Acne Treatment

Acne typically appears on the face, chest, back, and shoulders, where oil glands are most concentrated. Mild acne shows up as blackheads (open comedones) and whiteheads (closed comedones). Inflammatory acne produces red bumps (papules) and pus-filled spots (pustules). The most severe form is nodulocystic acne, which causes deep, painful, firm lesions under the skin that can last for weeks and often leave scars.

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You may also notice oily skin, post-inflammatory pigmentation that lingers after spots heal, and indented or raised scars in long-standing cases. Adult acne in women often clusters along the jawline and chin and tends to flare in the week before a menstrual period. If your breakouts are painful, leaving marks, or spreading to new areas, that is a clear signal to see a dermatologist rather than continue trying drugstore products.

Four factors drive acne: excess oil production, abnormal shedding of skin cells inside the pore, overgrowth of the bacterium Cutibacterium acnes, and inflammation. Hormones play a major role, which is why acne often starts at puberty and flares with menstrual cycles, pregnancy, polycystic ovary syndrome, and starting or stopping birth control. Genetics also matter, so if your parents had significant acne you are more likely to develop it too.

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Other contributors include certain medications such as corticosteroids, lithium, and some anticonvulsants, high-glycemic diets and skim dairy in some people, friction from helmets or face masks, and pore-clogging skincare or hair products. Stress and lack of sleep do not cause acne on their own, but they can worsen existing breakouts by raising inflammation in the skin.

For mild acne, prescription topicals form the foundation of care. Topical retinoids such as tretinoin, adapalene, and tazarotene normalize how skin cells shed and prevent new clogged pores. Benzoyl peroxide kills acne bacteria, and topical antibiotics like clindamycin reduce inflammation. Newer options include clascoterone (Winlevi), a topical androgen blocker, and dapsone gel for sensitive skin.

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Moderate to severe acne usually needs oral therapy. Doxycycline and minocycline are the most common oral antibiotics, used for short courses to bring inflammation down quickly. For women, hormonal treatments such as combined oral contraceptives or spironolactone work especially well for jawline breakouts and oily skin. Spironolactone is taken daily and most patients see real improvement by three months.

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For severe, scarring, or treatment-resistant acne, isotretinoin (formerly Accutane) is the most effective medication available and the only therapy that can produce long-term remission. A standard course runs five to seven months with monthly office visits and required lab monitoring through the iPLEDGE program. We discuss the side effect profile in detail and watch for them carefully throughout treatment.

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For acne scars and discoloration, we offer chemical peels, microneedling, fractional laser resurfacing, and subcision for tethered scars. Scar treatment works best after active acne is well controlled.

At your first visit we examine your skin under good lighting, ask about your history, prior products, and any medical conditions or medications that affect your treatment options. For women with hormonal patterns we may discuss bloodwork or coordinate care with your gynecologist or primary care doctor.

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Most acne treatments take six to eight weeks to show clear improvement and three to four months to reach full effect. Skin often looks worse for the first two to four weeks before it gets better, so patience and consistency matter. The most common reason patients fail acne therapy is stopping a medication too soon or using it inconsistently.

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We see you back at four to six week intervals to track progress, adjust strengths, and add or change treatments as needed. Insurance covers most acne medications because acne is a medical condition.

Schedule a visit if over-the-counter products have not worked after about two months, if you are getting deep painful cysts, if breakouts are leaving marks or scars, or if acne is affecting how you feel about yourself. You should also be evaluated if your acne started suddenly as an adult, if it is concentrated along the jawline with other signs like irregular periods or excess hair growth, or if you have tried multiple treatments without lasting results.

Wash twice a day with a gentle cleanser, not a harsh scrub, since over-washing inflames acne-prone skin. Use a non-comedogenic moisturizer and a daily broad-spectrum SPF 30 or higher, because many acne medications make skin more sun-sensitive. Look for the words noncomedogenic and oil-free on every product that touches your face, including makeup, sunscreen, and hair products that drift onto the forehead and hairline.

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Do not pick or squeeze lesions, because that is the fastest path to scars and dark marks. Change pillowcases weekly, wipe down phones, and shower soon after sweating. If you wear a helmet or mask regularly, clean the contact points and try to keep skin dry underneath. Diet changes alone rarely clear acne, but cutting back on skim dairy and very high-glycemic foods helps some patients as part of a broader treatment plan.