Anti-Aging Skin Care

The 9 Best Treatments for Acne

By Kim Crawford, M.D. Last updated: September 6, 2018
best treatments for acne

General information about clearing up acne:

One of the best treatments for acne is prevention. Do make sure your daily habits aren’t causing your breakouts in the first place. However, if your acne persists, it’s time to try the top acne solutions available. This article will reveal the best treatments for acne.

Let’s review the causes of acne first. Research is on mom’s side about “the chocolate, ” but it turns out chocolate is not the only culprit that causes acne flares. Indeed, it’s the fast food. It’s processed food. It’s inflammatory, sugary foods. For best acne control, you should be on an anti-inflammatory diet plan. Your gut microbiome needs to be in balance. One of the surprising health benefits of probiotics is that they will help clear up your skin if you are also eating healthfully.

Next, take a good look at what you are using to wash your face. Remember that gentle washing is necessary, but too much washing can irritate the whiteheads and blackheads, causing them to be more infected and making more pimples. Exfoliating, which removes the layer of dead skin cells, is also important for clear, healthy skin. After washing your face with a mild cleanser, exfoliate twice weekly with an enzyme mask (such as our pumpkin peel). Do not use a scrub unless you only have blackheads.

Take a look at your products:

All cosmetics, lotions, and sunscreens should be oil-free to avoid further clogging of pores. Look for product labels that read “non-comedogenic.” However, when it comes to makeup, as you’ll see in an upcoming article, that label is not always reliable. Don’t forget about hair products including conditioners and (the main culprits) gels, mousses and leave-in conditioners. It is hard to find hair products that cater to acne but do your best. Try to keep hair off your face. Style it in a bun (if possible) when you go to bed. Change your pillowcase frequently. Hair products get on your pillow, and that’s where you put your face. Now, let’s talk about treating the acne problems you might have.

Types of “vehicles” for treatment for acne:

Topical treatment is “enough” for most people with acne, but systemic (oral prescription) therapy is required in patients who have deep acne with nodules and cysts. If you are given a prescription for oral antibiotics, please remember that these are “death to the GI microbiome” and you’ll need a really good dosing of probiotics and prebiotics.

If you see a Dermatologist, have them review all medications you are taking. Corticosteroids (such as prednisone), anabolic steroids, lithium and some oral contraceptives can contribute to acne conditions. Creams are the right “vehicle” or form of topical for those with sensitive or dry skin who need non-irritating, non-drying formulations. People with oily skin may benefit more with gels, which have a drying effect.

However, gels may cause a burning-type irritation in some. Lotions work with any skin type. But then again, lotions often contain the burning-drying ingredient propylene glycol (unless made by Moorspa or other SkinDeep approved products). Solutions are mainly used with topical antibiotics, which are often dissolved in alcohol. Like gels, solutions work best for people with oily skin.

The Best Treatments for Acne: Non-Prescription

For those with non-inflammatory (open and closed comedones) or a mixture of inflammatory (papules or pustules) acne, OTC (over-the-counter) preparations may be sufficient. Here is the run-down on those.

Salicylic acid cleanser:

Salicylic acid breaks up the cells, which stick together in the inner lining of your skin’s pores. By doing this, it unclogs blackheads and whiteheads, making it the ideal acne cleanser. A good salicylic acid cleansing will help to rid your skin of excess cells by helping to exfoliate skin and unclog blocked pores. Acne occurs in part when there is a buildup of dead skin cells in the pores. Salicylic acid helps prevent the clogging that, along with oil and bacteria, produces pimples.

Here’s how it works. Salicylic acid is a keratolytic. Keratolytics work by softening the top layer of the skin (epidermis), making it easier to remove dead and shedding skin cells. Like aspirin, it’s chemical cousin, Salicylic acid has anti-inflammatory properties, which can help quiet down breakouts. Due to it’s chemical similarity to aspirin, people who are aspirin-allergic or have rosacea should use an alternate cleanser. However, if you’re choosing between a salicylic acid cleanser and a benzoyl peroxide cleanser you will find the salicylic preparation to be less irritating, and it won’t thicken your skin (more about that to come).

Glycolic lotion:

Glycolic acid is the second hydroxy-acid which helps to treat acne by speeding up your skin’s natural rate of exfoliation. Again, skin that is slow to exfoliate allows bacteria to build up and clog pores, thereby contributing to acne. Glycolic acid additionally helps to prevent acne by keeping your skin’s hydration levels optimized. It also helps to minimize pore size and diminish fine lines for a skin tightening effect.

It needs to have a Ph low enough for the acidity to be effective at getting rid of dead skin cells. Additionally, it needs to do this without burning the skin or causing excessive irritation. Clinical studies reveal that a Ph of 3.5 seems to be optimal. Acne can cause pitted, or pigmented and even colored scars on the skin. Glycolic skin peels and even lotions can improve skin color blemishes and mild acne scarring.

Benzoyl Peroxide Topicals:

Benzoyl peroxide unclogs skin pores. It also helps stop bacteria from growing and causing acne pimples and some cystic lesions. At first, acne may get worse. Your skin may get red and start to peel. Nothing is a quick fix, and this treatment may have a longer lag time than others. You may need to use the product for as long as 4 to 6 weeks before your acne starts improving. Strengths range from 2.5% to 10% benzoyl peroxide.

Start with the lowest strength to see how your skin reacts. Brand names include Brevoxyl and Triaz. This agent has bactericidal and comedolytic properties. It is the topical agent most studied to be effective against the primary bacteria responsible for acne, P. acnes, with activity as good as topical antibiotics. However, one universal thing that happens despite killing bacteria and unclogging pores is benzoyl peroxide makes the outer layer of dead skin cells (your stratum corneum) build up quicker. If you do not exfoliate systematically and carefully, bacteria will get trapped under dead skin cells. As a result, you’ll get “underground zits.”

Prescription treatment for acne:

There are many prescription medications for the treatment of acne. I’ll review the most common items which are also the most effective. Topical retinoids such as tretinoin or adapalene are effective in many patients with comedonal acne.

Patients with inflammatory lesions benefit from treatment with benzoyl peroxide, azelaic acid or topical antibiotics. Frequently, the use of anti-comedonal and antibacterial agents is required.

Azelaic Acid

This product has antibacterial and anti-keratinizing activity. It appears to be as effective as benzoyl peroxide or tretinoin (Retin-A) in the treatment of mild to moderate acne. Azelaic acid is available as a 20% cream (Azelex), which is applied twice daily. It’s fairly well tolerated, with only about 5% of people complaining of redness and irritation. This is a lower rate than those who use benzoyl peroxide and tretinoin (to be discussed below). If you have a dark skin tone azelaic acid should be used with caution because it decreases pigmentation.

Topical Retinoids

Retinoids, which are derivatives of vitamin A, function by slowing the desquamation process, thereby decreasing the number of comedones and micro-comedones.


Tretinoin is available as a cream, gel or liquid. It is now available in a new delivery system (Retin-A Micro) that may minimize the irritative effects seen with the three other mentioned forms. This delivery system works by encapsulating the medication in what are called microspheres. This system brings the medication more directly to the follicle. The 0.1% tretinoin microsphere gel shows to be less irritating than 0.1% tretinoin cream.

You can have a pustular flare during the first few weeks of using tretinoin therapy. This pustular flare is a sign of the accelerated resolution of existing acne. All retinoids including Accutane (given orally for cystic acne) are not to be used during pregnancy.


Studies show that 0.1% adapalene gel is at least as effective as 0.025 % tretinoin gel and significantly less irritating. There are no studies (as of this writing) comparing it to the Retin-A-Micro.

Topical Antibiotics

Topical antibiotics work directly by killing P. acnes. Through their bactericidal activity, they also have a mild, indirect effect on comedogenesis. These agents are available in a variety of forms and are applied once or twice daily. Topical erythromycin and clindamycin (Cleocin T) are the most common agents. Rarely are oral antibiotics prescribed anymore. I won’t repeat myself about the microbiome but just do “file that info.”

 A great acne-busting treatment:

best treatments for acneIPL Acne Therapy is an effective new light-based therapy growing in popularity.

The IPL Acne Therapy destroys the most common bacteria that cause acne—without drugs, without pain, and without downtime.

“Intense Pulse Light” is proven to be extremely effective on moderate inflammatory acne.

Its technology uses light that is UV-safe and has no known side effects. Pregnant women and people with photosensitivity should not use this technology. Other in-office technologies show promise, but this is the only one proven enough such that I’ll recommend it to you. By the way, the home IPL devices are not “up to snuff” either at this time so don’t waste your money.


  1. Can I use the glycolic and salicylic products you mentioned together if I have normal, not oily (well only on my forehead) skin?

    • Hi Hanna,
      Yes, in fact you can use a salicylic cleanser and the glycolic lotion we have. The glycolic lotion helps to keep your skin hydrated and the salicylic as a cleanser not a gel won’t dry you out. This combo works well for most people. Best, Dr.Kim

  2. My son is 21 and has an acne problem. I have been doing research trying to find ways to help him. This has made him feel insecure due to his appearance. Dr. Kim, there is so much great information on this blog and on others you have written. I would like to purchase a few items for him, could you please make a few recommendations.

    • Hi Dorthy!
      If you look in the blog you’ll see that the salicylic acid cleanser and the glycolic lotion we have work great. I would get him an exfoliant-pumpkin peel if skin is super think and oily and if not,the Vit C mask. Then you can get some OTC benzoyl peroxide. If he still has breakouts then see a dermatologist. NO PICKING either! Best, Dr.Kim

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