Complete Guide to Acne

Acne can be difficult to manage, but there are many treatment options that can help clear your skin. Be honest about how often you have break outs and what you’re doing to cope with them. What you say today will help shape your treatment plan.

Ask Your Doctor . . .

Newly diagnosed:

What might be causing my acne?

What are my treatment options?

Can you recommend over-the-counter products to help my skin?

Do I need to change my bathing and skincare routines?

How quickly will my skin start to look better?

Living with acne:

If my first treatment doesn’t work, what else can I try?

What should I do if I have side effects?

Are there any lifestyle changes I can make to help prevent acne?

Is there anything I can do to prevent acne scars?

How often should I schedule follow-up appointments?

TIP: Always share with your doctor any updates since your last visit—from new medicines to major life changes, including pregnancy or increased stress. These can impact what happens with your skin. And be honest about how your acne is affecting your life, and whether you’re following your treatment plan. Your doctor can’t help you if she doesn’t know what’s really going on.

Acne is a skin condition that includes different kinds of blemishes. Blemishes form when hair follicles (openings, or pores, in your skin’s surface) get plugged up with oil and dead skin cells.

Your follicles are connected to oil glands under the surface of your skin. These glands make oil that usually flows up through your follicles and onto your skin’s surface. But when you have acne, your oil glands make too much oil and shed too many dead skin cells. These mix together and, instead of flowing out, they plug up your follicles. Bacteria can also get trapped inside your follicles and multiply, and this can cause swelling and redness.

TIP: Ask your doctor what may be causing your acne. You can get acne at any age. Hormone changes during puberty, or for women, during your menstrual cycle, pregnancy or menopause, may be the cause. Taking prescription steroids for other health conditions, such as asthma, can also cause acne flare-ups.

Acne is more than just a few pimples on your face. Acne can produce different kinds of blemishes and affect other areas of your body, including your back, chest, neck, shoulders, upper arms and buttocks. Untreated acne can cause permanent scarring that is hard to treat. For patients with skin of color, acne can cause dark spots called post-inflammatory hyperpigmentation.

Types of Acne Blemishes

There are different types of blemishes, and you may have more than one type at a time:

Whiteheads—plugged follicles that close up and bulge, creating a raised, white colored bump.

Blackheads—plugged follicles that stay open. Air (not dirt) turns the plug black.

Papules—small, hard bumps that are often red and sore because of a swollen or inflamed follicle.

Pustules (pimples)—bumps filled with white or yellow pus that are often red and sore. They form when the wall of a plugged follicle breaks just below your skin’s surface.

Nodules—large, solid, sore bumps below your skin’s surface that form when the wall of a plugged follicle breaks deep below the surface.

Cysts (cystic acne)—like nodules, but they’re filled with pus.

Emotional Symptoms

Medical studies have shown that acne can affect your quality of life in serious ways. Having acne can even lead to depression or anxiety. Teenagers are especially at risk for developing depression. Talk to your doctor if your acne is causing you to avoid social situations or stay home from school or work. Your doctor can help clear most kinds of acne, reduce your risk of developing scars or dark spots and help to make old scars and dark spots look better.

Your doctor will recommend a treatment plan to help clear up acne and prevent new breakouts. Caring for your skin will be part of your plan, but your doctor may also give you medicine:

Medicines You Apply to Your Skin

Over-the-counter (OTC) topicals—These are creams, gels, lotions, soaps or pads with medicine in them. The two most common ingredients are benzoyl peroxide and salicylic acid. Some products also contain adapalene, alpha hydroxy acid, resorcinol or sulfur. They work by drying up oil, killing bacteria or getting rid of the dead skin cells that plug your follicles. You can buy these at the store, but first ask your doctor which one is right for you.

Prescription topicals—These can work like OTC topicals and may have similar ingredients, but they may also include antibiotics or medicines with retinoids. Topical antibiotics kill skin bacteria. Retinoids are made from vitamin A, and they help unclog pores. If you take a retinoid, you’ll need to use sunscreen when you’re outside because retinoids make your skin extra sensitive.

Medicines You Take by Mouth

If topical medicines aren’t helping, your doctor may recommend one of these:

Antibiotics—These work by killing bacteria and reducing swelling, and are usually prescribed for less than six months.

Birth control pills (for women)—These affect your hormones to decrease the amount of oil your skin makes. If your doctor says birth control pills are safe for you, you might take them long term.

Spironolactone (for women)—This medicine also affects your hormones to decrease the amount of oil your skin makes. It affects the male hormones in your body so it is only prescribed for women.

Corticosteroids—Your doctor may prescribe these, along with other medicines, to reduce inflammation if you have a severe form of acne. If you have cysts, your doctor may inject corticosteroids directly into them to help them heal more quickly.

Isotretinoin—Your doctor will only prescribe this as a last resort if you have very severe acne. It can have serious side effects, including birth defects if taken during pregnancy. It is a type of retinoid.

TIP: Remember, always tell your doctor about any other prescription or over-the-counter medicines or supplements you’re taking to make sure your new medicines are safe to take together.

Other Treatments

If medicines don’t work to help your acne, your doctor may recommend a procedure like light therapy or a chemical peel. You can also ask about treatments if you are bothered by acne scars or dark spots.

Sticking to It

What keeps you from sticking with your treatment plan?

Skin looks better?

Having side effects?

Costs too high?

Not helping?

Can’t remember?

Takes too much time?

Whether you miss your medicine every week or only once in a while, tell your doctor. Be honest about why you aren’t following your treatment plan, so your doctor can help you.

Small changes in your daily life and habits can help your acne get better. Find out what you need to do, why you need to do it, and a few simple ideas on how to get started.

Don’t pop pimples

WHY: Squeezing a blemish makes it worse by pushing dead skin cells, oil and bacteria down into your skin. It can also cause scarring.

HOW TO START: The urge to pick at blemishes can feel overwhelming. Take a deep breath and put the magnifying mirror away. Ask your doctor if you should use an over-the-counter or prescription spot treatment to help heal blemishes quickly and reduce the urge to pick.

Use Sunscreen

WHY: Sun exposure can cause dark spots on your skin to last longer.

HOW TO START: Choose a daily sunscreen with an SPF of 15 for dark skin or 30 for lighter skin. Some moisturizers include sunscreen. Check the label to make sure your sunscreen or moisturizer protects against UVA and UVB rays.

Reduce stress

WHY: While stress doesn’t cause acne, it can trigger your glands to make more oil, which could make your acne worse.

HOW TO START: Just having acne can be stressful. Work with your doctor to develop a plan for healthy stress relief. Your plan might include things like adding moderate exercise to your day or meditation. (Moderate exercise includes activities like walking, swimming or biking for half an hour five days a week.)

Clean your skin gently

WHY: You can’t scrub acne away. In fact, treating your skin roughly will cause redness and drying, and could make your acne worse.

HOW TO START: Ask your doctor to recommend a gentle cleanser for your face or body. Never scrub your skin during a breakout. Instead, use your hands or a gentle cotton cloth to clean your skin. And don’t use hot water to bathe or shower. It can cause your skin to get really dry.

Wash your face after sweating

WHY: Sweating, especially under a hat or sports helmet, can cause breakouts.

HOW TO START: Shower right away or keep cleansing wipes in your gym bag to gently clean your face and neck after workouts.

Shampoo regularly

WHY: If your hair is oily and touches your face it can transfer oil onto your skin.

HOW TO START: Wash your hair once a day and keep long hair pinned up away from your face and neck.

Moisturize your skin

WHY: Use a lightweight moisturizer that is oil-free and noncomedogenic to prevent drying caused by topical acne medicines. 

“Noncomedogenic” means it won’t clog your pores.

HOW TO START: Ask your doctor to recommend a moisturizer that’s right for you. Apply it twice a day (or as directed by your doctor). Putting on moisturizer right after you bathe or shower will help keep moisture in your skin.

Choose the right makeup

WHY: Some makeup contains oil and can clog your pores.

HOW TO START: Choose makeup that is oil-free. Look for "noncomedogenic" on the label.