Whether it’s one pimple or a cluster of blemishes, acne is a common problem that affects people of all ages — boys, girls, men, and women, according to the Mayo Clinic. (1) Acne, or acne vulgaris, occurs when glands in the skin produce and secrete too much of the skin’s natural oil, called sebum. Sebum, along with dead skin cells, can clog pores, resulting in acne. And sometimes, bacteria called Cutibacterium acnes (C. acnes) gets into pores, causing inflamed acne. (1) As many as 50 million Americans live with acne, and most of them are in their teen or young adult years. About 85 percent of teenagers will eventually get acne, notes the AAD. (3) Acne is a broad term for different types of breakouts that all have different symptoms, according to Johns Hopkins Medicine. (4) The National Institutes of Health and New York University Langone Health note that there are six specific types of acne: (5,6)
Whiteheads A whitehead forms when a closed pore becomes impacted with oil and dead skin cells. It appears as a white bump on the skin’s surface.Blackheads In a blackhead, the pore is only partially clogged and remains open. Blackheads turn black when oil and dead skin cells react to oxygen in the air.Papules Papules are tiny red, hard pimples. They form when bacteria get trapped in a pore.Pustules Pustules are similar to papules, but contain pus that’s made of dead white cells.Nodules These large inflamed lesions occur when a pimple extends into the deeper layers of the skin.Cystic acne This type of severe acne is similar to nodules and forms when the deeper layer of skin becomes inflamed. The difference is that cysts contain pus. These red lumps are soft, painful, and difficult to treat. Usually, they require a visit to a dermatologist.
In the same way that acne can take various forms, the severity of acne also varies depending on the type. Blackheads and whiteheads are noninflammatory and typically easier to control, per the AAD. Papules and pustules are an inflammatory type of acne. But inflammation doesn’t necessarily mean severe acne. (7) “People with mild acne can have some whiteheads and blackheads, and a few — but not more than 10 — inflamed, red pimples called papules or pustules,” says the San Francisco–based dermatologist Yoram Harth, MD, the medical director of MDacne. Whiteheads and blackheads, while they’re the less severe types, can still become a moderate problem. “People with moderate acne can have many blackheads and whiteheads, as well as 10 to 30 red, inflamed acne pimples,” Dr. Harth says. Severe acne includes the presence of nodules and cysts, or many breakouts on different parts of the body — face, back, neck, and chest. (7) “People with severe acne will usually have more than 30 red, inflamed pimples at any moment in time. They can also have a few deep cysts and nodules, which are more difficult to treat and usually heal with scars,” he says. Learn More About Signs and Symptoms of Acne A number of factors can exacerbate acne or increase your risk. Changes in hormone levels (such as during puberty or menstruation) Changing hormones causes the sebaceous glands to secrete more sebum, as the AAD notes. (8) Cosmetics or hair-care products Oily cosmetics can clog your pores, making you susceptible to breakouts. Having a family history of acne There appears to be a connection between acne and genes. So if your parents struggled with acne, you may, too. (1) Some medications You may have acne if you take other medications like corticosteroids or lithium. (1) Something rubbing on the skin (like a hat, helmet, or face mask) Breakouts can also occur whenever there’s any type of pressure or friction on your skin, says Kara Shah, MD, a board-certified general and pediatric dermatologist with Kenwood Dermatology in Cincinnati. This is called acne mechanica. (1) In the time of COVID-19, maskne or “mask acne” has unsurprisingly become a problem, given what dermatologists know about the effects of friction on skin. Stress Stress increases your body’s level of cortisol, a hormone that causes your glands to produce more sebum, per KidsHealth.org. (9) Learn More About the Causes of Acne: Common Risk Factors, Genetics, and More Some skin conditions are sometimes mistaken for acne. If you believe you have acne yet your skin doesn’t improve with treatment or worsens, your doctor can make an accurate diagnosis. (10) Unfortunately, some people struggle with acne even through their twenties. In fact, about 3 percent of adults over 35 continue to have acne off and on. (11) A good skin-care regimen is often the first line of defense for mild acne or the occasional pimple. But sometimes, treatment is needed to keep skin healthy.
Over-the-Counter Products
According to the Mayo Clinic, these solutions include medicated cleansers, lotions, creams, gels, and face pads. They typically contain acne-fighting ingredients such as: (13)
Benzoyl peroxideGlycolic acidSalicylic acidAzelaic acidNiacinamideTopical retinoids
These ingredients work by either preventing the plugging of hair follicles, fighting bacteria on the skin, reducing oil production, or exfoliating the top layer of skin. (13) Harth explains that to heal body acne — such as back acne — you will need an effective anti-acne treatment, such as benzoyl peroxide, which is the most effective for body acne, notes the AAD. (14)
Prescription-Strength Products
Options for ointments, creams, and lotions that you can receive from your dermatologist include: (13)
Topical antibiotics (Benzaclin Pump, BenzaClin, Neuac, Onexton, Duac, and Acanya)Oral antibiotics (Minocin, Oracea)Retinoids (Differin and Tazorac)Oral contraceptives for women (Ortho Tri-Cyclen, Yaz)Oral antihormonal medications for women (Spironolactone)Topical antihormonal medications for women such as Winlevi (clascoterone)Isotretinoin (Sotret, Claravis, Amnesteem, Accutane, and others), a pill that is selectively prescribed to manage very severe acne and is under close supervision by a healthcare professionalInjections of a corticosteroid
Dermatology Procedures
For stubborn acne, your dermatologist may recommend an in-office treatment, such as laser resurfacing therapy or a chemical peel. (13) Other in-office treatments include light therapy, steroid injections, or drainage and extraction of cysts and pimples, according to the Mayo Clinic. (15)
The Importance of Consistency in Treating Acne
You’ll probably need to treat acne for an extended period — not only during a breakout. Also, don’t stop an acne treatment until your doctor says it’s okay — otherwise, you run the risk of having another breakout just when your skin starts to clear, notes the Society for Pediatric Dermatology. (16) Without treatment, you may have persistent breakouts and scarring of the skin. Anxiety and low self-esteem are also associated with persistent acne, according to a review published in March 2018 in the International Journal of Women’s Dermatology. (17) Learn More About Treatment Options for Acne
Alternative and Complementary Therapies
Although traditional acne therapies are proven effective, you may want to experiment with home remedies to complement your plan. While these options won’t be as effective as medications or procedures, they may come with fewer side effects. Some acne medicines can cause dizziness, upset stomach, sun sensitivity, and blood clots. (3) Ingredients that may help fight acne include:
Cucumbers (18)Honey (19)Yogurt (20)Oatmeal (21)Turmeric (22)
More research is needed to determine the effectiveness of acne home remedies. (13) Learn More About Home Remedies for Acne
Wash your face twice a day. Use warm water and a mild cleanser, and don’t scrub too hard, or else you could damage the protective layer of your skin and make acne worse, warns Harth. (9)Keep hair off your face. Greasy, oily hair can make your skin oily, which can clog your pores and cause acne. Wash your hair regularly and keep hair off your face. (9)Use oil-free skin-care products. Look for “noncomedogenic” skin-care products, which don’t clog pores. Noncomedogenic products are less likely to result in acne breakouts.Don’t sleep in your makeup. Removing all traces of makeup before bedtime keeps your pores open and prevents acne. Sometimes, warm water isn’t enough to remove makeup. “You will usually need to use oil-free makeup remover wipes in addition to your cleanser,” notes Harth. Some dermatologists recommend micellar water, too, as part of a double-cleanse routine to help remove makeup without leaving an oily residue behind.Don’t touch your face. The more you touch your face, the greater the risk of transferring oil and dirt from your hands to your face, per the AAD. (23) Acne tends to occur on the face and forehead because this part of the body has more sebaceous glands. (1)
According to Harth, multiple studies have found that acne tends to be worse in people who eat sugary foods, refined carbohydrates, and dairy. A study published in the Journal of the American Academy of Dermatology in 2016 investigated the link between dairy and acne in teenagers between ages 14 and 17. According to these findings, milk consumption was associated with more acne. But oddly enough, this study found a link only with low-fat or skim milk, and not full-fat (whole) milk. (24) Past research evaluating the association between diet and acne in teenage girls, however, did find a positive link between acne and the consumption of whole milk. (25) Milk and other dairy products appear to raise levels of insulin-like growth factor 1 (IGF-1), which may trigger greater sebum production and contribute to breakouts. Blood sugar spikes sparked by eating sugary foods and refined carbohydrates can also lead to skin inflammation and cause the skin to produce more oil, past research suggests. (26) While the jury’s still out on whether diet choices definitely contribute to acne, Harth recommends erring on the side of caution. “The best diet for people with acne should include anti-inflammatory foods with a low glycemic load,” he says. The glycemic index (GI) ranks carbohydrates by how fast they increase blood sugar. Since low-GI foods eliminate blood sugar spikes, they might also reduce acne, per the AAD. (27) “Good examples are cold-water fish like mackerel, salmon, and sardines, leafy greens, nuts, certain seeds, and complex carbs like wild rice and quinoa," says Harth. Learn More About What to Eat and Avoid to Manage Acne Scarring is more likely with moderate or severe acne, and includes black marks or spots where acne once appeared. (28) The best way to reduce the risk of scarring is to leave acne alone — no touching, squeezing, or picking at bumps. (28). If you can’t keep your hands off your face, cover acne with a pimple patch. As a bonus, these patches contain salicylic acid to help treat breakouts. If scars don’t fade, work with your dermatologist to reduce their appearance. Your doctor might recommend an acne medication that gets rid of blemishes and stimulates collagen production. Collagen can minimize the appearance of existing scars. (29) According to KidsHealth.org and the American Society for Dermatologic Surgery, procedures to reduce or eliminate acne scars include: (28,30)
DermabrasionMicrodermabrasionChemical peelsMicroneedlingLaser treatmentsFillersPunch excisions
Learn More About Acne Scar Treatments According to the International Dermal Institute, clinical studies have found that persistent, low-grade acne affects about 40 percent to 55 percent of the adult population. (31) But acne doesn’t only affect people physically; it also affects some people financially. In 2013, an estimated 5.1 million people sought treatment for acne. (3)
Black Americans and Acne
According to past research, acne is one of the most common dermatological problems among Black people. (33) It can appear on any part of the body, but often appears near the hairline in Black women. (32) Acne in this area is likely the result of hair-care products clogging pores near the hairline. More than two-thirds of Black women with acne also develop post-inflammatory hyperpigmentation and scarring. (32) But despite the prevalence of acne among this group, Black individuals are less likely than their white counterparts to see a dermatologist for treatment, per research published in May 2018 in the Journal of Dermatological Treatment. Researchers said more studies are needed to understand the cause of this disparity. (34)
Hispanic Americans and Acne
Acne is a common dermatological diagnosis among Hispanic Americans. In a previous study of nearly 3,000 women treated with acne (between ages 10 and 70), acne was more prevalent in Hispanics (32 percent) compared with white participants (24 percent). (35) The research also found that hyperpigmentation, dyspigmentation, and atrophic scarring were more common among Hispanic individuals than white people.
Asian Americans and Acne
Among Asian Americans, acne is the second most common dermatological complaint, the first being dermatitis. (33) Dyspigmentation and scarring aren’t as common among Asian Americans, but hyperpigmentation does affect a greater percentage of this group. (35) According to the NHS, conditions related to acne include: (10)
MenstruationPregnancyPolycystic ovary syndrome (PCOS)DepressionStressAnxiety
Maybe you’ve heard that it’s okay to pop a pimple yourself. A dermatologist can safely remove pimples, but popping a pimple yourself increases the risk of scarring. Plus, you can spread bacteria from your hands to your face. (9) Maybe you’ve been told that spending time in the sun will improve your acne. This is also a myth. Some acne medications can make your skin more sensitive to the sun. So if you’re outdoors too long without wearing sunscreen, you can make your acne worse and increase your risk of skin cancer. (23) If you have acne-prone skin, choose a product labeled oil-free or noncomedogenic to avoid clogging pores. (36) You should also look for a physical or mineral sunscreen. This is ideal for sensitive skin because it’s also less likely to clog pores. (37) Rather than believe anything you hear, consult your dermatologist and get answers to your acne questions. Learn More About Acne Myths The American Skin Association has resources, news stories, and other helpful information related to skin health, including advice on preventing and treating acne. Learn about the different types of acne, treatment options, and general skin protection tips. Canadian Dermatology Association (CDA) Founded in 1925, the CDA works toward the advancement of science and medicine related to skin care. Their website provides a host of invaluable resources for the general public, patients, and dermatologists. You’ll find comprehensive information on acne causes, the psychological effects of acne, acne myths, and more. American Acne and Rosacea Society (AARS) The AARS aims to increase awareness of two common dermatological conditions, as well as support for clinical research and improved care among those living with acne and rosacea, a skin condition that causes redness and bumps. Visit the site to read industry news or find acne clinical trials near you. You can also make a donation to support the organization’s work. American Academy of Dermatology (AAD) The AAD’s acne resource center provides an abundance of information to help you achieve clearer skin. You can educate yourself on DIY acne treatments, subscribe to the newsletter, and stay up-to-date on ways to maintain healthy skin, or use the online search tool to find a dermatologist in your area.
Favorite Online Support Network
Acne Support Group Acne can take an emotional toll, and is even associated with mental health disorders including anxiety. Sometimes, knowing you aren’t alone in your struggle can help. With more than 42,000 members, this online support group is an excellent place to ask questions and receive support and encouragement from those who understand your situation. PORESpective Acne Blog This blog is an excellent place for tips and strategies that you might not find elsewhere. You’ll find advice on managing acne during pregnancy, back acne, acne treatments, and lifestyle posts. The blog’s co-creator Alissa Chasen is an aesthetician who also lives with acne.
Favorite App for Acne
MDacne Custom Acne Treatment Everyone’s skin is different, and sometimes, getting rid of acne requires a customized treatment. This is exactly what you’ll receive from the MDacne app, available on iOS and Android devices. Download the app and take a photo of your face. From here, the app assesses your skin and customizes an acne treatment plan for you.
Favorite Telemedicine for Acne
SkyMD If you need a dermatologist, but don’t have time for an in-person appointment, SkyMD provides a way to consult a dermatologist anytime, anywhere. These doctors can diagnose acne and other conditions, and even prescribe medication directly through the platform. It’s fast, convenient, and most importantly, affordable. DermatologistOnCall Whether you have acne, eczema, or another skin condition, this is a fast and convenient way to get in touch with a dermatologist and treat your skin. You can call from your tablet, smartphone, or computer. To get started, create an online profile and upload photos of your condition.
