Acne: Diagnosis and treatment

Do you continue to break out even though you’ve tried plenty of acne treatments? Are you convinced that nothing’s going to work, but given time, the acne will clear on its own?

You don’t have to wait. Board-certified dermatologists are at the forefront of advances in treating acne, so they can determine the most effective treatment plan for you.

Here’s what you can expect when you see a board-certified dermatologist for your acne.

How do dermatologists diagnose acne?

Effective treatment begins with an accurate diagnosis. If you have acne, your dermatologist can diagnose you by looking at the breakouts.

While examining your skin, your dermatologist will notice what types of acne you have and where the breakouts appear on your skin. Different types of acne often require different treatment.

With a dermatologist's help, virtually everyone can see clearer skin

To see clearing, you need to stick to your treatment plan and understand that it takes at least 6 to 8 weeks before you start to see fewer breakouts.

Sometimes what looks like acne isn’t acne: What looks like acne may be another condition. For example, some people mistake hidradenitis suppurativa, also called “acne inversa,” for acne. Treatment for this condition differs from that for acne.

Another condition that can be mistaken for acne is perioral dermatitis. It often causes acne-like breakouts around the mouth or “T-zone” of the face. A skin infection called folliculitis can also be mistaken for acne.

Whether you have acne or another condition, your dermatologist can give you an accurate diagnosis and create a treatment plan tailored to your needs.

How do dermatologists treat acne?

The goals of acne treatment are to:

• Clear existing acne.

• Stop new breakouts.

• Prevent acne scars.

While the goals are the same for each patient, there is no one-size-fits-all acne treatment. The best acne treatment for one patient is not necessarily the best treatment for another patient. Your treatment plan may include one or more of the following.

Medication you apply to your skin

This type of medication is often included in an acne treatment plan. Your dermatologist may include more than one topical (apply to the skin) medication, as this strategy helps fight the different causes of acne. The topical medications, all approved by the U.S. Food and Drug Administration (FDA), that dermatologists may include in an acne treatment plan are:

Retinoid you apply to your skin: This medication works to clear your pores, and can treat blackheads, whiteheads, and some pimples. If you develop dark spots after acne clears, a retinoid can help lighten these spots.

Dermatologists also may recommend a topical retinoid as a maintenance treatment. This type of treatment can keep your skin clear once acne is under control.

The retinoids used to treat acne are:

• Non-prescription retinoid

  • Adapalene (You’ll find acne treatment that contains this retinoid online and in stores.)

• Prescription retinoids

  • Tazarotene (Brand names: Arazlo, Avage, Fabior, Tazorac)

  • Tretinoin (Brand names: Altinac, Altreno, Atralin, Avita, Refissa, Renova, Retin-A, Tretin-X, Vesanoid)

  • Trifarotene (Brand name: Aklief)

Benzoyl peroxide: This active ingredient reduces acne-causing bacteria on your skin. It’s most effective when used along with another acne treatment that works on the other causes of acne. For this reason, your dermatologist may prescribe a medication that contains benzoyl peroxide and another acne medication like a retinoid or an antibiotic.

Benzoyl peroxide is also the active ingredient in plenty of acne-fighting products that you'll find online and in stores. They come in many forms from cleansing bars and washes to gels and creams.

Antibiotic you apply to your skin: This medication reduces both the inflammation that causes acne and acne-causing bacteria on the skin.

When a topical antibiotic is part of your treatment plan, you’ll use it along with an acne medication or wash that contains benzoyl peroxide. Doing so reduces your risk of developing antibiotic resistance, a condition that occurs when medications created to kill bacteria no longer work.

To reduce the risk of antibiotic resistance and increase how well each medication works, some acne treatments contain a topical antibiotic and another acne medication like benzoyl peroxide or a retinoid. This helps you get the right dose of each medication.

If the antibiotic that would be best for you isn’t available in a combination medication, your dermatologist will give you a prescription for a topical antibiotic and include another acne medication like benzoyl peroxide in your treatment plan. It’s important to use all medications as directed.

Combination medications: Benzoyl peroxide, some antibiotics, and a few retinoids can be effective acne treatments. Sometimes, two or all three of these medications are combined to create one acne medication that you apply to your skin. The benefits of combining these medications include:

• Fight different causes of acne with one medication.

• Increase how well each medication works.

• Reduce possible side effects like irritated skin.

• Get the right dose of each medication in one product.

Like other topicals, these medications work best for mild to moderate acne. Sometimes, they are used along with another treatment to help with more serious acne.

There are many prescription combination medications. Some contain the same medications, but different amounts of each medication. For example, one medication may contain 5% benzoyl peroxide and 1% clindamycin (an antibiotic). Another medication may contain 2.5% benzoyl peroxide and 1.2% clindamycin.

Possible side effects of these combination medications include dryness, irritated skin, peeling, burning, and worsening acne. You can reduce possible side effects by using the medication exactly as prescribed. Applying more than your dermatologist recommends will not clear acne faster.

If a combination medication is right for you, your dermatologist will select one that contains the medications and doses that meet your needs. Combination acne medications that your dermatologist may prescribe include:

• Retinoid + benzoyl peroxide (Brand names: Epiduo, Epiduo Forte, Twyneo)

• Retinoid + benzoyl peroxide + antibiotic (Brand name: Cabtreo)

• Retinoid + antibiotic (Brand names include: Veltin, Ziana)

• Benzoyl peroxide + antibiotic (Brand names include: Acanya, BenzaClin, Benzamycin, Duac, and Onexton)

Clascoterone: This is the first FDA-approved medication that can treat the hormonal causes of acne in both males and females. It’s approved to treat moderate to severe acne in people 12 years of age or older. You apply this medication twice a day.

• Brand name: Winlevi

Salicylic acid: Used for years to treat acne, salicylic acid opens clogged pores and exfoliates the skin. It’s effective for treating whiteheads and pimples. You’ll find salicylic acid available in different strengths and in different forms, including cleansers and moisturizers.

• Non-prescription medication: Be sure to use the product that your dermatologist recommends.

Azelaic acid: This acne treatment opens clogged pores and helps keep them open, works on the bacteria that cause acne, and reduces inflammation due to acne. This makes it an effective treatment for different types of acne.

Azelaic acid can also treat the dark spots that appear when acne clears.

• Brand names: Azelex, Finevin

Medication that works throughout your body

If you have moderate-to-severe acne, you may need stronger medication, so your dermatologist may prescribe one of the following:

Antibiotic: For years, dermatologists have prescribed an oral (take by mouth) antibiotic for acne. This medication can effectively treat moderate-to-severe pimples but not nodular acne.

Today, dermatologists prescribe an antibiotic for the shortest time, usually several months, needed to treat acne. They also include another medication like benzoyl peroxide in an acne treatment plan.

Dermatologists have expertise in using antibiotics to treat acne. They know which antibiotic to prescribe for each type of acne and how long to prescribe it. The FDA has approved three antibiotics to treat acne. All are approved to treat acne in patients nine years of age and older.

• FDA-approved antibiotics to treat acne: Doxycycline, minocycline, sarecycline

Birth control pills: A type of birth control pill called a combined oral contraceptive can be an effective acne treatment. Your dermatologist can tell you whether a combined oral contraceptive might be right for you, and if so, which one is recommended.

Before your dermatologist prescribes a birth control pill, they will ask you questions about your health. If you smoke, have heart disease, are pregnant, or plan to become pregnant, tell your dermatologist.

To get your acne under control, your dermatologist may prescribe other medication along with the pill.

The following combined oral contraceptives are FDA approved to treat acne:

• Brand names: Beyaz, Estrostep, Ortho Tri-Cyclen, Yaz

Spironolactone: For women who have stubborn hormonal acne, this medication can effectively treat acne on the face, chest, and back. Signs of hormonal acne include having stubborn acne on your lower face, including your chin and jawline. Another sign is that you predictably breakout during your period.

This medication may be an option when other treatments fail to clear acne.

Your dermatologist may prescribe spironolactone and a birth control pill. Taking both medications may deliver the best results. It’s also essential that women who can become pregnant use birth control. Spironolactone can cause severe birth defects.

Spironolactone is generally only a treatment for women. In men, possible side effects include developing breasts and erectile dysfunction.

• Brand names: Aldactone, CaroSpir

Isotretinoin: You may have heard people refer to this medication as Accutane. That’s a brand name of isotretinoin that’s no longer available. Dermatologists prescribe isotretinoin to treat nodular acne that hasn’t responded to other acne treatments. Nodular acne is the most severe type of acne and can cause scarring.

For more information, including the benefits and risks, visit Isotretinoin.

• Brand names: Absorica, Absorica LD, Amnesteem, Claravis, Myorisan, Sotret, Zenatane

Sometimes acne treatment needs extra help

To help you get the best possible results, your dermatologist may include a medical procedure in your treatment plan. Dermatologists perform these procedures during an office visit. Procedures that can help treat acne are:

Corticosteroid injection: To relieve the swelling and pain caused by a large, painful acne breakout, your dermatologist may inject a medication called a corticosteroid into an acne breakout. Treating acne this way can also reduce the patient’s risk of developing an acne scar.

While effective, dermatologists reserve this procedure for treating a few severe acne breakouts. Using it more than a few times isn’t recommended.

Chemical peel: When applied to acne, a chemical peel helps remove dead skin cells that are clogging your pores and excess oil. This can help clear acne.

Laser or light treatments: Laser or light-based therapy may be part of a treatment plan for mild-to-moderate acne. To learn more, go to Lasers and lights: How well do they treat acne?

Acne surgery: During this procedure, also called acne extraction, your dermatologist physically removes acne breakouts.

To avoid scarring and infection, this surgery should only be performed by a board-certified doctor who is trained and skilled in performing acne surgery. Dermatologists have this expertise.

Your dermatologist knows acne

With a dermatologist’s help, you don’t need to wait for acne to clear on its own. Your dermatologist knows how to safely combine acne treatments to clear acne and keep it from coming back. If you need a dermatologist who can help you with acne, go to Find a Dermatologist.

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References
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Written by:
Paula Ludmann, MS

Reviewed by:
Elaine T. Kaye, MD, FAAD
William Warren Kwan, MD, FAAD
Ata Moshiri, MD, MPH, FAAD
J. Klint Peebles, MD, FAAD

Last updated: 6/19/24