The predisposition to acne for specific individuals is likely explained by a genetic component, a theory which is supported by studies examining the rates of acne among twins and first-degree relatives.[2] Severe acne may be associated with XYY syndrome.[39] Acne susceptibility is likely due to the influence of multiple genes, as the disease does not follow a classic (Mendelian) inheritance pattern. Multiple gene candidates have been proposed including certain variations in tumor necrosis factor-alpha (TNF-alpha), IL-1 alpha, and CYP1A1 genes, among others.[18] Increased risk is associated with the 308 G/A single nucleotide polymorphism variation in the gene for TNF.[40]

Comedones (blackheads and whiteheads) must be present to diagnose acne. In their absence, an appearance similar to that of acne would suggest a different skin disorder.[27] Microcomedones (the precursor to blackheads and whiteheads) are not visible to the naked eye when inspecting the skin and can only be seen with a microscope.[27] There are many features that may indicate a person's acne vulgaris is sensitive to hormonal influences. Historical and physical clues that may suggest hormone-sensitive acne include onset between ages 20 and 30; worsening the week before a woman's period; acne lesions predominantly over the jawline and chin; and inflammatory/nodular acne lesions.[1]


The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use oral prescription medications for acne.
Salicylic Acid – One of the most common topical ingredients you can find over-the-counter, salicylic acid is generally used to reduce the appearance of acne, by reducing swelling and redness. Also known as a beta-hydroxy acid, it exfoliates your skin4 and unclogs your pores, too, but it is quite strong. You’ll only be able to find this in strengths around 2%, but it can still dry and irritate your skin, especially if yours is sensitive. The safest way to use this ingredient is according to the directions!
If you’re looking for a hormonal solution to your acne but don’t want to take a combined oral contraceptive, spironolactone may be the answer. This oral medication is a potassium-sparing diuretic originally designed to treat high blood pressure, but is now also used to treat acne. It mainly functions by reducing sebum production, leading to less acne formation13. If you are able to get pregnant, you don’t necessarily need to take a combined oral contraceptive, but you will want to use some form of birth control since spironolactone, like Accutane, is a well-known teratogen and is known for causing birth defects.
If your acne is severe, painful, or refusing to get lost, you may just be beyond what an over-the-counter treatment can do. Not only can a professional set you up with the really powerful stuff, but also Fitz Patrick explains that “working closely with an aesthetician or dermatologist means you can keep tweaking a routine to make it work best for you.”
Retinol: Retinol is simply another word for vitamin A, sort of like how we call vitamin B7 “biotin.” It’s important that our bodies get systemic vitamin A through our diet for good vision, a strong immune system, and general organ function, but some research suggests that vitamin A could have a positive impact on the skin when applied to it directly. The problem is, regular retinol doesn’t actually do much for acne. That’s because the retinoic acid found in retinol isn’t always activated when left to its own devices. We typically have to activate the retinoic acid synthetically through the creation of various medications.
Cysts are another troublesome type of acne to treat successfully without the help of a doctor. A cyst forms similar to a nodule—way beneath your skin’s surface. However, cysts are thought to form from pustules because they contain pus. They are painful when touched resemble a boil. They appear to be a large, red, swollen lump on the skin surface. People who are prone to them may get one large cyst or a clump of cysts.
Azelaic acid has been shown to be effective for mild to moderate acne when applied topically at a 20% concentration.[66][129] Treatment twice daily for six months is necessary, and is as effective as topical benzoyl peroxide 5%, isotretinoin 0.05%, and erythromycin 2%.[130] Azelaic acid is thought to be an effective acne treatment due to its ability to reduce skin cell accumulation in the follicle, and its antibacterial and anti-inflammatory properties.[66] It has a slight skin-lightening effect due to its ability to inhibit melanin synthesis, and is therefore useful in treating of individuals with acne who are also affected by postinflammatory hyperpigmentation.[1] Azelaic acid may cause skin irritation but is otherwise very safe.[131] It is less effective and more expensive than retinoids.[1]
Again, this is another straightforward method but one that is very effective. We use our sense of touch every day of our lives to ascertain the nature of things. Understanding what type of skin you have is also something that your sense of touch can help you with. Oily complexions will leave visible residue on your fingertips, while healthy, fresh skin will feel smooth to the touch.
The Pore Normalizing Cleanser is designed just to cleanse, not treat, which is a good thing: The Nurse Practitioner study emphasizes the importance of washing with mild cleansers in conjunction with topical acne medications to combat or avoid excessive skin irritation. This one is water-based and fragrance-free, and uses sodium laureth sulfate (as opposed to its harsh cousin sodium lauryl sulfate) to eliminate any chance for irritation.

Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin). Topical antibiotics alone aren't recommended.

Acne vulgaris and its resultant scars have been associated with significant social and academic difficulties that can last into adulthood, including difficulties obtaining employment.[30][177] Until the 1930s, it was largely seen as a trivial problem among middle-class girls – a trivial problem, because, unlike smallpox and tuberculosis, no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it.[165] During the Great Depression, dermatologists discovered that young men with acne had difficulty obtaining jobs, and during World War II, some soldiers in tropical climates developed such severe and widespread tropical acne on their bodies that they were declared medically unfit for duty.[165]


What's Going On: You might be all too familiar with these, which tend to make their debut when you’re in high school. "Blackheads, like whiteheads, are blocked pores," says Zeichner. What gives them their namesake color, though, is the oil. It's already dark, but blackheads also have a larger opening at the surface than whiteheads do, meaning air can enter and oxidize that oil sitting inside the pore, turning it even darker.
Contrary to the marketing promises of “blemish banishers” and “zit zappers,” immediate results are not the trademark of acne treatments — a frustrating truth to anyone suffering through a breakout. And while pimples are personal (your stress-induced spots will look and act differently than your best friend’s breakout), the best acne treatments will include a regimen of products to hit all of acne’s root causes. We tested 43 kits to find the most well-rounded breakout-fighting solutions on the market.
Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.
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