When whiteheads and blackheads become infected with bacteria, called Propionibacterium acnes, it leads to inflammatory acne. Regular bacteria is found in most whiteheads and blackheads, but P. acnes is attracted to the closed, oily environment. This bacteria makes acne more difficult to treat. The four different pimple types that characterize inflammatory acne are papules, pustules, nodules and cysts.
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.

Considerations: Because tazarotene is a retinoid (vitamin A derivative), like Accutane, it should not be used by women who are pregnant because of potential harm to the fetus. Exposure to sunlight should be avoided. Wind or cold may be more irritating when taking tazarotene. Side effects occured in 10-30% of patients and included dry peeling skin, burning, stinging, dry skin, redness, and itchiness.


What it is: Spironolactone is a prescription medication in tablet form used to treat certain patients with hyperaldosteronism (the body produces too much aldosterone, a naturally occurring hormone), low potassium levels, and in patients with edema (fluid retention) caused by various conditions.1 Learn more from the U.S. National Library of Medicine.
The use of antimicrobial peptides against P. acnes is under investigation as a treatment for acne to overcoming antibiotic resistance.[10] In 2007, the first genome sequencing of a P. acnes bacteriophage (PA6) was reported. The authors proposed applying this research toward development of bacteriophage therapy as an acne treatment in order to overcome the problems associated with long-term antibiotic therapy such as bacterial resistance.[178] Oral and topical probiotics are also being evaluated as treatments for acne.[179] Probiotics have been hypothesized to have therapeutic effects for those affected by acne due to their ability to decrease skin inflammation and improve skin moisture by increasing the skin's ceramide content.[179] As of 2014, studies examining the effects of probiotics on acne in humans were limited.[179]
But the side effects of targeted breakout cream treatments aren’t always worth it. “So many products instruct consumers to use benzoyl peroxide spot treat red bumps and pustules. I don’t recommend it,” says Dr. Lawrence Green, board-certified dermatologist and assistant clinical professor of dermatology at George Washington University. Such high concentrations of benzoyl peroxide cause added irritation and inflammation to already sensitive skin, so with this in mind, we cut kits that included spot treatments.

Efforts to better understand the mechanisms of sebum production are underway. The aim of this research is to develop medications that target and interfere with the hormones that are known to increase sebum production (e.g., IGF-1 and alpha-melanocyte-stimulating hormone).[10] Additional sebum-lowering medications being researched include topical antiandrogens and peroxisome proliferator-activated receptor modulators.[10] Another avenue of early-stage research has focused on how to best use laser and light therapy to selectively destroy sebum-producing glands in the skin's hair follicles in order to reduce sebum production and improve acne appearance.[10]
The Pore Normalizing Cleanser is designed just to cleanse, not treat, which is a good thing: The Nurse Practitioner study emphasizes the importance of washing with mild cleansers in conjunction with topical acne medications to combat or avoid excessive skin irritation. This one is water-based and fragrance-free, and uses sodium laureth sulfate (as opposed to its harsh cousin sodium lauryl sulfate) to eliminate any chance for irritation.

The recognition and characterization of acne progressed in 1776 when Josef Plenck (an Austrian physician) published a book that proposed the novel concept of classifying skin diseases by their elementary (initial) lesions.[163] In 1808 the English dermatologist Robert Willan refined Plenck's work by providing the first detailed descriptions of several skin disorders using a morphologic terminology that remains in use today.[163] Thomas Bateman continued and expanded on Robert Willan's work as his student and provided the first descriptions and illustrations of acne accepted as accurate by modern dermatologists.[163] Erasmus Wilson, in 1842, was the first to make the distinction between acne vulgaris and rosacea.[164] The first professional medical monograph dedicated entirely to acne was written by Lucius Duncan Bulkley and published in New York in 1885.[165][166]
If these ingredients are overused in any given product then serious damage could occur. Abuse of such ingredients as benzoyl peroxide or salicylic acid can cause your skin to become heavily irritated and even burnt. The only time these ingredients should be used in high doses is under the supervision of a qualified dermatologist. Even then, this should be a last course of action.
How to Handle It: Think of these as bigger, pissed-off whiteheads. Your best bet, says Zeichner, is to stock up on benzoyl peroxide, which kills the bacteria. A spot treatment like Murad Acne Spot Fast Fix ($22) should do the trick. Also, try not to pop them — as tempting as that may be. Since they're inflamed, they're more likely to scar if you go the DIY route.

For some, the right dosage can be found over-the-counter in concentrations as low as 2.5 percent or up to 10 percent, but for others, a prescription dosage is needed to see the best results. Prescription doses rarely go over 10 percent, as benzoyl peroxide is known to cause stinging, burning, itching, flaking, peeling, and redness2 when used in concentrations over 5 percent, but they may combine the benzoyl peroxide with other acne medications.


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