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If you’re experiencing hormonal acne, acne vulgaris, cystic acne or acne inversa, you should learn the potential sources of your problem. By understanding the cause of your acne, you’ll be better equipped to proactively prevent its formation, rather than just treating it ex posto facto. Watch out for these key acne-inducing factors and their relationship to skin:
Accutane is 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,” says Linkner. A course of Accutane can take about six to nine months. Sometimes patients need to repeat the course at a higher dosage in order to truly eliminate 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]
Whereas acne vulgaris clogs pores from the bottom up, acne inversa (or hidradenitis suppurativa) is a form of acne that clogs pores from the top down. It’s caused by excessively rapid skin growth, occluding the mouth of pores with shed skin cells. When the pores are blocked and clogged, they become inflamed and can create pimples and acne lesions. This form of acne is usually observed in intertriginous skin, where two skin areas may touch or rub together. Induced or aggravated by heat, moisture, maceration, friction and lack of air circulation. Examples of these areas include underarms, folds of the breasts, and between buttocks cheeks.
Side effects include increased skin photosensitivity, dryness, redness and occasional peeling.[81] Sunscreen use is often advised during treatment, to prevent sunburn. Lower concentrations of benzoyl peroxide are just as effective as higher concentrations in treating acne but are associated with fewer side effects.[80][82] Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial antibiotic resistance.[81]
Some people use natural treatments like tea tree oil (works like benzoyl peroxide, but slower) or alpha hydroxy acids (remove dead skin and unclog pores) for their acne care. Not much is known about how well many of these treatments work and their long-term safety. Many natural ingredients are added to acne lotions and creams. Talk to your doctor to see if they’re right for you.

The three-piece set doesn’t come with a sun protection treatment, but Paula’s Choice has one in the line, the Clear Ultra-Light Daily Fluid SPF 30+. “Sun protection is really important, especially with acneic skin,” says Townsend. “In many cases, stronger acne products can make the skin photosensitive to the sun.” This isn’t your normal gloppy white sunscreen. Its fluid formula slips over tender skin, doesn’t need a ton of rubbing in, and also leaves a mattifying finish.
A BHA product often cited includes salicylic acid, it must be between a pH between 3 and 4 to work. A BHA works to slough (to get rid of) off dead skin cells and encourage new skin growth. As a result, you may experience dry skin and scaliness around your acne, but this will dissipate over time as your skin begins to regenerate faster. Use this in a cleanser or spot treatment daily on the acne-affected areas of your skin.[6]
Misperceptions about acne's causative and aggravating factors are common, and those affected by it are often blamed for their condition.[177] Such blame can worsen the affected person's sense of self-esteem.[177] Until the 20th century, even among dermatologists, the list of causes was believed to include excessive sexual thoughts and masturbation.[166] Dermatology's association with sexually transmitted infections, especially syphilis, contributed to the stigma.[166]
The costs and social impact of acne are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over US$2.5 billion each year in direct costs.[13] Similarly, acne vulgaris is responsible for 3.5 million doctor visits each year in the United Kingdom.[20] Sales for the top ten leading acne treatment brands in the US in 2015, have been reported as amounting to $352 million.[176]
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.
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Combination therapy—using medications of different classes together, each with a different mechanism of action—has been demonstrated to be a more efficacious approach to acne treatment than monotherapy.[10][47] The use of topical benzoyl peroxide and antibiotics together has been shown to be more effective than antibiotics alone.[10] Similarly, using a topical retinoid with an antibiotic clears acne lesions faster than the use of antibiotics alone.[10] Frequently used combinations include the following: antibiotic and benzoyl peroxide, antibiotic and topical retinoid, or topical retinoid and benzoyl peroxide.[47] The pairing of benzoyl peroxide with a retinoid is preferred over the combination of a topical antibiotic with a retinoid since both regimens are effective but benzoyl peroxide does not lead to antibiotic resistance.[10]
Look for a mattress that allows enough space so that your partner can move around without impacting you or consider a mattress made for two sleepers like the Sleep Number bed.[1] This bed allows each person to choose their own firmness level. It also minimizes any disturbances their partner might feel. A foam mattress like the kind featured in advertisements where someone jumps on a bed with an unspilled glass of wine will help minimize the impact of your partner’s movements.[2]
Get at least eight hours of sleep. Sleeping kills two birds with one stone, as it helps to relax your body as well as detoxify it. If you aren’t getting enough sleep, chances are your skin hasn’t had the time or ability to renew its skin cells. Regulate your sleep cycle by going to bed at a consistent time every night and sleeping for a minimum of eight hours at least.[12]
Another once-daily gel your dermatologist might prescribe for acne is Aczone 7.5 percent. The active ingredient, dapsone, is both antimicrobial and anti-inflammatory, and it’s proven to help with blackheads, whiteheads, and deeper painful pimples. Oftentimes, Aczone is used alongside other acne treatments. And like many of those other remedies, Aczone can cause skin to dry out.
Like baby acne, eczema is very common in newborns, but it’s usually caused by dry (not oily) skin. Mild eczema can cause lots of small bumps, similar to baby acne. Since it often starts on the cheeks, it’s easy to confuse with baby acne. But, if it spreads into a rash that covers the skin or develops in other areas of your baby’s body, such as the folds of his elbows and knees, then it’s probably eczema, not acne. Eczema isn’t usually serious. You can treat it by using a gentle hydrating lotion on your baby’s skin after bathtime.
Contrary to the marketing promises of “blemish banishers” and “zit zappers,” immediate results are not the trademark of acne treatments — a frustrating truth to anyone suffering through a breakout. And while pimples are personal (your stress-induced spots will look and act differently than your best friend’s breakout), the best acne treatments will include a regimen of products to hit all of acne’s root causes. We tested 43 kits to find the most well-rounded breakout-fighting solutions on the market.
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Baby acne is usually mild, and it’s limited to the face 99 percent of the time, says Teri Kahn, MD, clinical associate professor of dermatology and pediatrics at University of Maryland School of Medicine and Mt. Washington Pediatric Hospital in Baltimore. “Typically, baby acne appears in the form of little whiteheads and blackheads on the forehead, cheeks, and chin,” she says. Other skin conditions, like eczema, show up on other parts of the body.


Popping pimples seems to be the quickest way to make the red spots on our skin disappear. But it can permanently damage your skin! When you squeeze a pimple, you’re actually forcing the oil substance and dead skin cells deeper into the follicle. The extra pressure exerted will make the follicle wall rupture, and spill the infected materials into the innermost part of our skin. This skin damage will lead to the loss of tissue, and finally cause acne scars.[2]
Cystic Acne: The most severe type of acne, cystic acne requires dermatological care and prescription acne medication to treat. Even the best acne products available over the counter are no match for this painful condition in which the area of the outbreak becomes inflamed, but not infected. Cystic acne can result in permanent scarring. However, it's important to know that all acne lesions can scar. Scarring is related to size, amount of inflammation, genetics and delay in therapy.
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Back acne (sometimes called "bacne") is a potentially embarrassing and sometimes painful condition where clogged hair follicles on the back cause pimples and blackheads. Back acne can be caused by the same factors as other types of acne: diet, hormones, certain medications, genetics or any combination thereof. But when you're considering how to get rid of back acne, also remember that most people have their back covered the majority of the day. The clothing we wear matters, and the way in which we wash the skin on our back is key for clear skin, the whole body over. Learn more about common back acne causes, the best acne products for your body, and how to prevent acne on the back from returning in this section.

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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.

Acne is different for everyone, but there may be some simple solutions to having clear skin. From the foods you eat to the stress in your life and the products you use, it may take a little time to find what works for you, but positive changes can greatly affect your life and the life of your children that may be affected by acne. If using essential oils, make sure to use pure oils and take it slow. Check with your doctor before using anything new.
The verdict on smoking and its relationship to acne is still undecided. The evidence goes back and forth; while many studies seem to prove this theory, other studies contradict such research. For example, research published in 2001 by the British Journal of Dermatology concluded that out of 896 participants, smokers tended to have more acne in general; the more they smoked, the worse their acne felt and appeared. Confusingly, a study published just five years later in the Journal of Investigative Dermatology offered opposing research; nurses interviewed over 27,000 men within a span of 20 years and found that active smokers showed significantly lower severe than non-smokers. Although smoking’s relationship with acne vulgaris is undetermined, smoking has proven effects on acne inversa. It also disrupts hormonal balance, lowers vitamin E levels (an essential antioxidant in skin), induces higher instances of psoriasis, decreases oxygen flow to skin cells, and slows the healing process of open sores. Acne aside, smoking promotes wrinkles and premature aging. Did we mention it’s also deadly? Kick this habit to the curb; your skin will thank you.
Scientists initially hypothesized that acne represented a disease of the skin's hair follicle, and occurred due to blockage of the pore by sebum. During the 1880s, bacteria were observed by microscopy in skin samples affected by acne and were regarded as the causal agents of comedones, sebum production, and ultimately acne.[164] During the mid-twentieth century, dermatologists realized that no single hypothesized factor (sebum, bacteria, or excess keratin) could completely explain the disease.[164] This led to the current understanding that acne could be explained by a sequence of related events, beginning with blockage of the skin follicle by excessive dead skin cells, followed by bacterial invasion of the hair follicle pore, changes in sebum production, and inflammation.[164]
Topical antibiotics deemed safe during pregnancy include clindamycin, erythromycin, and metronidazole (all category B), due to negligible systemic absorption.[47][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.[47][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.[20] 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]
Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It doesn't necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
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.
Oral antibiotics are recommended for no longer than three months as antibiotic courses exceeding this duration are associated with the development of antibiotic resistance and show no clear benefit over shorter courses.[87] Furthermore, if long-term oral antibiotics beyond three months are thought to be necessary, it is recommended that benzoyl peroxide and/or a retinoid be used at the same time to limit the risk of C. acnes developing antibiotic resistance.[87]
How to Handle It: Your best bet is benzoyl peroxide. "Benzoyl peroxide can kill acne-causing bacteria and reduce inflammation," says Zeichner. Try a cream like the La Roche-Posay Effaclar Duo Dual-Action Acne Treatment ($37), which also exfoliates with lipo-hydroxy acid. Be aware that it can seriously dry out skin so moisturize well after you use it.
Another vice that can lead to worsened acne is alcohol. As we mentioned, your diet and acne are related. One glass of wine won’t trigger a breakout – even contains beneficial antioxidants! – but excessive alcohol consumption can alter your hormone levels. Making matters worse, many people drink due to stress, which also affects acne-inducing hormones. Alcohol impairs the liver’s ability to purify toxins, and if the liver is compromised, toxins are expelled through different channels such as your skin. It’s full of that sugar we just warned you about and weakens your immune system, which inhibits your body’s natural ability to fight off P. acnes bacteria. If you pass out after a night of drinking without washing your face, your pores are more likely to become clogged and create pimples. Almost everyone enjoys indulging in a drink every now and then, but moderation here is key.
Similar to the above natural acne remedies, these acne treatments can be inexpensive and worth giving a try. Best of all, these use products you probably already have in your household, like apple cider vinegar and toothpaste. Use home remedies for acne with caution if you have cystic acne, open sores or inflammatory acne, which are best treated with medical supervision.
A nodule is an abnormal tissue growth which can either develop just below the skin or anywhere within the skin’s three layers (the epidermis, dermis, and subcutaneous tissue). Nodules commonly form in regions such as the face, neck, armpits, and groin, although they can also develop on internal organs such as the lungs, thyroid, and lymph nodes. They create solid, raised lumps that are more than 1 to 2 centimeters in diameter, with the potential to reach up to the size of a hazelnut. Nodules are hard and firm to the touch, unlike cysts whose pus makes them softer to the touch. This type of severe acne should be consulted by a doctor, as it might be indicative of a more serious condition.
Topical and oral preparations of nicotinamide (the amide form of vitamin B3) have been suggested as alternative medical treatments.[134] It is thought to improve acne due to its anti-inflammatory properties, its ability to suppress sebum production, and by promoting wound healing.[134] Topical and oral preparations of zinc have similarly been proposed as effective treatments for acne; evidence to support their use for this purpose is limited.[135] The purported efficacy of zinc is attributed to its capacity to reduce inflammation and sebum production, and inhibit C. acnes.[135] Antihistamines may improve symptoms among those already taking isotretinoin due to their anti-inflammatory properties and their ability to suppress sebum production.[136]
Acne that’s more inflammatory is denoted as moderate acne. This happens when there are occasional nodules and possibly mild scarring. Severe acne occurs when there are a lot of inflammatory lesions, nodules and possibly scarring. It’s also considered severe if the acne is still present after six months of treatment or if it causes serious psychological issues.

Whereas acne vulgaris clogs pores from the bottom up, acne inversa (or hidradenitis suppurativa) is a form of acne that clogs pores from the top down. It’s caused by excessively rapid skin growth, occluding the mouth of pores with shed skin cells. When the pores are blocked and clogged, they become inflamed and can create pimples and acne lesions. This form of acne is usually observed in intertriginous skin, where two skin areas may touch or rub together. Induced or aggravated by heat, moisture, maceration, friction and lack of air circulation. Examples of these areas include underarms, folds of the breasts, and between buttocks cheeks.


The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle.[1] In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle.[10] However, increased production of oily sebum in those with acne causes the dead skin cells to stick together.[10] The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone.[10] This is further exacerbated by the biofilm created by C. acnes within the hair follicle.[45] If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo).[1][10][20] In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).[1][10]
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