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^ Jump up to: a b c Zaenglein, AL; Graber, EM; Thiboutot, DM (2012). "Chapter 80 Acne Vulgaris and Acneiform Eruptions". In Goldsmith, Lowell A.; Katz, Stephen I.; Gilchrest, Barbara A.; Paller, Amy S.; Lefell, David J.; Wolff, Klaus (eds.). Fitzpatrick's Dermatology in General Medicine (8th ed.). New York: McGraw-Hill. pp. 897–917. ISBN 978-0-07-171755-7.

Scientists initially hypothesized that acne represented a disease of the skin's hair follicle, and occurred due to blockage of the pore by sebum. During the 1880s, bacteria were observed by microscopy in skin samples affected by acne and were regarded as the causal agents of comedones, sebum production, and ultimately acne.[163] During the mid-twentieth century, dermatologists realized that no single hypothesized factor (sebum, bacteria, or excess keratin) could completely explain the disease.[163] This led to the current understanding that acne could be explained by a sequence of related events, beginning with blockage of the skin follicle by excessive dead skin cells, followed by bacterial invasion of the hair follicle pore, changes in sebum production, and inflammation.[163]
The third phase of the life cycle of acne is inflammation. At this point, your body’s immune system may deal with the problem, but if it doesn’t, different bacteria can move into the pore. Detecting an enemy bacterial invader, your body responds by emitting white blood cells to the infected area. In some cases, the white blood cells have a difficult time fighting the bacteria, and some die, contributing to the oily buildup and creating pus.
Flutamide, a pure antagonist of the androgen receptor, is effective in the treatment of acne in women.[101][108] It has generally been found to reduce symptoms of acne by 80 or 90% even at low doses, with several studies showing complete acne clearance.[101][109][110] In one study, flutamide decreased acne scores by 80% within 3 months, whereas spironolactone decreased symptoms by only 40% in the same time period.[110][111][112] In a large long-term study, 97% of women reported satisfaction with the control of their acne with flutamide.[113] Although effective, flutamide has a risk of serious liver toxicity, and cases of death in women taking even low doses of the medication to treat androgen-dependent skin and hair conditions have occurred.[114] As such, the use of flutamide for acne has become increasingly limited,[113][115][116] and it has been argued that continued use of flutamide for such purposes is unethical.[114] Bicalutamide, a pure androgen receptor antagonist with the same mechanism as flutamide and with comparable or superior antiandrogenic efficacy but without its risk of liver toxicity, is a potential alternative to flutamide in the treatment of androgen-dependent skin and hair conditions in women.[106][117][118][119]
This is a low foaming formula that doesn’t produce much lather or foam which, for some, may be quite drying. It’s non-comedogenic and moisturizing, without being oily, leaving skin feeling soft and smooth. As the name suggests, it’s the best normal and oily skin types, and for some with combination skin. Due to its low-foaming nature, it doesn’t strip skin of natural oils, promoting skin health and healthy cell growth and protection. However, it may not be good for people with sensitive skin types.
Hydroquinone lightens the skin when applied topically by inhibiting tyrosinase, the enzyme responsible for converting the amino acid tyrosine to the skin pigment melanin, and is used to treat acne-associated postinflammatory hyperpigmentation.[34] By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time.[34] Improvement in skin hyperpigmentation is typically seen within six months when used twice daily. Hydroquinone is ineffective for hyperpigmentation affecting deeper layers of skin such as the dermis.[34] The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone.[34] Its application only to affected areas lowers the risk of lightening the color of normal skin but can lead to a temporary ring of lightened skin around the hyperpigmented area.[34] Hydroquinone is generally well-tolerated; side effects are typically mild (e.g., skin irritation) and occur with use of a higher than the recommended 4% concentration.[34] Most preparations contain the preservative sodium metabisulfite, which has been linked to rare cases of allergic reactions including anaphylaxis and severe asthma exacerbations in susceptible people.[34] In extremely rare cases, repeated improper topical application of high-dose hydroquinone has been associated with an accumulation of homogentisic acid in connective tissues, a condition known as exogenous ochronosis.[34]
Several scales exist to grade the severity of acne vulgaris, but no single technique has been universally accepted as the diagnostic standard.[68][69] Cook's acne grading scale uses photographs to grade severity from 0 to 8 (0 being the least severe and 8 being the most severe). This scale was the first to use a standardized photographic protocol to assess acne severity; since its creation in 1979, the scale has undergone several revisions.[69] The Leeds acne grading technique counts acne lesions on the face, back, and chest and categorizes them as inflammatory or non-inflammatory. Leeds scores range from 0 (least severe) to 10 (most severe) though modified scales have a maximum score of 12.[69][70] The Pillsbury acne grading scale simply classifies the severity of the acne from grade 1 (least severe) to grade 4 (most severe).[68][71]
Sodium sulfacetamide-sulfur is another acne medications often found in over-the-counter treatments, and it works especially well for those with mild-moderate acne that is largely made up of pimples. This is because it effectively dries out excess sebum without drying out the skin, and some studies suggest that this combination of sodium sulfacetamide and sulfur has antibacterial properties. According to one study published in The Journal of Clinical and Aesthetic Dermatology, sodium sulfacetamide 10 percent-sulfur 5 percent can significantly reduce the size of p. acnes colonies when used as an emollient foam6. This treatment option is also available as a facewash, topical gel, and topical cream, and can be found at most drugstores.
You will see the results from the top performers in the comparison chart. Although any of these treatment systems can safely and effectively help reduce blemishes, Exposed Skin Care stands above the rest as the best acne treatment system. All the products are safe and regulated by the FDA, but Exposed Skin Care also works for a variety of skin types, including sensitive skin. The thing we like most about Exposed Skin Care is the 6-month money back guarantee. Many blemish products expect you to use them for six to eight weeks before you see results and then only provide you with a 1-month guarantee. If you purchase individual products in the store, you are stuck with them, since many do not come with any guarantees. Exposed Skin Care allows you to give their product a fair trial before you decide if it is working for your skin.
Considerations: THERE IS AN EXTREMELY HIGH RISK THAT A DEFORMED INFANT CAN RESULT IF PREGNANCY OCCURS WHILE TAKING ACCUTANE IN ANY AMOUNT AND EVEN FOR SHORT PERIODS OF TIME. FEMALES WHO ARE PREGNANT OR WHO MAY BECOME PREGNANT WHILE UNDERGOING TREATMENT SHOULD NOT TAKE ACCUTANE. There are many other warnings as well.1-3 Side effects of Accutane are many, some of which include dry and cracked lips, dry skin, dry nose and mouth, mild to moderate muscle or joint aches.1-2,4-7
For those with acne-prone skin, it can be tough finding a sunscreen that doesn’t clog pores and meshes well with your skincare regimen. Oily sunscreens often lead to breakouts. In addition to the wash, toner, moisturizer and treatments, the Clear Start kit includes an acne-safe (read: oil-free) sunscreen in its lineup — perfect for those wanting the best of both worlds in avoiding all types of red faces.
In most cases, acne products need to be used for at least 30 days before you can begin to ascertain its efficacy. Some skin and acne types may see noticeable results in a few days and end up totally clear in just a few weeks. Others may take several weeks to see the slightest change, or need to have their regimen adjusted as their skin adapts. Treating acne can often be a months-long process.
Benzoyl peroxide is an antibacterial ingredient, and it’s very effective at killing the P. acnes bacteria that causes breakouts. But benzoyl isn’t without its downsides. The leave-on creams and cleansing treatments can dry out sensitive skin types and bleach clothing if you aren’t careful. Board-certified dermatologist Eric Meinhardt, M.D., previously told SELF that it's best to stick to formulations that have no more than 2 percent of benzoyl peroxide listed on the active ingredients chart; stronger concentrations are harder on your skin without being any tougher on bacteria.

Misperceptions about acne's causative and aggravating factors are common, and those affected by it are often blamed for their condition.[176] Such blame can worsen the affected person's sense of self-esteem.[176] Until the 20th century, even among dermatologists, the list of causes was believed to include excessive sexual thoughts and masturbation.[165] Dermatology's association with sexually transmitted infections, especially syphilis, contributed to the stigma.[165]
Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.
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