A 2013 study on acne vulgaris in The Nurse Practitioner concurred that a multidimensional approach to acne is usually necessary because most people have a combination of symptoms. Based on the advice of dermatologists and aestheticians, we turned our focus to regimen sets, analyzing the ingredients of more than 40 kits before finding our top picks.
1. Topical Treatment: This refers to acne medications which are applied directly onto the skin, such as creams, gels, serums and ointments. Topical treatments can be found over-the-counter (OTC) or at a pharmacy when prescribed by a doctor. If you’re shopping for topical treatment solutions, look for products that contain acne-fighting ingredients such as salicylic acid, benzoyl peroxide, and glycolic acid that can penetrate pores to loosen and dissolve debris. Topical solutions are generally best suited to treat mild to moderate acne. 2. Systematic Treatment: Systemic acne medications are consumed orally, such as antibiotics or hormone pills, and work from the inside out to help clear your complexion. Antibiotics can help kill the bacteria lodged within infected pores to reduce inflammation, redness and swelling. Hormones pills such as birth control are frequently used to regulate androgen levels and treat hormonal acne. You won’t be able to purchase systemic treatments OTC and will need a doctor’s recommendation for these medications. 
Chemical peels can be used to reduce the appearance of acne scars.[32] Mild peels include those using glycolic acid, lactic acid, salicylic acid, Jessner's solution, or a lower concentrations (20%) of trichloroacetic acid. These peels only affect the epidermal layer of the skin and can be useful in the treatment of superficial acne scars as well as skin pigmentation changes from inflammatory acne.[32] Higher concentrations of trichloroacetic acid (30–40%) are considered to be medium-strength peels and affect skin as deep as the papillary dermis.[32] Formulations of trichloroacetic acid concentrated to 50% or more are considered to be deep chemical peels.[32] Medium-strength and deep-strength chemical peels are more effective for deeper atrophic scars, but are more likely to cause side effects such as skin pigmentation changes, infection, and small white superficial cysts known as milia.[32]

The other downside to Proactiv+ is that the bottles are small — like, half the size of Paula’s Choice small. Combine that with its recommended two or three-times daily application, and you’re going to be going through a lot of kits, which ultimately means spending more money on your treatment. If Proactiv is the only thing that works for you, it may very well be worth the investment, but we recommend starting with Paula’s Choice to see if you can get the same results at a cheaper price.
While you can certainly benefit from a great skin-care regimen, "in cystic acne, usually you need internal treatment," he says. "Topical medications usually don't work. Accutane is a great miracle cure for really bad cystic acne, but most people with cystic acne will improve with oral antibiotics — sometimes for two weeks, sometimes for three weeks."
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]
C. acnes also provokes skin inflammation by altering the fatty composition of oily sebum.[45] Oxidation of the lipid squalene by C. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels.[45] Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4).[45] LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein.[45] PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells.[45] The inflammatory properties of C. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase.[45] These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.[45]
Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties.[132][133] It opens obstructed skin pores and promotes shedding of epithelial skin cells.[132] Salicylic acid is known to be less effective than retinoid therapy.[20] Dry skin is the most commonly seen side effect with topical application, though darkening of the skin has been observed in individuals with darker skin types.[1]
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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]
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.
It’s no surprise that coconut oil may help since it’s so useful in just about anything. But there is a reason for this. Coconut oil contains properties that encourage the elimination of bacteria, which is why there are so many uses of coconut oil for skin. Lauric acid is the main ingredient in coconut oil, and this acid that makes it an effective treatment against acne because it provides antibacterial results. (17)  

Whereas blackheads are open, whiteheads are closed comedones. They appear as small, white, round bumps on the skin’s surface. Whiteheads form when a clogged pore is trapped by a thin layer of skin leading to a buildup of pus. They range in size – from virtually invisible to large, noticeable blemishes – and can appear on the face or all over the body. Whiteheads are generally painless and non-inflammatory, so they don’t exhibit redness or swelling. Although they are unsightly, this type of pimple is generally considered a mild form acne.
If one partner likes bringing devices to bed and the other partner doesn’t, there’s very little compromise to be found. Science is pretty unanimous on the fact that screens can cause harm to a healthy sleeper. Both partners should agree on a time to keep technology out of the bedroom or turn screens off. This will prevent both partners from having their sleep interrupted and can help you power down after a long day.
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Dermal or subcutaneous fillers are substances injected into the skin to improve the appearance of acne scars. Fillers are used to increase natural collagen production in the skin and to increase skin volume and decrease the depth of acne scars.[146] Examples of fillers used for this purpose include hyaluronic acid; poly(methyl methacrylate) microspheres with collagen; human and bovine collagen derivatives, and fat harvested from the person's own body (autologous fat transfer).[146]
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]
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Oh, hello old friend. Salicylic acid is the go-to fix for pimply preteens. And cruising through the aisles at the drugstore, you’ll find it as the active ingredient on the majority of products labeled “acne wash” or “spot treatment.” Salicylic acid is a beta-hydroxy acid that works by dissolving excess oil and gently exfoliating away dead skin cells. Salicylic also has anti-inflammatory properties to help with inflamed cystic breakouts that can occur when blockages deep in the hair follicles rupture beneath the skin. It’s best to apply this ingredient as a toner, moisturizer, or leave-on spot treatment instead of a face wash to give it time to do its work. And keep in mind, salicylic acid can dry out the skin if over-applied, so maybe choose only one product with the ingredient to use every day.
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.
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.
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]
Benzoyl peroxide (BPO) is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly skin irritation). In the skin follicle, benzoyl peroxide kills C. acnes by oxidizing its proteins through the formation of oxygen free radicals and benzoic acid. These free radicals are thought to interfere with the bacterium's metabolism and ability to make proteins.[79][80] Additionally, benzoyl peroxide is mildly effective at breaking down comedones and inhibiting inflammation.[78][80] Benzoyl peroxide may be paired with a topical antibiotic or retinoid such as benzoyl peroxide/clindamycin and benzoyl peroxide/adapalene, respectively.[36]
In 2015, acne was estimated to affect 633 million people globally, making it the 8th most common disease worldwide.[9][18] Acne commonly occurs in adolescence and affects an estimated 80–90% of teenagers in the Western world.[19][20][21] Lower rates are reported in some rural societies.[21][22] Children and adults may also be affected before and after puberty.[23] Although acne becomes less common in adulthood, it persists in nearly half of affected people into their twenties and thirties and a smaller group continue to have difficulties into their forties.[2]
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