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Types, Treatment, and Lifestyle Factors

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Acne is sometimes thought of as an issue for tweens and teens.

While it often happens in adolescence, it doesn’t necessarily stop once you’ve blown the candles out on your 20th birthday.

Reid Maclellan, MD, a member of the adjunct faculty at Harvard Medical School, says the idea that breakouts clear up with age is one of many myths about acne.

Other misconceptions, like the myth that having acne means your skin is dirty, can also interfere with proper treatment.

Complicating matters, there are several types of acne that require different approaches, and individuals respond differently to treatments.

“Acne is not a one-size-fits-all treatment,” says Maclellan, who is also the director of Proactive Dermatology Group and founder and CEO of Cortina. “Each individual person is unique and different, so what may work for one individual with a certain type of acne may not work for another.”

Whether you’re a teen trying to manage frustrating breakouts or an adult experiencing hormonal or cystic acne, you have options available to you.

Here’s what Maclellan and two other dermatologists have to say about how to treat acne based on your specific situation.

The most common types of acne are:

Aaron Secrest, an academic/research dermatologist at the University of Utah, says these types are broken into two groups:

Both types of acne are caused by:

Acne subtypes

There are also several subtypes of acne, including:

  • adult hormonal acne (occurs due to hormonal fluctuations)
  • acne excoriée (occurs when someone with acne compulsively picks their skin, leading to scarring)
  • acne mechanical (occurs due to friction or pressure against the skin)
  • acne conglobata (occurs when nodules, abscesses, and cysts link below the skin, causing redness and swelling)
  • acne as a side effect of medications

Adult hormonal acne

Adult hormonal acne occurs when sex hormones rise and fall. This can cause excess sebum production, changes to circulation and pH balance, and inflammation.

Acne excoriée

Acne excoriée, also known as excoriation or skin picking disorder, occurs when acne is picked at. It’s most commonly found among adolescents with anxiety disorders or obsessive-compulsive disorder (OCD).

Acne mechanica

This type of acne occurs when the skin is squeezed, rubbed, or exposed to pressure. It often occurs in professionals who wear masks or helmets, like football players or medical staff.

It typically shows up on the:

  • face
  • arms
  • legs
  • torso
  • buttocks

Acne conglobata

Acne conglobata is rare but severe and most often seen in teenage males, according to 2018 research. It happens due to sebum and bacterial buildup and can lead to large, red, painful bumps on the skin.

Acne as a medication side effect

Acne may be a side effect of several types of medication, according to older 2013 research. These include:

One common thread between all acne types and subtypes is the recommendation from dermatologists not to pop the pimple. Maclellan warns it can lead to scarring.

Fungal acne

Fungal acne technically isn’t acne. It’s actually caused by yeast.

“Fungal acne is a very rare condition that I have seen less than five times in the past decade, despite its popularity on social media,” Secrest says. “It is caused by a yeast, Malassezia furfur, and can occur after chronic use of oral and topical antibiotics to treat inflammatory acne.”

Erin Schoor, MD, a dermatologist with NYU Langone, says fungal acne is most common in people with oily skin.

Though pharmacies are full of products that promise to unclog pores, over-the-counter (OTC) remedies are not always the best route.

“When the acne becomes inflamed or OTC medications are not working, prescription medications are recommended,” Schoor says. “Antibiotics can be more helpful for deeper inflammation, which can lead to scarring.”

Prescription products and medications are most often needed for inflammatory acne.

Topical treatments

Mild to moderate inflammatory acne typically requires a prescription-strength topical treatment, Schoor says.

According to 2016 research, these products typically contain ingredients like:

Retinoids are a derivative of vitamin A that typically — but not always — requires a prescription. A 2017 report supported their use in acne therapy.

Maclellan says benzoyl peroxide is also typically more effective than salicylic acid. Still, he noted some people find it causes dryness, flaking, and irritation. In this case, he might prescribe a product with salicylic acid instead.

A 2020 study suggested azelaic acid was less effective than benzoyl peroxide.

A 2021 review indicated niacinamide could aid in treating several skin conditions, including acne.

A 2016 study on acne treatment mentioned that sulfur has become less popular because of its smell. The same study indicated that topical corticosteroids could be used for very inflammatory acne but noted they should only be used for a short duration.

A 2018 case study suggested that oral dapsone may help treat nodulocystic acne if isotretinoin (Accutane) doesn’t work.

Oral medication

Oral antibiotics may be prescribed to treat inflammatory acne. The most common include:

  • macrolides, like erythromycin, clindamycin, azithromycin, and roxithromycin
  • fluoroquinolones, like levofloxacin
  • tetracyclines, like doxycycline, minocycline, and lymecycline
  • co-trimoxazole

Schoor says spironolactone, a water pill normally used for blood pressure, may also help with hormonal acne treatment but should be avoided during pregnancy.

Schoor notes that oral antibiotics are not a long-term solution and are usually combined with other, often topical treatments for the most effectiveness.

“Oral antibiotics are limited to a 3-month treatment for fear of antibiotic resistance and side effects,” she says.

Isotretinoin can also come in pill form and may help with moderate to severe acne, but it’s also not a long-term treatment.

“This pill is usually given for 4 to 6 months and is weight-based,” Schoor says. “It can cause birth defects if a pregnant person takes isotretinoin and is associated with other potential side effects, so it is monitored closely.”

Maclellan says hormonal birth control may aid in treating hormonal acne.

Injections

Schoor says cortisone can be injected into a deeper nodule or cyst for a more rapid resolution.

Research from 2016 suggested that these injections, particularly using the corticosteroid triamcinolone acetonide, may reduce the appearance of keloid scars and their post-surgical reappearance.

Still, researchers indicated that this treatment isn’t without risk, including side effects like pain and skin atrophy, characterized by a loss of skin elasticity.

A 2020 study indicated that using glucocorticoids could also induce skin atrophy.

Laser and light-based therapies

According to Schoor, individuals hoping to avoid medication sometimes opt for laser therapy. She says it’s most effective for scar treatment. Research from 2016 suggested laser and light-based therapies were effective.

There are several sources to choose from, including:

  • fluorescent lamps
  • full-spectrum lights
  • green light
  • violet light
  • blue metal halide lamps
  • xenon flash lamps
  • laser

The American Academy of Dermatology (AAD) says people often see results, but they vary and can take time, typically about 12 weeks.

However, lasers and light treatment can rarely clear acne completely and are typically not recommended as a lone treatment.

Photodynamic therapy (or PDT) is a similar option that uses lower-powered light sources to nix P. acnes.

It’s most effective when combined with topical treatments, like aminolevulinic acid (ALA).

A 2013 study of 75 patients suggested it can help treat acne conglobata.

Other physical treatments

The AAD indicates acne scar removal surgery and fillers can aid in treating a few depressed acne scars.

Per 2016 research, other treatments may include:

  • comedone extraction to remove scarring, usually combined with isotretinoin
  • cryoslush therapy, or brushing a combination of solid carbon dioxide and acetone on the infected skin area
  • cryotherapy, usually with liquid nitrogen, to destroy diseased skin tissue, improve cosmetic appearance, and aid in the treatment of acne conglobata

There are a lot of options when it comes to acne treatments, and it can be overwhelming. It’s important to speak with a dermatologist if you can to get personalized recommendations for you. You can even do so via telemedicine or with an app.

Acne that is mild, comedonal, and without scarring can sometimes be treated with OTC and natural remedies.

Over-the-counter ingredients

Experts and research suggest these are the best ingredients to try if you’re trying to treat and reduce the appearance of acne:

Benzoyl peroxide

Benzoyl peroxide can often be found in gels and lotions. OTC benzoyl peroxide is available in concentrations ranging from 2.5% to 10%, according to a 2021 review.

Schoor says OTC products with benzoyl peroxide can help unclog pores and reduce comedones.

Maclellan also says it’s effective. However, like its prescription counterpart, it can cause skin irritation.

Salicylic acid

Like benzoyl peroxide, Schoor says OTC products with salicylic acid aid in unclogging pores and treating comedones. Maclellan says it’s typically less harsh than benzoyl peroxide.

An older 2012 review suggested that salicylic acid can be found in products at concentrations of 0.05% to 5%. Researchers noted that it may help the appearance of acne, but results from OTC concentrations may be modest.

Nicotinamide

Nicotinamide is available in products over the counter and as a supplement.

A small 2017 review of 10 studies called for more research, however, two studies of oral nicotinamide supplementation suggested it led to a significant reduction in acne.

Peptides

A 2021 review listed antimicrobial peptides as a promising treatment for acne. This ingredient reduces bacteria, a trigger for acne, though more research is needed to confirm its effectiveness.

Azelaic acid

Azelaic acid, found in cleansers and creams, is a naturally-occurring ingredient with antibacterial and anti-inflammatory properties.

A 2021 review suggested it could help with acne treatment and post-inflammatory discoloration.

Azelaic acid may cause more hyperpigmentation in individuals with darker skin. Mild stinging is also a noted side effect.

Glycolic acid

Schoor says glycolic acid is good for exfoliation, which can help with cell turnover.

A 2020 study indicated that even at concentrations as low as 0.2%, glycolic acid could be an effective OTC treatment for acne.

Vitamin A

Retinols and retinoids are both vitamin A derivatives, but retinoids typically require a prescription.

Differin gel is the only retinoid that’s currently available OTC.

Schoor says it’s very effective in treating acne, and that OTC retinols are often effective at treating mild forms of acne as well.

Natural and DIY options

There’s not much evidence to support the efficacy of natural and DIY remedies for acne. Still, some herbs and home remedies can be used.

A few ingredients that have come up in research include:

Green tea

A 2019 study indicated that green tea extract has anti-inflammatory properties.

The main polyphenol in green tea, known as epigallocatechin-3-gallate (EGCG), may have sebo-suppressive effects. It inhibits the growth of P. acnes and has anti-inflammatory benefits, according to a 2016 review.

Still, other studies of green tea’s efficacy in reducing acne showed no improvement, the 2016 review noted.

Tea tree oil

A 2021 review suggested that tea tree essential oil may be as effective as topical benzoyl peroxide or salicylic acid for mild to moderate acne, but researchers noted the evidence was low quality.

Basil oil

A 2021 review indicated basil essential oil might reduce acne lesions.

A 2016 review also suggested that Ocimum gratissimum, a form of basil oil, reduced lesions faster than 10% benzoyl peroxide lotion. Another study mentioned by the authors indicated that Ocimum sanctum and Ocimum basilicum, two other forms of basil oil, may have antimicrobial activity against P. acnes.

While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of essential oils. It’s important to talk with a healthcare professional before you begin using essential oils and be sure to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.

Copaiba Oil

A 2016 review indicated that this ingredient might help heal pre-existing pustules and prevent future pustule outbreaks if used for 21 days. Another study mentioned by the authors noted its anti-inflammatory effects.

Minerals

A 2021 review indicated that research suggests that seaweed-based therapies may help treat acne lesions.

A 2016 review suggested clay minerals like talc, often used in masks, may help acne treatment, particularly blackheads and spots.

Treating acne goes beyond visits to a dermatologist’s office. Tweaking aspects of your lifestyle and routine may aid in the reduction of the condition.

Skin care routine

Maclellan says the most important lifestyle tweak someone with acne can make is implementing a daily skin care routine that reduces their type of acne.

“When I say daily skin regimen, I mean a multi-step approach,” Maclellan says.

Though ingredients may vary based on the type of acne and individual, Maclellan says the six basic building blocks are consistent.

“There’s a myth that your face is dirty if you have acne,” Maclellan says, adding that it prompts some people to scrub their face. This action actually harms the skin barrier, which Maclellan says can exacerbate acne.

Washing twice per day with a gentle cleanser is a better solution, he says.

He recommends looking for a cleanser with benzoyl peroxide. Patch test it on a small area of skin for a few days. If you notice irritation, Maclellan suggests opting for a cleanser with salicylic acid.

Exfoliating with an alpha or beta hydroxide acid, such as salicylic or glycolic acid, can nix the dead skin cells that worsen acne.

Maclellan says a retinol or retinoid cream not only typically helps with any type of acne, but it has benefits for skin starting to show signs of aging as well.

Retinoid creams can make your skin even more susceptible to sunburns. Wearing a sunscreen of at least SPF 30 and reapplying every 2 hours if you’re in the sun is critical.

Maclellan suggests using a mineral-based sunscreen, as chemical sunscreens can irritate acne-prone skin.

Diet

Some research suggests diet may contribute to acne.

Research from 2016 suggested a link between high sugar foods and acne. The researchers also indicated a weak association between acne and dairy consumption.

The AAD notes that low glycemic foods may reduce pimples and that some evidence suggests cow’s milk — but not yogurt and cheese — may affect acne.

A 2021 study indicated that participants with acne had higher fast food intake but lower dairy intake than non-acne participants. Consumption of vegetables and water did not have a significant effect.

Mental health care

Though there have been several studies that suggest acne can trigger stress, there’s limited research about the reverse.

A 2017 review suggests that the idea that stress can trigger or worsen acne is underestimated. Researchers called for a holistic approach to treatment that includes working with mental health professionals.

Therapy can be an important part of acne treatment. This includes modalities like cognitive behavioral therapy (CBT) for anxiety and OCD, as well as more generalized therapy for support with self-esteem and confidence.

Maclellan notes acne can occur anywhere there are sebaceous glands. He says the areas with the most oil glands and most prevalence of acne are:

  • the face
  • shoulders
  • upper back
  • chest

The face is the primary spot where acne occurs, but certain types of acne are more likely to appear on specific body parts.

The appearance of each type of acne will be more or less the same wherever it appears on the body, as will the treatment.

Acne on the lower face and jawline

Hormonal acne usually appears on the lower face and jawline. It presents as deep cysts and nodules.

Treatments can include:

  • retinoids
  • oral antibiotics
  • topical use of benzoyl peroxide
  • topical use of azelaic acid
  • topical use of Winlevi (clascoterone)
  • spironolactone for females

Hormonal treatments, such as birth control, are also commonly prescribed, Secrest says.

Acne on the back and body

Secrest says tight-fitting clothes and backpacks can trigger acne mechanica on the back and body. Avoiding these items can help reduce this issue. Otherwise, standard treatments apply.

Try washing with a gentle cleanser containing acne-fighting ingredients like benzoyl peroxide, retinoid cream, and topical antibiotics.

The back is also a common spot for acne conglobata to appear, according to 2018 research.

Acne on the buttocks

Severe acne conglobata can also appear on the buttocks, particularly in adolescent males.

Potential treatment options include:

  • antibiotics
  • glucocorticoids
  • surgical incisions
  • retinoids
  • excision, the use of a scalpel to remove tissue above the fat layer.

The AAD notes that acne can affect a person emotionally as well as physically, including triggering anxiety, depression, and feeling alone.

But people should feel comfortable living their day-to-day lives, and Maclellan says there are ways to do so without worsening acne.

At the gym

A 2021 study did not indicate a link between exercise and acne. Still, Maclellan says some behaviors at the gym can trigger acne by spreading bacteria and clogging pores.

Taking some extra steps at the gym can help prevent post-workout breakouts, including:

  • removing make-up before a workout
  • wearing clean workout clothes
  • applying sunscreen before heading out, and reapplying every 2 hours if you’re taking an outdoor fitness class
  • toweling off and reapplying sunscreen to dry skin after sweating and before heading home
  • wiping down equipment before use
  • showering and using a gentle cleanse after working out

Maclellan says it’s best only to get the skin wet twice per day. Scheduling your workout in the morning or evening can help ensure you aren’t washing the skin and breaking down the barrier too often, he says.

In the sun

Maclellan says people with oily, acne-prone skin may be hesitant to wear sunscreen, as their skin already feels greasy. However, it’s essential.

Broad-spectrum, mineral-based sunscreens of SPF 30 or higher are the least irritating for people with acne, he says.

Maclellan says people with oily, acne-prone skin may be hesitant to wear sunscreen, as their skin already feels greasy. However, it’s essential.

Remember, retinoids can up the risk of sunburn. Some individuals taking retinoids may need to avoid the sun, particularly during peak hours of 10 a.m. to 4 p.m.

At the pool

A dip in an indoor or outdoor pool shouldn’t affect acne too much, particularly if you follow a few best practices, Maclellan says. These include:

  • Wear broad-spectrum, water-resistant sunscreen and reapply to dry skin after getting out of the water.
  • Check the water resistance of the sunscreen on the bottle, and be sure to reapply to dry skin as needed.
  • Moisturize, as pool chemicals may dry out the skin.

Maclellan adds that it’s acceptable to rinse off in the shower after going in the pool but avoid overwashing or scrubbing the skin.

Secrest breaks down acne development and treatment by age into three general groups: Tweens, teens, and 20+. Here’s what to know about dealing with acne throughout your life.

Ages 10 to 12

Secrest says this is the age people typically notice blackheads or whiteheads. He most frequently sees it in the T-Zone (forehead and middle of the face). He suggests opting for a retinoid.

Adapalene is available over the counter. Tretinoin, or Retin-A, can be prescribed by a dermatologist.

Instructing tweens to avoid picking at acne can help them avoid scarring later.

Ages 13 to 19

As people hit their teenage years, Secrest says acne becomes a combination of comedonal and inflammatory acne and requires a combination of treatments.

He suggests Adapalene for comedones and larger pores.

For inflammatory acne, Secrest recommends using an antibacterial wash, preferably with benzoyl peroxide, on the face, shoulders, chest, and back.

“The benzoyl peroxide needs time to soak into the skin, so I recommend to patients to rinse their faces in the shower, apply the benzoyl peroxide, and then leave it on for at least 5 to 10 minutes before rinsing it off,” Secrest says.

Ages 20+

Secrest says he treats just as many adults as teens and tweens these days, and the triggers can vary. If the usual rounds of topical washes aren’t working, it’s best to see a dermatologist for prescription topical or oral medication.

Adult hormonal acne has deeper cysts and nodules that often appear on the lower face and around the jawline, Secrest says. The breakout can last for weeks.

“Because these are deep acne spots, they rarely respond to topical over-the-counter acne products, so a visit to a dermatologist is necessary to prescribe a medication to counter the hormonal imbalance,” he says.

Acne from supplements

Secrest says testosterone treatments are a common cause of medication-induced acne.

“Very few [people] I have seen are willing to give up their testosterone supplements, so they need strong oral acne medications to combat this medication’s side effects,” he says.

Have more questions about acne? We’ve got you covered.

What’s the best acne treatment?

The best acne treatment is the one that works best for your skin and acne type. No one treatment works for everyone.

Mild acne, particularly blackheads and whiteheads, can often be treated with OTC topical products, such as cleansers or creams with benzoyl peroxide.

Inflammatory acne typically needs prescription-strength medications and creams, such as retinol and oral antibiotics. Sometimes, surgery, lasering, or another physical procedure is required to reduce the appearance of scarring.

Acne isn’t just triggered by physiology. Mental health can also be at play.

Some conditions, like anxiety and OCD, may prompt compulsive picking and cause scarring. Stress may also play a role in breakouts. Medications like selective serotonin reuptake inhibitors (SSRIs), talk therapy, and other de-stressing activities like exercise can aid in the treatment of these issues.

How do I get rid of acne in 5 minutes?

It’s not possible to nix acne in 5e minutes, but you can reduce its appearance.

Secrest says that anecdotally, Visine may reduce redness. Concealers can also cover up pimples.

Icing the pimple can minimize pain and swelling, according to the AAD.

How do I get rid of acne overnight?

Maclellan says using a cleanser with an acne-fighting product like benzoyl peroxide or salicylic acid can help reduce acne quickly, though you may not be able to get rid of it overnight.

You may be able to find spot treatments, such as creams, with a higher concentration of benzoyl peroxide at a drugstore.

Still, he cautions about overdoing it — especially if your cleanser already has the ingredient. It’s irritating and can worsen skin damage.

Scrubbing hard will also damage skin, so avoid it.

What is the ultimate cure for acne?

There’s no cure for acne, Schoor and Maclellan say: only treatments.

A skin care regimen that includes twice-daily use of a cleanser and moisturizer with ingredients proven to treat acne, such as benzoyl peroxide, is your best bet.

SPF is also a must to prevent further skin damage. Some forms of acne require prescription-strength products, oral antibiotics, and physical treatments like lasering.

Speak with a dermatologist if OTC remedies aren’t working for you.

How can I drastically reduce acne?

First, figure out what type of acne you have and the severity. That will determine whether you need prescription-strength or OTC treatments. A dermatologist can help you figure that out.

At home, use a cleanser with an ingredient like benzoyl peroxide, glycolic acid, or nicotinamide twice per day.

Apply sunscreen daily and reapply every 2 hours if you’re in the sun. Try to refrain from scrubbing the face or popping pimples, as that will only cause more skin damage. Take any medications as prescribed.

Consider lifestyle changes, such as mental health treatment for stress or compulsive pimple picking, and dietary changes at the discretion of a medical professional.

Acne treatments may have unwanted side effects, particularly under certain conditions. Secrest warns benzoyl peroxide may dry out skin, so using a moisturizer is necessary.

Forget the myth that drying out the skin will solve acne, Maclellan urges. “Dry skin will try to produce more oil,” he says.

Schoor adds that doxycycline, a common antibiotic used for acne, can cause sun sensitivity and worsen reflux. Retinoids can also exacerbate sun sensitivity.

Sun protection is essential all the time, especially during acne treatment.

Individuals who are pregnant or trying to become pregnant will need to speak with their providers, Schoor says. Retinoids should be avoided during pregnancy.

Acne can occur at any age, and treatment isn’t one-size-fits-all. The best course for you will depend on the type of acne you have, the severity, and how your body reacts to specific treatments.

Though there’s no cure for acne, multiple therapies are available. These range from OTC and prescription topical products to antibiotics and physical treatments like surgery or lasering.

A skin care regimen that includes washing with a cleanser twice per day and using SPF is a way to reduce acne and prevent reoccurrence and further skin damage.


Beth Ann Mayer is a New York-based freelance writer and content strategist who specializes in health and parenting writing. Her work has been published in Parents, Shape, and Inside Lacrosse. She is a co-founder of digital content agency Lemonseed Creative and is a graduate of Syracuse University. You can connect with her on LinkedIn.

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