This updated guide explains contemporary acne management: dermatologists handle severe and scarring cases while primary care can treat mild acne. Treatment goals are to heal lesions, prevent new ones, avoid scarring, and reduce psychological impact. Topical agents (benzoyl peroxide, retinoids like adapalene, salicylic acid) remain first-line. Oral antibiotics, hormonal therapies, and isotretinoin are used for more severe disease, with isotretinoin subject to pregnancy-prevention programs. Procedures (peels, lasers, microneedling) address persistent lesions and scarring. Expect 6-12 weeks for improvement and consult a dermatologist for nodules, scarring, or treatment-resistant acne.

Who treats acne

Dermatologists are the skin specialists who manage all forms of acne, with priority given to moderate-to-severe or scarring cases. Primary care doctors, family physicians and pediatricians commonly treat mild acne and can start first-line therapies or refer when needed. If acne affects your wellbeing, seek care - it's a common condition and treatments are effective.

Goals of treatment

Acne care has four practical goals:
  • Heal existing lesions (pimples, pustules, nodules).
  • Prevent new lesions from forming.
  • Reduce the risk of permanent scarring.
  • Minimize psychological distress and social impact.
These aims guide choice of topical, oral, and in-clinic procedures.

Common medications and how they work

Topical treatments are the backbone for mild-to-moderate acne. Key options include:
  • Benzoyl peroxide: antibacterial and comedolytic; reduces Propionibacterium/ Cutibacterium acnes and lowers resistance when combined with antibiotics.
  • Topical retinoids (e.g., adapalene): normalize follicle cell turnover and prevent clogged pores. Low-strength adapalene (0.1%) is available over the counter; stronger formulations require a prescription.
  • Salicylic acid and sulfur: help unclog pores and reduce scale; common in washes and leave-on products.
  • Topical antibiotics: effective short term but should not be used alone due to resistance concerns; combine with benzoyl peroxide or a retinoid.
Oral options for moderate-to-severe acne or widespread inflammation include short courses of tetracycline-class antibiotics (doxycycline, minocycline), hormonal therapies for people with menstrual-related acne (combined oral contraceptives, spironolactone), and oral isotretinoin for severe or treatment-resistant nodulocystic acne. Isotretinoin requires enrollment in pregnancy-prevention and monitoring programs (for example, iPLEDGE in the U.S.).

Procedures and scar treatment

In-office options can speed recovery or treat scarring. These include chemical peels, light and laser therapies, intralesional steroid injections for inflamed nodules, comedone extraction, microneedling, and laser resurfacing for established scars. Microdermabrasion has limited benefit for active inflammatory acne but may help texture when acne is controlled.

What to expect and safety

Most topical therapies take 6-12 weeks to show noticeable improvement; full benefit can take several months. Common side effects are skin dryness, irritation, and increased sensitivity to sun. Follow instructions, start gently, and check with a clinician if side effects are severe or persistent.

When to see a dermatologist

Seek specialist care for nodules or cysts, rapidly spreading or scarring acne, treatment failure after appropriate first-line therapy, or significant emotional distress related to acne. Early, tailored treatment reduces scarring and improves outcomes.
  1. Confirm current status and name of U.S. isotretinoin pregnancy-prevention program (iPLEDGE) and any recent regulatory changes.

FAQs about Acne Treatment

How long before acne treatment shows results?
Most topical treatments require 6-12 weeks to show noticeable improvement; several months may be needed for full effect. Oral therapies can act faster for inflammation, but timelines vary by medication.
Can I use benzoyl peroxide with other products?
Yes. Benzoyl peroxide is often combined with topical retinoids or used alongside oral antibiotics to lower bacterial resistance. It may bleach fabrics and can cause dryness, so start with lower concentrations or alternate-night use.
Are topical antibiotics still recommended?
Topical antibiotics can help but should not be used alone because of antibiotic resistance. They work best combined with benzoyl peroxide or a topical retinoid and for limited durations.
When is isotretinoin appropriate?
Isotretinoin is reserved for severe nodulocystic acne or acne that has not responded to other treatments. It requires close monitoring and strict pregnancy-prevention measures due to high teratogenic risk.
What treatments reduce acne scarring?
For established scars, dermatologists use microneedling, laser resurfacing, chemical peels, dermal fillers, and targeted resurfacing procedures. Early treatment of active acne also lowers the chance of scarring.