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If you're struggling with acne, you're not alone. Acne affects people of all ages. It can be frustrating to deal with and take a serious toll on your mental health.

Depending on the type of acne you have, acne can be comedonal (whiteheads and blackheads), inflammatory (pimples and pus-filled bumps), and cystic (painful cysts and nodules). Each requires a different treatment approach. And it may take some trial and error before finding the best acne treatment for you.

Whether you've tried different treatments in the past with varying amounts of success or you just want to learn more about your options, here's a guide to find the best acne treatment for you.

Over-the-counter (OTC) Topical treatments

Topical treatments are applied directly to the skin. They're great for treating mild acne. For moderate or severe acne, topical treatments can be combined with more powerful treatments.

Here are OTC treatments for acne.

Benzoyl peroxide

Benzoyl peroxide kills bacteria on the skin and keeps pores from clogging. Here's what to know about benzoyl peroxide:

• What it treats: It treats all types of acne.

• How it comes: It comes in different strengths and formulations, such as washes, foams, and gels.

• Safety: It's considered safe to use in limited amounts during pregnancy.

• Skin irritation: Sometimes benzoyl peroxide can cause skin irritation, like redness and peeling. To avoid this, start with a lower strength and by using it less often (like once a day, instead of two to three times a day). It can also bleach clothing and linens.

Salicylic acid

Salicylic acid exfoliates your skin and keeps your pores from clogging. Here's what to know about salicylic acid:

• What it treats: It treats all types of acne, but it works best for whiteheads and blackheads.

• How it comes: It comes in different strengths and formulations, such as creams, lotions, or gels.

• Safety: Salicylic acid may be safe to use during pregnancy for short periods, but it isn't as well-studied as benzoyl peroxide.

• Skin irritation: Salicylic acid can cause irritation, including redness and dry skin. If this happens, use it less often or try a lower strength.

Azelaic acid

Azelaic acid is a medication that helps block bacterial growth and lowers inflammation.

• What it treats: It treats inflammatory acne and improves dark spots that acne can leave behind.

• How it comes: It comes in different strengths and formulations, such as creams, gels, or foams.

• Safety: Azelaic acid is safe to use during pregnancy.

• Skin irritation: In some people, azelaic acid can cause burning or stinging that usually goes away after a few weeks.

Retinoids

Retinoids are medications related to vitamin A. You can apply topical retinoids directly to your skin for their anti-acne and antiaging effects. Topical retinoids work by increasing skin renewal. This keeps your skin looking brighter and younger. Retinoids also unclog your pores. More on this below.

Many topical retinoids are prescription-only, such as tretinoin (Retin-A, Altreno). But adapalene is available OTC in a lower strength (Differin 0.1%). There isn't a lot of research comparing tretinoin to adapalene for acne, but they're both considered effective. Though adapalene may be less likely to cause skin irritation.

There are also several OTC products that contain retinoids sold under different names, such as retinol, retinyl esters, and retinyl propionate. While these OTC products may work for acne, there's not a lot of research on how they work compared to tretinoin or adapalene.

Prescription topical treatments

Prescription-strength topical creams are used to treat all types of acne. And they're often combined with other treatments (including the OTC products discussed above).

Here are the best acne prescription creams.

Topical retinoids

Topical retinoids are one of the best treatments for all types of acne. They're chemically similar to vitamin A. As discussed earlier, topical retinoids work by improving skin cell renewal and helping to remove dead skin cells. They also help to clear up dark spots.

These prescription topical retinoids come in various strengths and formulations. They're also used in combination with other medications. Examples include:

• Tretinoin (Retin-A, Atralin, Avita)

• Adapalene (Differin 0.3%)

• Tazarotene (Tazorac, Fabior, Arazlo)

• Aklief (trifarotene)

• Tretinoin / clindamycin (Ziana, Veltin), in combination with a topical antibiotic

• Adapalene / benzoyl peroxide (Epiduo, Epiduo Forte)

All topical retinoids can cause skin irritation, like redness, peeling, and burning. The best way to avoid this is to start slowly. For example, you could use it on alternate days. Then you can gradually work your way up to nightly use. Moisturizing regularly can help avoid skin irritation, too. Because retinoids can cause sun sensitivity, wearing sunscreen every morning is important.

Topical retinoids should be avoided during pregnancy.

Topical antibiotics

Topical antibiotics treat inflammatory acne by killing bacteria and reducing inflammation in the skin. They come in different formulations. You can also get topical antibiotics in combination with other medications. Common antibiotic creams and gels for acne include:

• Clindamycin (Clinda-Derm, Clindagel, Cleocin-T)

• Erythromycin (Erygel)

• Dapsone (Aczone)

• Minocycline (Amzeeq)

• Erythromycin / benzoyl peroxide (Benzamycin)

• Clindamycin / benzoyl peroxide (Acanya, Onexton)

In general, topical antibiotics don't cause many side effects. But some people can get skin irritation, like red, dry, or itchy skin. Antibiotic creams and gels can also make your skin more sensitive to the sun.

Short courses of topical clindamycin and erythromycin are safe to use during pregnancy.

Winlevi

Winlevi (clascoterone) is a new type of prescription cream that can treat hormonal acne. It's not known exactly how Winlevi works, but it seems to block androgen hormones (such as testosterone) that influence oil (sebum) production in your skin.

Common Winlevi side effects include skin redness, itching, and peeling.

Prescription oral medication for acne

Oral medications are pills you take by mouth. They can be helpful alongside topical treatments, especially for moderate and severe acne.

Oral antibiotics

Oral antibiotics work to treat acne by killing bacteria and lowering inflammation.

Here's what to know about taking antibiotics for acne:

• How it works: Since oral antibiotics are usually used for about 3 months, they should always be combined with other treatments. This way, you can continue with an acne treatment when you stop using antibiotics. This also helps prevent the risk of developing bacterial resistance (when bacteria stop responding to antibiotics).

• Side effects: Antibiotic side effects include nausea, vomiting, and diarrhea. Serious reactions aren't common, with the exception of allergic reactions, like skin rashes.

• Safety: Some antibiotics are safe for use in pregnancy, but not all. It's best to check with your doctor or pharmacist if it's possible you could be pregnant or may become pregnant soon.

Here are some common antibiotics for acne:

• Minocycline (Minocin)

• Doxycycline (Doryx, Doxy)

• Tetracycline

• Erythromycin (E.E.S., Ery-tab)

• Azithromycin (Zithromax)

Birth control

Oral contraceptive pills that contain estrogen and progestin hormones (combination birth control pills) can help treat all types of acne.

Here's what to know about using oral contraceptive pills to treat acne:

• How it works: Oral contraceptive pills work by lowering levels of androgen hormones (like testosterone), making them good for hormonal acne. The pill can be used along with other acne treatments.

• Side effects: Common birth control pill side effects - like nausea, period changes, and mood changes - usually fade after a few months.

• Risks: They've also been linked to an increased risk of blood clots and strokes.

These birth control pills are FDA-approved to treat acne:

• Ethinyl estradiol / norgestimate (Ortho Tri-Cyclen, TriNessa)

• Ethinyl estradiol / norethindrone acetate / ferrous fumarate (Tilia Fe)

• Drospirenone / ethinyl estradiol (Yaz)

• Drospirenone / ethinyl estradiol / levomefolate (Beyaz)

Spironolactone

Spironolactone is a blood pressure medication that's used off-label for hormonal acne in women, in keeping with guidelines from the American Academy of Dermatology.

• How it works: Spironolactone works by lowering testosterone levels and blocking androgen hormone activity. Spironolactone can be used in combination with other medications.

• Safety note: This medication isn't safe to use during pregnancy.

• Side effects: Spironolactone can cause diarrhea, nausea, and vomiting. It can also cause irregular periods and electrolyte (salt) imbalances in the blood.

Isotretinoin (Accutane)

Isotretinoin (Accutane, Absorbica, Amnesteem) is a retinoid taken as a pill to treat severe cystic acne. Here's what to know about this treatment:

• What it treats: It works by speeding up cell turnover and shrinking oil glands.

• Length of treatment: Most people take Accutane for 4 to 6 months, and about 85% of people get permanently clear skin afterwards.

• Side effects: Accutane can cause many side effects. The most serious one is birth defects. So, Accutane can't be used during pregnancy. Common side effects - like dry lips, high cholesterol, and muscle pain - usually go away after stopping the medication.

• Risks: Accutane has also been linked to depression, suicide, and inflammatory bowel disease (IBD). Although Accutane doesn't necessarily cause these problems, it's important to know about them before starting treatment.

Corticosteroids

Corticosteroids (also called steroids) can help treat inflammatory acne. Here's what to know about this treatment:

• What it treats: They're typically prescribed at a low dose for a short period of time.

• Length of treatment: In some situations, corticosteroids can also be injected into painful acne cysts by a specialist provider for quick relief (usually 48 to 72 hours).

• Side effects: Steroid injections can lead to thin skin and discoloration. Steroid pills aren't used as often as other acne treatments because they can have more serious side effects, like nausea, weight gain, high blood pressure, and Type 2 diabetes.

Choosing the best acne treatment

Choosing the right acne treatment for you depends on a few things, like what type of acne you have and how severe it is. Keep in mind that what works for one person may not work for the next. Often, a combination of medications works better than just one at a time.

It's also important to give each medication a chance to work. This usually means persevering for at least 3 months before trying something different.

Here are some common ways different types of acne are treated.

Hormonal acne

This type of acne is caused by hormone changes during menstrual periods and pregnancy, and around menopause.

Close-up of the neck and chin with hormonal acne.

Treatment usually includes a combination of these medications:

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

• Oral treatments: Birth control pills, spironolactone, antibiotics

Cystic acne

Cystic acne can be painful and is more likely to leave behind permanent scars.

Close-up of a cyst in cystic acne on the face.

Treatment usually includes a combination of these medications:

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

• Oral treatments: Antibiotics, isotretinoin (Accutane), steroids

• Other: Steroid injections

Comedonal acne

Some people just have stubborn whiteheads and blackheads, without experiencing pimples or acne cysts.

Close-up of the cheek with comedonal acne and many blackheads and whiteheads.

In this situation, treatment can include some combination of these medications, such as these topical treatments:

• Retinoids

• Antibiotics

• Benzoyl peroxide

• Salicylic acid

• Azelaic acid

Inflammatory acne

Inflammatory acne mainly has two types of pimples: papules (small red, brown or violet bumps) and pustules (papules that are filled with pus).

Close-up of the forehead with inflammatory acne.

If inflammatory acne is pretty mild, it may be treated with topical medications alone. For more severe acne, pills are usually required to help get it under control. Treatment usually includes a combination of these medications:

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

• Oral treatments: Antibiotics, isotretinoin (Accutane)

Lifestyle strategies

When it comes to treating acne, certain lifestyle strategies can help prevent and treat different types of acne. Here are some practices that can improve your skin health:

• Eat a balanced and nutritious diet. Sugar and other high-glycemic foods (like refined white flour and white rice) have been linked to acne. For some people, dairy can also worsen acne. Stick to minimally processed and whole foods to see if you notice improvement. You can also try cutting out dairy for 2 to 3 weeks to see if your skin benefits.

• Manage your stress levels. There's a strong connection between your mind and skin. Experiencing stress can contribute to worsening acne. Try to take steps to reduce stress in your life, like getting enough sleep and practicing meditation.

• Exercise regularly. Getting exercise can stabilize your blood glucose levels and reduce stress. Both can improve the appearance of acne.

Frequently Asked Questions

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