Choose acne treatments based on whether lesions are non-inflammatory (blackheads/whiteheads) or inflammatory (papules, pustules, cysts). Start with OTC options - benzoyl peroxide, salicylic acid, or adapalene - for mild acne. For moderate to severe disease, dermatologists use topical retinoids, antibiotics, hormonal treatments (oral contraceptives, spironolactone), and isotretinoin for nodulocystic or scarring acne. In-office procedures can treat persistent cysts. Complementary remedies like tea tree oil may help but can irritate. Consult a dermatologist for persistent, painful, or scarring acne.

Understand the type and severity of your acne

Acne forms when excess sebum, dead skin cells, and bacteria plug hair follicles. Lesions range from non-inflammatory comedones (blackheads and whiteheads) to inflammatory papules, pustules, and deeper cysts. Treatment depends on lesion type, severity, skin type, and patient factors like pregnancy or hormonal status.

First-line over-the-counter options

For mild, non-inflammatory acne, start with topical over-the-counter (OTC) products. Benzoyl peroxide (available in 2.5-10% strengths) reduces bacteria and inflammation and helps clear pores. Salicylic acid exfoliates inside pores and softens comedones. Adapalene (a topical retinoid) is now available OTC (commonly 0.1%) and normalizes cell turnover to prevent new clogs.

Use one active at a time and introduce products slowly to limit irritation. If skin becomes too dry or irritated, reduce frequency or switch formulations.

Prescription topical and systemic treatments

If OTC care is insufficient, dermatologists prescribe stronger options:
  • Topical retinoids (tretinoin, adapalene prescription strengths, tazarotene) unclog follicles and help fade post-inflammatory marks.
  • Topical antibiotics (clindamycin) are often paired with benzoyl peroxide to lower resistance risk.
  • Oral antibiotics (doxycycline, minocycline) treat moderate inflammatory acne for limited courses to reduce resistance.
  • Hormonal therapies: combined oral contraceptives with certain progestins are FDA-approved for acne in women. Spironolactone, an anti-androgen, is widely used off-label to control hormonally driven acne in adult women.

Isotretinoin for severe or scarring acne

Isotretinoin (commonly known by brand names and generics) is the most effective option for severe nodulocystic acne or scarring disease. It reduces sebum production, shrinks sebaceous glands, and alters skin cell behavior. Isotretinoin requires strict monitoring for side effects, including teratogenicity; people who can become pregnant must follow a regulated pregnancy-prevention program in the United States (iPLEDGE) .

In-office procedures

Dermatologists can treat persistent cysts and comedones with targeted procedures: intralesional corticosteroid injections to flatten painful nodules, sterile drainage or excision for selected cysts, comedone extraction, chemical peels, and some laser/light therapies. These are adjuncts to medical therapy, not standalone cures for most patients.

Complementary approaches and lifestyle

Some topical natural products, like tea tree oil (in low concentrations), show modest benefit but can irritate or sensitize skin. Avoid recommending essential oils as primary therapy. Diet can influence acne in some people - high-glycemic diets and certain dairy products have been linked to worse acne for some - but responses vary. Consider dietary changes under clinician guidance rather than routine allergy testing.

When to see a dermatologist

See a dermatologist for moderate-to-severe inflammatory acne, painful nodules or cysts, scarring, or if OTC and initial prescription treatments fail. Early, appropriate treatment reduces the risk of scarring and improves outcomes.
  1. Confirm current status and recent changes (if any) to the iPLEDGE program and pregnancy-prevention requirements for isotretinoin in the United States.

FAQs about Best Acne Treatments

What over-the-counter products work best for mild acne?
Benzoyl peroxide (2.5-10%), salicylic acid, and OTC adapalene (0.1%) are effective first-line options. Use one active at a time and introduce products slowly to reduce irritation.
When is isotretinoin appropriate?
Isotretinoin is appropriate for severe nodulocystic acne, widespread inflammatory disease that doesn't respond to other therapies, or acne that causes scarring. It requires close monitoring and adherence to pregnancy-prevention protocols.
Are hormonal treatments effective for acne?
Yes. Combined oral contraceptives with certain progestins are FDA-approved for acne in women, and spironolactone is commonly used off-label to treat hormonal acne in adult women.
Can diet or essential oils help acne?
Some people see improvement after reducing high-glycemic foods or certain dairy; evidence varies. Tea tree oil has modest topical benefits but can cause irritation. Use lifestyle changes under clinician guidance.
When should I see a dermatologist?
See a dermatologist for moderate-to-severe acne, painful nodules or cysts, scarring, or if OTC and initial prescription treatments do not help.

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