The first step is to understand the definition of acne, which is the clogging of a pore with dead skin, oil, and bacteria, says Jessie Cheung, MD, a dermatologist based in Chicago. But because there’s no way to know for sure what’s behind a breakout, you’ll want to see a dermatologist about what treatments you should try. Here are popular medication options that can help clear up your skin once and for all.
1. Benzoyl Peroxide
This go-to ingredient is an effective pimple-erasing medication because it helps unclog pores and targets Cutibacterium acnes (C. acnes), the bacteria that causes breakouts. But it doesn’t work overnight. You might notice some improvements after about three weeks, though it can take four to eight weeks for blemishes to fade away, according to the American Academy of Dermatology (AAD). The downside? It can be drying and cause redness and peeling, especially if you have sensitive skin. In general, benzoyl peroxide is a good option for people with mild or moderate acne — for example, those who have some pimples and breakouts but don’t have nodular acne. Extra downside? It can stain towels and clothing. Be sure to let the product absorb fully. Where to Get It Find it in over-the-counter preparations, such as gels, face washes, or spot cream.
2. Glycolic Acid
This alpha hydroxy acid exfoliates the top layer of skin, helping to keep your pores clear. Plus, the treatment also bolsters collagen production, smoothing out lines and wrinkles and lightening dark spots, Dr. Cheung says. Production of collagen slows as we age. In fact, according to Scientific American, after age 20, that production will begin declining by an estimated 1 percent annually. Where to Get It Beauty stores and drugstores carry over-the-counter versions of cleansers, serums, peels, and moisturizers. If you need something stronger, see your dermatologist for an in-office peel. RELATED: The Skin-Care Glossary Every Woman Needs to Have
3. Salicylic Acid
Otherwise known as o-hydroxybenzoic acid and beta hydroxy acid, salicylic acid revs up exfoliation, which helps bring pimples up to the skin’s surface. It also helps clear plugged-up pores that can cause pimples and reduces inflammation. But the downside of boosting skin cell turnover is that some people find this to be too drying and irritating, Cheung says. If you’re pregnant, your doctor may want you to choose a different treatment. An article published in the journal Canadian Family Physician suggests that only a tiny proportion of salicylic acid is absorbed through the skin, meaning it’s unlikely to pose a risk to your unborn baby. However, there haven’t been any studies examining if salicylic acid is safe for pregnant women to use topically. If you’re pregnant, consult your dermatologist and ob-gyn to figure out if this ingredient is right for you. Where to Get It The drugstore shelves are packed with salicylic washes, creams, gels, and foams. Cheung also likes using salicylic acid for in-office peels.
4. Azelaic Acid
When smoothed onto the skin, this grain derivative (specifically a dicarboxylic acid) fights P. acnes bacteria, reduces oiliness, and lessens inflammation. That characteristic means it can also help calm redness and flushing, and potentially treat rosacea, per a review published in November 2014 in the Cochrane Library. Where to Get It You’ll find it as a gel, foam, or cream in both over-the-counter and prescription products, according to MedlinePlus. RELATED: 10 Things Your Skin Is Trying to Tell You (and How to Respond)
5. Niacinamide
This form of niacin, a B vitamin, reduces inflammation and lessens oil production, according to a review protocol published in November 2014 in the Cochrane Review. Also, a study published in the Journal of Research in Medical Sciences found that a 5 percent niacin-based gel was effective at treating mild to moderate acne — that is, about 10 to 20 pimples — but not nodular acne. Where to Get It You can find 2 to 4 percent gels over the counter. Your dermatologist can prescribe stronger formulations.
6. Sulfur
Typically found in volcanic areas, this chemical helps inhibit the growth of acne-causing bacteria. Many products also combine sulfur with another ingredient like sulfacetamide to reduce inflammation. Where to Get It Sulfur can be found as a prescription from your dermatologist or in some over-the-counter products. Cheung recommends sticking to the face washes. It can be a bit smelly, but using a wash means the active ingredient can be delivered to your skin and rinsed off afterward.
7. Topical Retinoids
“These are the backbone to any good acne regimen,” Cheung says. Derived from vitamin A, retinoids slough off the top layer of skin to keep pores clear, and ultimately help prevent pimples from popping up. They’re especially good for women who’re grappling with acne along with fine lines and wrinkles. Because retinoids stimulate collagen production, they can smooth out the skin and help reverse signs of aging. The only downside is that they can be drying, so dermatologists recommend slowly easing into the regimen. For example, start by applying the product every two days, then every other day, and so on. Where to Get It You can find adapalene, a retinoid gel designed to reduce acne, over the counter. Other skin formulas are available by prescription only or over the counter in doctor’s offices. There are also creams that contain a weaker version of retinoids, called retinol, available over the counter. RELATED: Should You Add Apple Cider Vinegar to Your Skin-Care Routine?
8. Combination Hormonal Birth Control Pills
Per MedlinePlus, hormonal birth control pills contain a combination of a type of estrogen and progestin. These oral contraceptives target inflammatory acne (larger bumps) as well as blackheads and whiteheads, according to Informed Health Online, a health information source in Germany. Birth control works by inhibiting the production of a type of hormone called androgen, which is linked to acne, so this can be a good choice for people with hormonally driven acne — for example, women who tend to break out around the time of their menstrual periods. Cheung adds that birth control pills may lead to weight gain in some women. Yet a review of 49 studies published in the Cochrane Review suggests that combination birth control (that is, birth control with progestin and estrogen) does not cause weight gain in women. Where to Get It Either a dermatologist or gynecologist can issue you a prescription.
9. Spironolactone
This diuretic medication, traditionally prescribed for conditions like high blood pressure, also blocks testosterone, and so reduces oil production and lessens the likelihood of a breakout occurring, says Cheung. Where to Get It Ask your dermatologist for a prescription. RELATED: 7 Natural Oils for Smooth and Radiant Skin
10. Isotretinoin
This oral form of vitamin A is “the only acne treatment that treats the three causes of acne: superficial bacteria, inflammation, and clogged pores,” Cheung says. “It’s great for people suffering from severe acne who’ve tried everything, including topicals and in-office treatments.” You’ll take this for four to five months, but the effects can linger — oftentimes, people feel that their skin is drier or more sensitive, she says. But, she points out, for many people, it’s worth it to have clearer skin for the long term. Where to Get It You’ll need a prescription from your doctor. Isotretinoin comes with some serious risks. For example, a January 2018 review in the British Journal of Dermatology found that despite isotretinoin helping clear up participants’ acne, on average, men taking it were twice as likely to see negative side effects as men in a control group, such as those taking a placebo or an antibiotic. Side effects included headaches, depressive symptoms, chapped lips, dry skin, eye sensitivity to light, and a rare yet severe skin reaction called Stevens-Johnson syndrome, which causes flu-like symptoms and a reddish-purplish rash, according to the Mayo Clinic. For pregnant women, isotretinoin may increase the risk for birth defects, so women going on it will need to follow the Food and Drug Administration’s iPLEDGE program. This entails taking two pregnancy tests before starting the medication, plus monthly pregnancy tests during the regimen, and committing to using two types of birth control one month before, during, and after stopping the drug.
11. Lasers
By heating up the skin, lasers can kill off acne-causing bacteria — plus, the heat to skin cells prompts them to respond by rebuilding collagen, Cheung says. Still, keep your expectations in check. The AAD notes that lasers are often not 100 percent effective, and you may need an additional medication to help clear your skin. The AAD further says you’ll likely need multiple treatments over several weeks to see results. Where to Get It There are many options available, but you should talk to your dermatologist about which laser treatment is right for you. Additional reporting by Melinda Carstensen
