Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity.[137] In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus.[137] Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B).[137] Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel.[47][137] Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm.[137] Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester.[137] Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy.[138] In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters.[137] Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X).[137] Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects.[1] Finasteride is not recommended as it is highly teratogenic.[1]
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Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.

For UVA protection, a sunscreen with a high UVA protection of PA+++ or higher of PA++++ as recommended, especially to treat PIE. PPD is the UVA equivalent of SPF; use a sunscreen with a minimum of PPD20. The PA+ system has a + that corresponds to a tier of PPD protection. Of note, different countries use different PA systems. Japan and Taiwan changed their PA system to a 4+ tier system while Korea uses a 3+ tier system.
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]

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]
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.
Garlic is fantastic for fighting acne due to its high levels of antioxidants, as well as its’ anti-bacterial, anti-fungal, and anti-viral properties. There are two ways you can use garlic to clear up acne. The first is a preventative measure, which is simply by adding more garlic to your diet. This helps your general health as well as purifies your blood, which can help to stop future break outs. For more immediate results, take a peeled clove of garlic and rub it on the troubled area several times a day. If your skin is sensitive, try crushing the garlic and mixing it with some water.
This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
^ White, Stephen D.; Bordeau, Patrick B.; Blumstein, Philippe; Ibisch, Catherine; GuaguÈre, Eric; Denerolle, Philippe; Carlotti, Didier N.; Scott, Katherine V. (1 September 1997). "Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96)". Veterinary Dermatology. 8 (3): 157–164. doi:10.1046/j.1365-3164.1997.d01-16.x. ISSN 1365-3164.

There are a number of mild chemical peels available over the counter, but acne scar removal requires a stronger peel typically administered by a doctor or dermatologist. Trichloroacetic acid (TCA) peels are slightly stronger than alpha hydroxy acid (AHA) peels and may be used for acne scar treatment. The strongest type, phenol peels, may cause significant swelling and require up to two weeks of recovery time at home. Neither are recommended for people with active severe acne.


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.
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]
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.
A major mechanism of acne-related skin inflammation is mediated by C. acnes's ability to bind and activate a class of immune system receptors known as toll-like receptors (TLRs), especially TLR2 and TLR4.[45][64][65] Activation of TLR2 and TLR4 by C. acnes leads to increased secretion of IL-1α, IL-8, and TNF-α.[45] Release of these inflammatory signals attracts various immune cells to the hair follicle including neutrophils, macrophages, and Th1 cells.[45] IL-1α stimulates increased skin cell activity and reproduction, which in turn fuels comedo development.[45] Furthermore, sebaceous gland cells produce more antimicrobial peptides, such as HBD1 and HBD2, in response to binding of TLR2 and TLR4.[45]

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]


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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."
Sometimes birth control alone isn’t enough to really make a difference in hormonal acne. That’s when your doctor might recommend adding in an androgen blocker such as Spironalactone. Spiro (as it’s called) minimizes the amount of androgen hormones in circulation by blocking the receptors that bind with testosterone. When these pills are taken at the same time as an oral contraceptive, 90 percent of women see an improvement in breakouts, according to Linkner. The drug is sometimes prescribed to women with PCOS (polycystic ovarian syndrome) to relieve androgen-related symptoms like excessive hair growth, hypertension, oily skin, and acne.

There are a number of mild chemical peels available over the counter, but acne scar removal requires a stronger peel typically administered by a doctor or dermatologist. Trichloroacetic acid (TCA) peels are slightly stronger than alpha hydroxy acid (AHA) peels and may be used for acne scar treatment. The strongest type, phenol peels, may cause significant swelling and require up to two weeks of recovery time at home. Neither are recommended for people with active severe acne.
3. Self-Care: Self-care practices and lifestyle choices can also help clear complexions. Nutrition, stress management, ample sleep, and good hygiene can help treat existing acne and might be able to prevent it from forming in the first place. Self-care practices can – and should! – be used in conjunction with all skincare treatments; they even deliver health benefits for those without acne problems.
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 swear by the disinfecting power of tea tree oil for acne treatment. It can be applied either full strength or slightly diluted with water directly onto pimples. Use a small amount on a clean cotton swab or cotton pad and dab on the affected areas immediately after cleansing. Because tea tree oil can be drying, you might choose to use both tea tree oil and coconut oil for acne as part of your clear skin regimen.
When we sleep, healing happens, and at the same time, it’s a great time to apply a home remedy and let it get it to work on eliminating toxins that can cause acne. The Psychiatric Clinics of North America reports that stress is a factor affecting all organs. Though it’s easy to forget, the skin is an organ. In fact, it’s your largest organ! Getting plenty of rest can help reduce acne-associated stress. (9) 
Isotretinoin (previously known as Accutane) is the most effective form of acne therapy and the only one that can actually result in a cure for your acne. After finishing a course 80 percent of people never see acne again. It works so well because it unclogs pores, kills bacteria, reduces oil production and reduces inflammation. It's taken as a daily pill. Isotretinoin has numerous rare and potential side effects that has made it a controversial choice, but for patients with severe acne there is often no other option. Patients taking isotretinoin must also be on highly effective birth control as the drug can cause birth defects. Isotretinoin can only be taken under close medical supervision.

Tea tree oil, also known as melaleuca, is one of my favorite and most recommended remedies for acne because it has amazing microbial properties that help fight the bacteria causes acne. A study published in the Australasian Journal of Dermatology revealed that tea tree oil provides positive results for mild acne with no serious adverse effects. The study asked participants to apply tea tree oil to the affected area of the face twice a day for three months with assessments conducted at four, eight and 12 weeks of use. The acne was reduced, making tea tree oil a great choice for how to get rid of pimples. (14)


Finally, we included light therapy devices that treat acne. These are not the laser devices that the dermatologist uses. Instead, these are tools you can use at home to clear up your skin. They usually work best on your face where there is less tissue for the light to penetrate. Plus, you can treat yourself with light therapy at the same time you use salicylic acid or benzoyl peroxide, too.

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.
Warning: Sulfur smells like rotten eggs. But it is an effective ingredient at drying up pus-filled pimples and whiteheads (you’ve gotta take the good with the bad). It works by sucking up the oil. Sulfur is typically mixed with other active ingredients to get the most efficacy and fragrances to mask the strong scent. You can often find it in masks and spot treatments.
A good way to lessen constant acne is to improve your lifestyle choices. Try to maintain a fresh and healthy diet, incorporating a lot of fresh fruits and nuts. Try your best to avoid dairy products and any packaged foods. The more fresh the food is, the better it is for your skin. Exercise is also a vital component in the maintenance of healthy skin. Try to complete some form of cardio for at least 30 minutes a day, 3-4 times a week. If none of this is successful, consider consulting a dermatologist.
Acne usually improves around the age of 20, but may persist into adulthood.[75] Permanent physical scarring may occur.[20] There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts.[3][31][51] Another psychological complication of acne vulgaris is acne excoriée, which occurs when a person persistently picks and scratches pimples, irrespective of the severity of their acne.[61][156] This can lead to significant scarring, changes in the affected person's skin pigmentation, and a cyclic worsening of the affected person's anxiety about their appearance.[61] Rare complications from acne or its treatment include the formation of pyogenic granulomas, osteoma cutis, and solid facial edema.[157] Early and aggressive treatment of acne is advocated by some in the medical community to reduce the chances of these poor outcomes.[4]

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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