Acne vulgaris, the most common form of acne, is an inflammatory condition prevalent in both adolescents and adults. 

Research shows that around 85% of people aged between 12 and 24 will develop a minor form of acne.

Without the appropriate acne treatment, open or closed acne lesions — like blackheads or whiteheads — can result in permanent scarring and pigment changes.

Patients may experience a range of acne presentations, from mild to severe and in different locations on the body depending on genetics and the root cause of the condition.

The right acne treatment is essential for controlling the severity of the condition and helping patients feel more comfortable and confident in their own skin.

Treatments for acne vulgaris should help to reduce the frequency and severity of symptoms and improve the skin’s appearance. 

When it comes to the treatment of acne, however, there is no one-size-fits-all approach. The best treatment for your acne may depend on several factors.

Acne treatments generally fall into one of a few categories: over-the-counter treatments, topical retinoids, oral antibiotics, hormonal therapies, or oral retinoids.

At Nava MD, we believe that being informed about your skin allows you to make the best choices for treating its concerns. 

In this article, we help you make sense of different kinds of acne treatments, what to look out for in the ingredients list, and how to beat acne for good.

Types of Acne

Before we take a closer look at different treatment options, it’s important that you’re able to identify different kinds of acne. 

Knowing exactly what is happening to your skin can help you and your doctor decide on a course of action for treating breakouts.

Acne often develops due to a build-up of dead skin cells that clog the pores and get infected by bacteria. There are three kinds of acne; mild, moderate, and severe.

Mild Acne

This is the most common form of acne that occurs on the face. Most people that develop mild acne will only experience a small breakout.

Mild acne typically results in clogged pores with relatively few pimples and pustules. The latter are similar to pimples but are often filled with yellow pus in the center. 

This type of acne is usually treatable with over-the-counter (OTC) acne treatments and by making changes to your diet and lifestyle.

Moderate and Severe Acne

Moderate and severe acne is often caused by a range of factors that are largely out of your control. This includes hormonal changes and genetics. 

Moderate acne typically results in red and swollen inflammatory acne pustules and nodules—painful, hard acne marks that form deep under the skin’s surface.

People with severe acne may experience many large, inflamed pustules and nodules.

It’s also not uncommon for people with severe acne to report physical pain from their acne. Beyond the physical toll, patients must also be aware of the potential effects on mental health.

Treating moderate to severe acne depends on the severity and extent of the breakouts on the skin. 

These two types of acne will require a more aggressive treatment plan that includes a combination of topical treatments, antibiotics, and hormonal therapy.

Types of Treatments

When a dermatologist decides on the best course of action for any form of acne, they will take the following into account:

• The patient's age.
• The severity of the condition.
• Their response to previous treatments.
• Other underlying or causative medical conditions.

Ultimately, topical therapies, oral antibiotics, and hormonal therapies all aim to interrupt the formation of acne at an early stage.

These treatments help manage critical inflammatory acne, hormonal causes, and sebum production while reducing the risk of long-term scarring or physical alteration.

Below, we outline some of the most common treatments for acne.

Topical Therapies: The First Line of Defense

The standard of care for treating mild acne is topical therapy. Moderate acne can benefit from topical treatments depending on the severity of the breakout.

Topical therapies are products that are applied directly to the skin to combat acne. Most topical products take the form of a gel or lotion.

Topical treatments are also antimicrobial, which means they kill or slow down the production of bacteria that cause breakouts. 

Let’s take a closer look at some common topical therapies and what they can do for you.

Over-The-Counter Treatments 

OTC products are generally the first approach patients take on their own to treat acne. 

These products are affordable, readily available remedies and will typically use an antimicrobial solution at a lower potency than a prescription.

Benzoyl peroxide 2.5% and salicylic acid 2% are great examples of effective OTC ingredients. Both ingredients are available in varying concentrations, ranging from 2.5% to 10%. 

Starting with milder concentrations, like a 2.5% solution, is likely better for someone with acne-prone skin.

This is because higher concentrations tend to irritate the skin, causing inflammation and making the skin more prone to acne. 

Salicylic Acid 

Salicylic acid forms part of the alpha-hydroxy acid (AHA) family.

AHAs are primarily used to exfoliate skin and decrease inflammation. They also remove dead skin cells, allowing new cells to be pushed to the skin’s surface. 

This makes salicylic acid an effective treatment for mild acne because it removes excess oil and dead skin cells that clog pores. It also eases irritation and reduces swelling.

Although salicylic acid will take a while to work, you should contact your dermatologist if you don't see results after 6 weeks.

Benzoyl Peroxide

Similar to salicylic acid, benzoyl peroxide fights acne by killing bacteria and unclogging pores.

Benzoyl peroxide helps stave off the effects of cutibacterium acnes that strengthen resistance to antibiotic therapies. 

This topical treatment is effective and relatively fast-acting, but you should discuss using it with your dermatologist first as it can cause skin irritation and peeling.

Benzoyl peroxide and salicylic acid products work best for people with normal to oily skin. Those with sensitive skin should use products containing these ingredients with caution.

These ingredients can be found in products like cleansers, creams, toners, and serums.

While OTC products are popular DIY options to treat acne, evidence is still relatively thin when compared to prescription-strength formulations.

Retinoids

Retinoids are one of the most effective products to treat cystic acne. This product is a vitamin A derivative and is available as an OTC or prescription treatment.

They can play a big part in the health of our skin by accelerating the skin cell turnover process, helping to heal scars and smooth wrinkles more quickly. 

Retinoids also help restore collagen and elastin, and they’re a functional ingredient in many anti-aging beauty products.

The primary application for retinoid therapy is against the microcomedone phase—the early acne phase when dead skin cells accumulate in the pores. 

This is what causes blockages rather than allowing excess oil to flow through and be removed from the skin.

There are two types of retinoids commonly used in skincare; retinol and tretinoin. Retinol is often found in OTC products and is gentler on the skin than some prescription solutions. 

This is because retinol products are “diluted” forms of retinoic acid. 

This means that retinol still needs to be converted into retinoic acid before it can start delivering results.

They also contain inconsistent concentrations and are easily degradable, especially when exposed to light. 

Tretinoin, on the other hand, is pure retinoic acid and activates the body’s Retinoic Acid Receptors (RAR) and Retinoid X Receptors (RXR) directly. 

This makes tretinoin more effective in accelerating the skin’s cell turnover process and producing collagen and elastin. 

Not only does this allow fresh skin cells to travel from the inner layer of the skin to the surface much faster, but it also means you will have cleaner pores, less acne, and fewer dark spots. 

However, due to its strength, it can cause a range of other problems, such as redness and irritation.

Clindamycin

Clindamycin is a topical antibiotic that prevents bacteria from growing and causing infected acne. It’s a prescription medication and is available in a 1% gel or lotion.

Topical clindamycin stops bacteria from multiplying and kills these harmful cells directly. It also prevents clogged pores and shuts down protein production. 

By preventing protein production, clindamycin slows down the bacterial growth that causes acne to develop. 

As an anti-inflammatory ingredient, clindamycin can also soothe painful acne, as well as improve the appearance of inflamed or irritated skin.

Clindamycin is often prescribed with other acne medications, like benzoyl peroxide and tretinoin, because it’s not as effective on its own.

Niacinamide

Niacinamide is one of dermatology’s wonder ingredients because it helps manage and soothe a variety of everyday skin conditions. 

As an OTC vitamin B derivative, niacinamide prevents signs of aging, combats hyperpigmentation, and gives the skin a more radiant look.  

Niacinamide is also a useful ingredient for fighting inflammatory acne because of how effectively it can calm the skin. 

Using niacinamide for acne will help manage excess oil production—one of the main causes of clogged pores and breakouts.

Niacinamide is also non-irritating which makes it suitable for sensitive skin.

Combination Therapy

Using retinoids and antibiotics applied at separate times—depending on compatibility—is typically more beneficial to a patient than using either treatment alone. 

The reason for using medication at different intervals is to avoid oxidation of the retinoid. 

Benzoyl peroxide prevents the growth of a key acne-forming bacteria, P. acnes, allowing retinoids to do their job more effectively without risking future resistance.

In addition, topical forms of erythromycin and clindamycin are effective at reducing inflammation and lesions by as much as 70%. 

Still, these therapies also come with a warning: routine use can lead to resistance within one month when these treatments are used alone. 

Combination therapy can limit the likelihood of such an outcome.

Systemic Therapies: Fighting Severe Acne

Systemic therapies are taken orally, absorbed into the bloodstream, and target specific physiologic pathways to relieve acne symptoms.

They are often the next stage in acne treatment when topical agents do not work or when acne is more severe. 

Standard treatment options include one or a combination of the treatments in the next section. 

Antibiotics

When patients experience moderate to severe acne and topical agents are not effective or tolerated, dermatologists might recommend using one of several oral antibiotics. 

The most popular oral antibiotics for treating acne are tetracycline and macrolide.

While some topical treatments have been shown to be more effective, oral antibiotics can have a similar inflammatory reduction response, up to 67%. 

This means that they slow the growth of bacteria, which stops acne from developing and becoming infected. 

Oral antibiotics are most effective when paired with a treatment like benzoyl peroxide to prevent antibiotic resistance.

While there are no common side effects to using oral antibiotics, the medication does make your skin more susceptible to sun damage. 

Dermatologists can prescribe varying or higher doses of many medications to provide more control and improved results. It’s best to allow the drug at least six weeks to see results.

Hormonal Therapy

Hormonal therapy can be an effective treatment for women experiencing moderate to severe acne. 

This is because it helps rebalance hormonal abnormalities that may be contributing to acne formation.

Some of the most effective hormonal therapies for acne are oral contraceptives because they can treat blackheads, whiteheads, nodules, and cystic acne. 

Patients should focus on estrogen-containing oral contraceptives because those containing only progesterone can make acne worse. 

This is because progesterone can increase the production of excess oil on the skin which is known to clog pores and lead to acne breakouts. 

However, a licensed doctor can help you make this decision. 

Excess androgen production was once thought to be the cause of hormonal acne. This led to the development of antiandrogen therapies. 

While this is no longer the common belief, antiandrogen therapy may still be a beneficial treatment for some people. 

This treatment helps to lessen acne scars and doesn’t cause as much skin irritation.

Isotretinoin

Isotretinoin is typically the last option for acne treatment because it is the most aggressive and potentially volatile option. 

It’s an oral retinoid found in potent acne medications such as Accutane and Accutin.

There is no denying its benefits: it decreases sebum production, unclogs pores, reduces bacteria, and is an anti-inflammatory. 

Unfortunately, the medicine carries several risks, such as pancreatitis. A dermatologist will want to monitor isotretinoin patients closely to reduce the likelihood of adverse reactions.

Because of the risks associated with isotretinoin, dermatologists typically only prescribe it in severe cases or those instances where patient history or history with topical or oral therapies indicate it may be necessary. 

Although isotretinoin is suitable for all skin types, people with sensitive skin should speak to their dermatologist about the oral retinoid before starting treatment. 

Patients will also need to submit to a range of tests, including thorough bloodwork, before being prescribed the medication. Dermatologists may repeat these tests monthly or quarterly.

Acne may worsen for the first 1-2 weeks of taking isotretinoin while your body adjusts to the treatment. 

It may also take up to 2 months to start seeing results and prescriptions usually range between 4-6 months.

Remember to Check the Label Before You Buy

Not all acne treatments are created equally. While some will improve the appearance of breakouts, others might do more harm than good.

Here are a few examples of ingredients in products that can clog pores and cause additional skin irritation on acne-prone skin:

• Benzaldehyde 
• Isopropyl Palmitate 
• Coconut oil 
• Parabens
• Algae extract 
• Lanolin

Custom Therapies and the Importance of Dermatological Intervention

Patients with acne-prone skin should recognize the uniqueness of their skin condition. While we all share biological traits, your condition and complexion are unique.

Don’t assume that one therapy will work for you just because it worked for your friend. If you are ever unsure, you should speak to a licensed professional.

A professional can help you understand the specifics of your condition and design or select a custom acne treatment plan specific to your needs.

Dermatologists are trained and experienced in treating acne and similar skin conditions, and their guidance can do wonders to accelerate the process for treatment-seeking acne sufferers. 

It's not just about prescription meds – dermatologists can select the correct combinations and potencies, too.

The Nava MD Solution

At Nava MD, our licensed clinicians want to help you find the best possible products that will treat your acne and improve your complexion. 

Our wide range of offerings includes many of the helpful ingredients listed in this article, such as niacinamide, clindamycin, and tretinoin.

After completing a virtual consultation, you’re connected to a board-certified dermatologist for access to prescription ingredients typically reserved for in-office visits. 

Virtual visits from Nava MD are an affordable, convenient way for patients to avoid the common stressors and costs associated with going to a doctor's office while still receiving the care they need.

It’s the fast, convenient, and affordable way to get acne help from the comfort of your home, with medications delivered to your door if prescribed, and ongoing care from your clinician when required.

Take our free online skin consultation to start your journey to better skin today.

References

https://pubmed.ncbi.nlm.nih.gov/15304471/

https://pubmed.ncbi.nlm.nih.gov/1451291/

https://pubmed.ncbi.nlm.nih.gov/2948929/

https://pubmed.ncbi.nlm.nih.gov/12833004/

https://pubmed.ncbi.nlm.nih.gov/10971320/

https://pubmed.ncbi.nlm.nih.gov/17276540/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080563/

https://pubmed.ncbi.nlm.nih.gov/10951152/

https://pubmed.ncbi.nlm.nih.gov/15814882/