Topical antibiotics deemed safe during pregnancy include clindamycin, erythromycin, and metronidazole (all category B), due to negligible systemic absorption.[46][137] Nadifloxacin and dapsone (category C) are other topical antibiotics that may be used to treat acne in pregnant women, but have received less study.[46][137] No adverse fetal events have been reported from the topical use of dapsone.[137] If retinoids are used there is a high risk of abnormalities occurring in the developing fetus; women of childbearing age are therefore required to use effective birth control if retinoids are used to treat acne.[19] Oral antibiotics deemed safe for pregnancy (all category B) include azithromycin, cephalosporins, and penicillins.[137] Tetracyclines (category D) are contraindicated during pregnancy as they are known to deposit in developing fetal teeth, resulting in yellow discoloration and thinned tooth enamel.[1][137] Their use during pregnancy has been associated with development of acute fatty liver of pregnancy and is further avoided for this reason.[137]
Oral antibiotics are the standard of care in managing acne that is moderate to severe, resistant to topical therapy and covers large body surface areas. Oral antibiotics that may be prescribed to treat acne include tetracycline, doxycycline, minocycline, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim and azithromycin. Combination therapy (the use of two or more therapies) including oral antibiotics and topical medication (often retinoids) may help treat acne.
Recommended therapies for first-line use in acne vulgaris treatment include topical retinoids, benzoyl peroxide, and topical or oral antibiotics.[78] Procedures such as light therapy and laser therapy are not considered to be first-line treatments and typically have an adjunctive role due to their high cost and limited evidence of efficacy.[77] Medications for acne work by targeting the early stages of comedo formation and are generally ineffective for visible skin lesions; improvement in the appearance of acne is typically expected between six and eight weeks after starting therapy.[1]
If you take a close look at the acne-fighting ingredients, you will find that no single ingredient does all the work to get rid of acne. Each one has a unique effect that plays a role in the elimination of acne, but only when they are used combined or in sequence in a system do they have ability to get rid of acne altogether. This is why it is so important to use an effective system for fight acne, not just a single product.
Diet. Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse. A small study of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. Further study is needed to examine why this happens and whether people with acne would benefit from following specific dietary restrictions.
A complete skin care regimen to control acne usually starts with washing. The ideal face wash creates a soft creamy lather in warm water. It rinses off dirt, excess oil, and makeup, leaving the face ready for the next step in daily skin care, whether that is toner, moisturizer, exfoliant, sunblock, or more makeup. It is fragrance-free, and it does not create a foam, film, or tingly sensation on the face. Any product that foams and suds vigorously, like a detergent, is a strict no-no for acne treatment, especially on dry skin.
Even though scientists know how pimples and blackheads are formed, they are still not sure what causes you to have a body full of blemishes and the guy sitting next to you not to have a single spot on his face? It’s probably related to hereditary factors. If your parents dealt with acne when they were younger, you’re more likely to struggle with acne, too.
The side effects depend on the type of treatment you use. Generally, for topical, over-the-counter creams, you can watch out for stinging, redness, irritation and peeling — these side effects usually don’t go any deeper than the skin. Others, like oral antibiotics or hormonal medications, could come with new sets of complications, so we suggest talking to your doctor before pursuing the treatment.
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] 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]
Blue light rays penetrate follicles to kill off acne-causing bacteria. For severe cases, photodynamic therapy adds a topical solution called Levulan to blue light therapy. Note that these treatments can cause temporary redness and may not be covered by insurance. Prices vary greatly depending on the location and severity of acne, but can cost at least $50 for one blue light treatment and $100 or more per photodynamic therapy session. Most patients will need multiple treatments to see effective results, but many dermatologists offer package deals.
Genetics is thought to be the primary cause of acne in 80% of cases.[2] The role of diet and cigarette smoking is unclear, and neither cleanliness nor exposure to sunlight appear to play a part.[2][13][14] In both sexes, hormones called androgens appear to be part of the underlying mechanism, by causing increased production of sebum.[5] Another frequent factor is excessive growth of the bacterium Propionibacterium acnes, which is normally present on the skin.[5]
Acne vulgaris Acne conglobata Acne miliaris necrotica Tropical acne Infantile acne/Neonatal acne Excoriated acne Acne fulminans Acne medicamentosa (e.g., steroid acne) Halogen acne Iododerma Bromoderma Chloracne Oil acne Tar acne Acne cosmetica Occupational acne Acne aestivalis Acne keloidalis nuchae Acne mechanica Acne with facial edema Pomade acne Acne necrotica Blackhead Lupus miliaris disseminatus faciei
Comedonal is the mildest type of acne and doesn’t cause painful swelling or inflammation in most cases. It usually manifests as blackheads or whiteheads on the skin. Blackheads occur when dirt and germs under the skin’s pores cause the skin to appear dark. Males going through puberty, as well as young adults, will experience some form of comedonal acne in their lives. It also may occur because of allergic reactions to skin or hair products, but most acne lesions, such as whiteheads and blackheads, occur because of a hard blockage of excess sebum in skin pores.

Oftentimes, our first instinct when we encounter bumps, pimples and other blemishes on our skin is to touch it. But if you’ve been dealing with acne for a while, you’ve probably learned by now that these practices only make acne and skin problems worse. For starters, our hands come into contact with more bacteria, pathogens and contaminants than any other part of our bodies. Even when we try to wash our hands often, there is only so much of that we can avoid putting on our faces every time we reach out to touch it. So, there’s the fact that we could be adding harmful bacteria our facial skin to begin with. But it doesn’t end there.


How to Handle It: Pair two of the best-known acne-fighting ingredients, salicylic acid and benzoyl peroxide, in the week leading up to your period. (If you're feeling bloated, now's the time to do it.) The combo can help prevent hormonal acne from happening in the first place. Zeichner suggests following a salicylic acid wash, like fan-favorite Neutrogena Oil-Free Acne Wash Pink Grapefruit Facial Cleanser ($7), with a benzoyl peroxide spot treatment, such as Murad Acne Spot Fast Fix ($22). If you're still seeing zits, "visit your dermatologist to discuss prescription options, like birth control pills, oral spironolactone — which blocks oil — or topical Aczone 7.5 percent gel," says Zeichner. "It's shown to be particularly effective in adult women without causing irritation." Oral contraceptives level out those hormone fluctuations, keeping your oil production normal and your skin clear.
The best acne treatment will also include gentle cleanser. Regular bars of soap have harsher cleansers in them that can create problems of their own and encourage bacteria to spread. It is also a good idea to use makeup wipes to clean off any makeup (if you wear it) before you wash your face. Only washing your face without the wipe or wiping your face without the wash is not a good combination. You will either end up missing some of the makeup or you will end up leaving preservatives and other residues on your face.

“We’ve seen it work against a wide range of organisms, including 27 of the 32 strains of acne-causing bacteria,” says Michael Murray, ND, a naturopath and coauthor of The Encyclopedia of Natural Medicine. Multiple studies, including a review of research in the International Journal of Dermatology, back the plant’s power. You can find tea tree oil in a wide variety of soaps, skin washes, and topical solutions. Look for a minimum concentration of 5 percent of the oil to test how your skin reacts. If you find it is too irritating as an all-over treatment, you can use tea tree as a simple spot treatment for more stubborn pimples.
Acne vulgaris and its resultant scars have been associated with significant social and academic difficulties that can last into adulthood, including difficulties obtaining employment.[30][177] Until the 1930s, it was largely seen as a trivial problem among middle-class girls – a trivial problem, because, unlike smallpox and tuberculosis, no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it.[165] During the Great Depression, dermatologists discovered that young men with acne had difficulty obtaining jobs, and during World War II, some soldiers in tropical climates developed such severe and widespread tropical acne on their bodies that they were declared medically unfit for duty.[165]
Pustules, as their name suggests, are filled with pus. They usually have a white or yellow center surrounded by extremely inflamed skin that is pink or red. The pus isn’t just bacteria and skin cells—it contains some dead white blood cells that were trying to fight the bacteria, too. Squeezing these can cause the skin around them to darken and scar.
What it is: You may have heard of tretinoin in reference to "Retin-A" wrinkle treatments. Tretinoin is retinoic acid and vitamin A acid combined, and comes in various strengths in creams, gels, and liquids for topical use on the skin. It is used to treat acne and also to treat sun damaged skin or wrinkles and is usually applied once per day.1Learn more from the U.S. National Library of Medicine.
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.
Simple alcohols like isopropyl alcohol, SD alcohol, and denatured alcohol are everywhere in acne treatment because they trick you into thinking they’re working: Splash some on and any oil on your face instantly vaporizes. However, these ingredients destroy the skin’s barrier, called the acid mantle. When your acid mantle is damaged, you’re actually more susceptible to breakouts, enlarged pores, and inflammation. To make matters worse, evaporating all the oil on your face can actually set your sebaceous glands into overdrive, leaving your skin oilier than ever. If any product included a simple alcohol high up in its ingredients list, we nixed its whole kit.
Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.
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