What are the treatments for acne?

From the Guidelines

To get rid of acne, use a consistent skincare routine that includes gentle cleansing twice daily with a face wash containing salicylic acid (1-2%) or benzoyl peroxide (2.5-5%), and apply a topical treatment with ingredients like benzoyl peroxide, salicylic acid, or adapalene (Differin) directly to pimples, as recommended by the guidelines of care for the management of acne vulgaris 1.

Treatment Options

For moderate to severe acne, consider over-the-counter products with higher concentrations or consult a dermatologist for prescription options like tretinoin, clindamycin, or oral medications such as antibiotics or isotretinoin 1.

• Topical retinoids, benzoyl peroxide, and topical antibiotics are strongly recommended for acne treatment 1.
• Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy 1.
• Conditional recommendations are made for topical clascoterone, salicylic acid, azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone 1.

Lifestyle Factors

Lifestyle factors matter too—change pillowcases regularly, clean phone screens, maintain a balanced diet low in dairy and high-glycemic foods, manage stress, and stay hydrated 1.

• Results typically take 4-8 weeks to become noticeable, so consistency is key.
• Acne forms when pores become clogged with excess oil and dead skin cells, creating an environment where bacteria can thrive, causing inflammation and breakouts.
• The recommended treatments work by removing excess oil, exfoliating dead skin cells, killing bacteria, and reducing inflammation.

Limiting Systemic Antibiotic Use

Limiting systemic antibiotic use is recommended to reduce the development of antibiotic resistance and other antibiotic-associated complications 1.

• Combining topical therapies with multiple mechanisms of action and combining systemic antibiotics with topical therapies are recommended as good practice statements 1.
• Intralesional corticosteroid injections are recommended as an adjuvant therapy for larger acne papules or nodules 1.

From the FDA Drug Label

If you are pregnant, think you are pregnant or are nursing an infant: No studies have been conducted in humans to establish the safety of tretinoin in pregnant women. AND WHILE YOU'RE ON TRETINOIN THERAPY Use a mild, non-medicated soap Avoid frequent washings and harsh scrubbing. Acne isn't caused by dirt, so no matter how hard you scrub, you can't wash it away. Washing too frequently or scrubbing too roughly may at times actually make your acne worse. Wash your skin gently with a mild, bland soap. Two or three times a day should be sufficient. Pat skin dry with a towel Let the face dry 20 to 30 minutes before applying tretinoin. Remember, excessive irritation such as rubbing, too much washing, use of other medications not suggested by your physician, etc., may worsen your acne.

The treatments for acne include:

• Using a mild, non-medicated soap
• Avoiding frequent washings and harsh scrubbing
• Washing the skin gently with a mild, bland soap two or three times a day
• Applying tretinoin once daily before bedtime, or as directed by a physician
• Using a moisturizer or a moisturizer with sunscreen that will not aggravate acne (noncomedogenic) every morning after washing 2
• Applying Tretinoin Cream or Tretinoin Gel once a day, before retiring, to the skin where acne lesions appear, using enough to cover the entire affected area lightly 2

From the Research

Treatments for Acne

• Topical retinoids are a mainstay of acne treatment, as they expel mature comedones, reduce microcomedone formation, and exert anti-inflammatory effects 3, 4, 5, 6.
• The US FDA has approved tretinoin, adapalene, and tazarotene for acne treatment, while topical tretinoin, isotretinoin, and adapalene are accredited in Canada and Europe 3.
• Topical retinoids have a favorable safety profile, with local adverse effects such as erythema, dryness, itching, and stinging being the most common 3, 4, 6.
• The efficacy and tolerability of topical retinoids vary, with tazarotene 0.1% being more effective than tretinoin 0.025% or 0.1% microsphere gel or adapalene 0.1% gel or cream 4, 6.
• Adapalene 0.1% gel is equally effective to tretinoin 0.025% or tretinoin microsphere 0.1% gel or tretinoin 0.05% cream or isotretinoin 0.05% gel, and is significantly better tolerated than tazarotene 0.1% gel 4, 6.
• Combination therapy with either benzoyl peroxide or topical retinoids plus topical antibiotics is proven most effective for moderate comedonal and mild to moderate papulopustular acne 7.
• For mild comedonal acne, monotherapy with topical retinoids is the treatment of choice 7.