If you’re struggling with acne, you’re not alone. Acne affects people of all ages and can take a serious toll on your mental health. Depending on the type of acne you have, treatments will vary. This guide will help you find the best acne treatment for you.

Types of Acne

Acne can be comedonal (whiteheads and blackheads), inflammatory (pimples and pus-filled bumps), or cystic (painful cysts and nodules). Each type requires a different treatment approach, and it may take some trial and error to find what works best for you.

Over-the-Counter (OTC) Topical Treatments

Topical treatments are applied directly to the skin and are great for treating mild acne. For moderate or severe acne, they can be combined with more powerful treatments. Here are some common OTC treatments for acne:

Benzoyl Peroxide

• What it treats: All types of acne.
• How it comes: Different strengths and formulations, such as washes, foams, and gels.
• Safety: Considered safe to use in limited amounts during pregnancy.
• Skin irritation: Can cause redness and peeling. Start with a lower strength and use less often to avoid irritation. It can also bleach clothing and linens.

Salicylic Acid

• What it treats: All types of acne, best for whiteheads and blackheads.
• How it comes: Different strengths and formulations, such as creams, lotions, or gels.
• Safety: May be safe during pregnancy for short periods, but not as well-studied as benzoyl peroxide.
• Skin irritation: Can cause redness and dry skin. Use less often or try a lower strength if irritation occurs.

Azelaic Acid

• What it treats: Inflammatory acne and improves dark spots.
• How it comes: Different strengths and formulations, such as creams, gels, or foams.
• Safety: Safe to use during pregnancy.
• Skin irritation: Can cause burning or stinging that usually goes away after a few weeks.

Retinoids

• Topical retinoids are related to vitamin A and they increase skin renewal, unclog pores, and have anti-aging effects.
• Common OTC retinoids: adapalene (Differin) in specific strengths. Prescription retinoids include tretinoin (Retin-A), tazarotene, and others.
• Skin irritation: Can cause redness, peeling, and burning. Start slowly and use moisturizer to avoid irritation. Sunscreen is important due to sun sensitivity.
• Pregnancy: Avoid during pregnancy.

Prescription Topical Treatments

Prescription-strength creams are used to treat all types of acne and are often combined with other treatments, including OTC products.

Topical Retinoids

• Retinoids like tretinoin, adapalene (in higher strengths), tazarotene, and Aklief (trifarotene).
• Can cause similar skin irritation as OTC retinoids.

Topical Antibiotics

Topical antibiotics treat inflammatory acne by killing bacteria and reducing inflammation. They come in various formulations and sometimes in combination with other medications, such as:

• Clindamycin (Clinda-Derm, Cleocin-T)
• Erythromycin (Erygel)
• Dapsone (Aczone)
• Minocycline (Amzeeq)
• Clindamycin/benzoyl peroxide (Acanya, Onexton)

Side effects: Red, dry, or itchy skin. Antibiotic creams can also make your skin more sensitive to the sun.

Winlevi

• A new prescription cream (clascoterone) for hormonal acne by blocking androgen hormones.
• Side effects: Skin redness, itching, and peeling.

Prescription Oral Medications for Acne

Oral Antibiotics

• Treat acne by killing bacteria and reducing inflammation.
• Common options include minocycline, doxycycline, tetracycline, erythromycin, and azithromycin.
• Side effects: Nausea, vomiting, and diarrhea.
• Pregnancy: Some antibiotics are safe during pregnancy, check with a healthcare provider.

Birth Control Pills

• Combination birth control pills can treat all types of acne by lowering androgen levels.
• Side effects: Nausea, period changes, mood changes.
• Risks: Increased risk of blood clots and strokes.
• Examples: Ethinyl estradiol/norgestimate (Ortho Tri-Cyclen); Drospirenone/ethinyl estradiol (Yaz).

Spironolactone

• Blood pressure medication used off-label for hormonal acne in women.
• Side effects: Diarrhea, nausea, irregular periods, and electrolyte imbalances.
• Pregnancy: Not safe during pregnancy.

Isotretinoin (Accutane)

• Treats severe cystic acne by speeding up cell turnover and shrinking oil glands.
• Side effects: Dry lips, high cholesterol, muscle pain; risks of depression and birth defects.
• Pregnancy: Not safe during pregnancy.

Corticosteroids

• Treat inflammatory acne, typically prescribed at low doses for short periods.
• Side effects: Can lead to thin skin, discoloration, nausea, weight gain, high blood pressure, and diabetes.

Choosing the Best Acne Treatment

Choosing the right acne treatment depends on your type and severity of acne. Often, a combination of medications works best. It's important to give each treatment a chance, usually 3 months, before switching.

Hormonal Acne

Caused by hormone changes during menstrual periods, pregnancy, and menopause. Treatment usually includes:

• Topical treatments: Retinoids, antibiotics, Winlevi, benzoyl peroxide, salicylic acid, azelaic acid.
• Oral treatments: Birth control pills, spironolactone, antibiotics.

Cystic Acne

Painful and can leave permanent scars. Treatment usually includes:

• Topical treatments: Retinoids, antibiotics, benzoyl peroxide, salicylic acid, azelaic acid.
• Oral treatments: Antibiotics, isotretinoin (Accutane), steroids.
• Other: Steroid injections.

Comedonal Acne

Involves stubborn whiteheads and blackheads. Treatment options include:

• Topical treatments: Retinoids, antibiotics, benzoyl peroxide, salicylic acid, azelaic acid.

Inflammatory Acne

Mainly involves papules and pustules. Treatment usually includes:

• Topical treatments: Retinoids, antibiotics, benzoyl peroxide, salicylic acid, azelaic acid.
• Oral treatments: Antibiotics, isotretinoin (Accutane).

Lifestyle Strategies

Some lifestyle practices can help prevent and treat acne, such as:

• Diet: Eat a balanced, nutritious diet and avoid high-glycemic foods and dairy if they worsen acne.
• Stress: Managing stress can reduce acne. Try to get enough sleep and practice meditation.
• Exercise: Regular exercise can stabilize blood glucose levels and reduce stress.