Azelaic acid has been shown to be effective for mild to moderate acne when applied topically at a 20% concentration.[66][129] Treatment twice daily for six months is necessary, and is as effective as topical benzoyl peroxide 5%, isotretinoin 0.05%, and erythromycin 2%.[130] Azelaic acid is thought to be an effective acne treatment due to its ability to reduce skin cell accumulation in the follicle, and its antibacterial and anti-inflammatory properties.[66] It has a slight skin-lightening effect due to its ability to inhibit melanin synthesis, and is therefore useful in treating of individuals with acne who are also affected by postinflammatory hyperpigmentation.[1] Azelaic acid may cause skin irritation but is otherwise very safe.[131] It is less effective and more expensive than retinoids.[1]
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Spot treatments are designed to give problem pimples a mega-dose of concentrated benzoyl peroxide — in a couple of regimens, like the Proactiv Teen Kit, the spot treatment had nearly three times the benzoyl peroxide as its all-over treatment. The logic: If benzoyl peroxide can be irritating to the skin in high concentrations, limiting its intensity to just the pimple itself could save the rest of your healthy skin.

Hydroquinone lightens the skin when applied topically by inhibiting tyrosinase, the enzyme responsible for converting the amino acid tyrosine to the skin pigment melanin, and is used to treat acne-associated postinflammatory hyperpigmentation.[35] By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time.[35] Improvement in skin hyperpigmentation is typically seen within six months when used twice daily. Hydroquinone is ineffective for hyperpigmentation affecting deeper layers of skin such as the dermis.[35] The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone.[35] Its application only to affected areas lowers the risk of lightening the color of normal skin but can lead to a temporary ring of lightened skin around the hyperpigmented area.[35] Hydroquinone is generally well-tolerated; side effects are typically mild (e.g., skin irritation) and occur with use of a higher than the recommended 4% concentration.[35] Most preparations contain the preservative sodium metabisulfite, which has been linked to rare cases of allergic reactions including anaphylaxis and severe asthma exacerbations in susceptible people.[35] In extremely rare cases, repeated improper topical application of high-dose hydroquinone has been associated with an accumulation of homogentisic acid in connective tissues, a condition known as exogenous ochronosis.[35]
Genetics play a big part in who gets acne and how severely, but each blemish can be blamed on some combination of sebum production, a bacteria called Propionibacterium acnes (P. acnes), plugged follicles, and inflammation. Finding a good treatment is really about finding the right combination of ingredients to troubleshoot each of those issues. Some factors that might worsen acne include hormones, certain medications, diet and stress.
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.
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Lavender oil is another favorite of mine, not only because it can help prevent and keeps acne at bay, but it smells amazing, and provides relaxation qualities — something much needed in today’s world. Lavender helps regenerate skin cells, minimize sun spots and even reduce scarring caused by acne. Additionally, it can help reduce swelling and inflammation that may be caused by acne due to the polysaccharides it contains. (20) 
Flutamide, a pure antagonist of the androgen receptor, is effective in the treatment of acne in women.[101][108] It has generally been found to reduce symptoms of acne by 80 or 90% even at low doses, with several studies showing complete acne clearance.[101][109][110] In one study, flutamide decreased acne scores by 80% within 3 months, whereas spironolactone decreased symptoms by only 40% in the same time period.[110][111][112] In a large long-term study, 97% of women reported satisfaction with the control of their acne with flutamide.[113] Although effective, flutamide has a risk of serious liver toxicity, and cases of death in women taking even low doses of the medication to treat androgen-dependent skin and hair conditions have occurred.[114] As such, the use of flutamide for acne has become increasingly limited,[113][115][116] and it has been argued that continued use of flutamide for such purposes is unethical.[114] Bicalutamide, a pure androgen receptor antagonist with the same mechanism as flutamide and with comparable or superior antiandrogenic efficacy but without its risk of liver toxicity, is a potential alternative to flutamide in the treatment of androgen-dependent skin and hair conditions in women.[106][117][118][119]
Keep in mind that even if some products market themselves toward severe acne breakouts, all the kits we looked at are definitely designed for mild to moderate acne. Not sure if you fit on that scale? You’re not alone! When you’re in the middle of a breakout, all acne seems severe, so it can be difficult to self-diagnose your symptoms. We talked to dermatologists and cosmetic chemists to better understand the differences between the various types of acne (see below).
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The main hormonal driver of oily sebum production in the skin is dihydrotestosterone.[1] Another androgenic hormone responsible for increased sebaceous gland activity is DHEA-S. Higher amounts of DHEA-S are secreted during adrenarche (a stage of puberty), and this leads to an increase in sebum production. In a sebum-rich skin environment, the naturally occurring and largely commensal skin bacterium C. acnes readily grows and can cause inflammation within and around the follicle due to activation of the innate immune system.[10] C. acnes triggers skin inflammation in acne by increasing the production of several pro-inflammatory chemical signals (such as IL-1α, IL-8, TNF-α, and LTB4); IL-1α is known to be essential to comedo formation.[45]
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Everything you need to know about cystic acne Cystic acne is an uncommon and severe form of acne. The skin condition results from blocked pores in the skin that cause infection and inflammation. Treatment often requires the help of a specialist doctor who can prescribe potent drugs. Read on to learn about symptoms, causes, diagnosis, and prevention. Read now
Believe it or not, as with adolescent acne, hormones are believed to be mainly to blame. In the case of newborns, however, it’s not their own hormones that are probably prompting the pimple problems, but Mom's — which are still circulating in baby's bloodstream as a holdover from pregnancy. These maternal hormones stimulate baby's sluggish oil-producing glands, causing pimples to pop up on the chin, forehead, eyelids and cheeks (and, sometimes, the head, neck, back and upper chest).
The Anti-Redness Exfoliating Solution is mostly water, but its 2 percent salicylic acid is enough to eat through oil and remove the dead skin cells clogging your pores — and it boasts a higher concentration than nearly every other kit we looked at. Sodium hyaluronate, the super-moisturizing humectant we fell in love with in our review on the Best Face Moisturizer, also caught our eye sitting smack dab in the middle of the ingredients list.
The severity of acne vulgaris (Gr. ἀκµή, "point" + L. vulgaris, "common")[24] can be classified as mild, moderate, or severe as this helps to determine an appropriate treatment regimen.[20] There is no universally accepted scale for grading acne severity.[15] Mild acne is classically defined by the presence of clogged skin follicles (known as comedones) limited to the face with occasional inflammatory lesions.[20] Moderate severity acne is said to occur when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and are found on the trunk of the body.[20] Severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions and involvement of the trunk is extensive.[20][25]
Post-inflammatory hyperpigmentation is not an acne scar, but a red, pink, brown or tan skin discoloration where acne has previously flared up. It'll usually disappear on its own in a year or so. Many skin lightening products claim to help reduce the visibility of these acne "scars." Their active ingredient, hydroquinone, works to slow melanin production and can reduce dark brown marks, but melanin isn't the cause of red and pink acne discolorations. A better option is to use the best foundation for acne prone skin you can find to hide the marks until they naturally fade away.
There are several low-level light devices designed as at-home acne remedies on the market—but do they really work? Some, like the Zeno electronic "zit-zapper" are FDA-approved as acne remedies, but reviews with these products are typically mixed. Even the best acne treatment won't work for everyone, as the severity of the acne, types of acne and quality of the device are all factors. Ask your dermatologist for a recommendation if you're considering purchasing an at-home light device to treat your acne.
Complementary therapies have been investigated for treating people with acne.[151] Low-quality evidence suggests topical application of tea tree oil or bee venom may reduce the total number of skin lesions in those with acne.[151] Tea tree oil is thought to be approximately as effective as benzoyl peroxide or salicylic acid, but has been associated with allergic contact dermatitis.[1] Proposed mechanisms for tea tree oil's anti-acne effects include antibacterial action against C. acnes, and anti-inflammatory properties.[65] Numerous other plant-derived therapies have been observed to have positive effects against acne (e.g., basil oil and oligosaccharides from seaweed); however, few studies have been performed, and most have been of lower methodological quality.[152] There is a lack of high-quality evidence for the use of acupuncture, herbal medicine, or cupping therapy for acne.[151]
Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It's even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.
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