any tougher on bacteria.
Warning: Sulfur smells like rotten eggs. But it is an effective ingredient at drying up pus-filled pimples and whiteheads (you’ve gotta take the good with the bad). It works by sucking up the oil. Sulfur is typically mixed with other active ingredients to get the most efficacy and fragrances to mask the strong scent. You can often find it in masks and spot treatments.
You’ve probably heard of the benefits of retinoid creams for anti-aging, but vitamin A is also efficient at clearing up acne. “[Retinoids] cause skin cells to turn over at a faster rate, decrease oil production, and help skin exfoliate,” board-certified dermatologist Rita Linkner, M.D., tells SELF. Another benefit: Acne is inflammation, and retinoids are anti-inflammatory.
Shah often recommends over-the-counter retinols or prescription retinoids to her acne-prone patients. “I find that compared to other treatments they are beneficial for not just treating acne but also preventing new acne from forming as they help prevent that initial stage of the follicle getting clogged,” she says. “They can also help with some of the post acne [problems] such as hyperpigmentation.” But keep in mind if you have sensitive skin (or eczema or rosacea), a prescription retinoid might be too strong an option. However, your dermatologist can recommend an over-the-counter retinol with a low concentration (0.1 to 0.25 percent), which might be better tolerated. Retinol also isn’t a quick fix. It takes time to see results, and it’s something you’ll have to keep using to maintain its benefits. Shah also mentions that retinol plays well with other acne treatments on the list. "Retinol can be combined with other over-the-counter or prescription medications such as benzoyl peroxide, topical antibiotics, and oral medications. The right combination depends on the severity of the acne and your skin type."
If you have more severe acne, you should reach out to a dermatologist for a stronger treatment.
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.
7. A cortisone shot
Cortisone is a quick fix for acne emergencies. We mean got a big board meeting tomorrow kind of quick. Go into the dermatologist’s office for a shot of this corticosteroid, and acne will disappear in 24 to 48 hours. The treatment works to curb inflammation, which makes it best for cystic breakouts and can be really good at combatting hormonal flare-ups. If done incorrectly, a cortisone shot can leave a small depression in the skin that lasts about eight weeks. “It’s a rare side effect that happens if dosage of cortisone is too high,” explains Linkner. “You want to go to someone who knows what they’re doing.”
8. Birth control pills
If you notice that you’re breaking out right around your period every month, your acne might be linked to hormones. “A sensitivity to the hormones called androgens manifests in the form of cystic acne,” says Linkner. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Birth control, which has estrogen and progestin, helps keep hormones balanced and skin clear. Ortho Tri-Cyclen, Estrostep, and YAZ are all FDA-approved as acne treatments.
Sometimes birth control alone isn’t enough to really make a difference in hormonal acne. That’s when your doctor might recommend adding in an androgen blocker such as Spironalactone. Spiro (as it’s called) minimizes the amount of androgen hormones in circulation by blocking the receptors that bind with testosterone. When these pills are taken at the same time as an oral contraceptive, 90 percent of women see an improvement in breakouts, according to Linkner. The drug is sometimes prescribed to women with PCOS (polycystic ovarian syndrome) to relieve androgen-related symptoms like excessive hair growth, hypertension, oily skin, and acne.
Accutane (isotretinoin) has a mixed reputation, but among dermatologists it’s the finisher for patients with severe acne. “If you have an acne patient that doesn’t respond to anything, [Accutane] can really be a game changer,” board-certified dermatologist Adam Friedman tells SELF. Accutane is an oral retinoid, and it has all the same benefits of a topical retinol but is even more effective.
Accutane is especially good for cystic acne in women and body acne in men. “Oral vitamin A basically shuts down your sebaceous glands. If you suppress [them] for a long enough period, you can cure someone of their acne, and about 50 percent do hit that cure rate,” says Linkner. A course of Accutane can take about six to nine months. Sometimes patients need to repeat the course at a higher dosage in order to truly eliminate acne.
But Accutane has mixed reviews for a reason. It makes the skin super dry and sensitive, which means it’s important to keep moisturizers and lip balm nearby while you’re on the treatment. Oh, and don’t even think about waxing your eyebrows (just imagine your skin ripping off). There’s another downside to Accutane: It requires a lot of paperwork and office visits. Since isotretinoin can cause birth defects, you have to come into the dermatologist once a month to get a pregnancy test and take a lengthy survey with embarrassing questions about your sex life to prove that you are using sufficient birth control. These precautions are intense, but dermatologists agree that the final results for Accutane are like no other. “This is one of the few medicines that I can look [patients] in the eye and guarantee them it will work,” says Friedman
11. Azelaic acid
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.
A dermatologist can prescribe oral antibiotics as a quick fix for acne, but it's not typically the first choice. While you might see immediate results, as soon as you get off of the antibiotics the acne will return. And Linkner warns, “While you’re on them, [you can get] yeast infections, nausea, upset stomach.”
This story originally appeared on Self.
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