When it comes to finding the right acne treatment, there are a million products out there—and they’re not all created equal. From acne washes to creams and spot treatments, the options can be overwhelming, making it impossible to tell which is truly the best acne treatment for you.
Even more frustrating? The fact that we’re still dealing with acne at all. Seriously, we thought the breakouts would be over soon after AP Calculus. But it’s actually something that can affect people in their 20s and 30s, and even well past their 50s.
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. Keep reading to learn what causes acne in the first place, plus the best acne treatments worth spending your hard-earned dollars on.
So, what causes acne?
Pimples form when the oil and dead skin cells on your skin combine to form a plug that blocks the pores. Usually, your skin naturally sheds dead skin cells. But if your body produces a lot of sebum (oil), the dead skin cells can get stuck in your pores, according to the American Academy of Dermatology (AAD).
Sometimes, a bacteria called p. acnes also gets trapped in the pore, where it multiplies. “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 you’ll find below 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.
There is no one-size-fits-all solution to acne.
All the dermatologists we talked to agreed on this point. 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, it is helpful to work with a derm to get it right.
First, your derm will examine your skin to determine the severity of your acne and give it a “grade” (grade 1 is mild; grade 4 is severe) and figure out which type (or types) you have, the AAD explains. Then, they’ll see which type of treatment would work best: topical or oral (or both). Here’s the difference between each, per the AAD:
- Topical acne treatment: This is the most common type of acne treatment. Some work by killing acne-causing bacteria while others get rid of acne by decreasing oil. The ingredients in topical acne treatments may include: retinoids, benzoyl peroxide, antibiotics, or salicylic acid.
- Oral acne treatment: These medications, which work internally, 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 helps with hormonal acne), and isotretinoin (commonly referred to as Accutane, even though that specific brand was discontinued).
Here are the best acne treatments for occasional to moderate acne.
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 (BHA) that works by dissolving excess oil and gently exfoliating away dead skin cells.
Salicylic acid 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. Although it's totally fine to use salicylic acid in a face wash, you may find that you have better results when using it as a toner, moisturizer, or leave-on spot treatment because these give it more time to do its work. And keep in mind, salicylic acid can dry out the skin if over-applied, so it may be wise to choose only one product with the ingredient to use every day.
2. Glycolic acid
Glycolic acid is an alpha-hydroxy acid (AHA) that gently 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 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.
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 that retinoids can also be irritating and 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 (possibly a few months), and it’s something you’ll have to keep using to maintain its benefits.
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.
And here are the best acne treatments for more severe acne.
6. Dapsone gel
Another prescription option your dermatologist might prescribe for acne is dapsone gel, like the brand name version Aczone. Dapsone is both antimicrobial and anti-inflammatory, and it’s proven to help with blackheads, whiteheads, and deeper painful pimples. Oftentimes, dapsone is used alongside other acne treatments. And, like many of those other remedies, this 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 combating 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,” Dr. Linkner explains. “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,” Dr. Linkner says. 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 often 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, many women see an improvement in breakouts, according to Dr. 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.
Isotretinoin is a particularly strong retinoid. It 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, [isotretinoin] can really be a game changer,” board-certified dermatologist Adam Friedman tells SELF. Commonly referred as Accutane even though that particular brand was discontinued, isotretinoin is an oral retinoid, and it has all the same benefits of a topical retinol but is even more effective.
It’s 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,” Dr. Linkner says. A course of isotretinoin 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 isotretinoin 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 isotretinoin: 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 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 isotretinoin 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,” Dr. Friedman says.
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. The ingredient is good at treating malasma, acne, and rosacea, Dr. Linkner says. Your dermatologist can prescribe products with high concentrations of azelaic acid, and you can also find over-the-counter options with lower concentrations of this active ingredient.
A dermatologist can prescribe oral antibiotics to help with 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 Dr. Linkner warns, “While you’re on them, [you can get] yeast infections, nausea, upset stomach.”
The bottom line: Acne is a pain no matter what your age—but you don’t have to live with it. If over-the-counter treatments aren’t working for you, talk to your dermatologist, who can determine the best acne medication for you.
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Originally Appeared on Self