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Table of content

What Causes Acne?

There are four main causes of acne:

  1. Excess oil production
  2. Hair follicles clogged by oil and dead skin cells
  3. Bacteria
  4. Hormones

Acne commonly occurs on the face, forehead, chest, upper back, and shoulders because these areas of skin have the most oil glands. Hair follicles and oil glands are connected. When the follicle is small and the wall bulges it creates a whitehead. If the follicle opening is large and open to the surface it causes a blackhead. A blackhead may look like dirt is stuck in your pores, however, the pore is actually clogged with bacteria and oil, when exposed to the air it turns brown. If the blocked follicles become inflamed or infected with bacteria a pimple may develop. A pimple is a raised red spot with a white center. In more severe acne cases these blockages can become very inflamed and infected causes firm swelling below the skin’s surface causing nodules and cystic acne.

There are some factors that can trigger acne, these include:

  • Hormones - Androgens are hormones that increase in boys and girls during puberty which causes the body to create more sebum, the oil produced in the skins oil glands. Hormonal changes during menstruation and pregnancy can also affect sebum production.
  • Medications - certain medications like corticosteroids, testosterone or lithium can trigger acne breakouts
  • Diet - Certain foods could aggravate acne in some people, like skim milk, carb-rich foods like bread, bagels, and chips.
  • Stress - doesn’t necessarily cause acne, but if you already have acne stress can aggravate it
  • Air pollution
  • Blocking clothing like headgear, hats, sports helmets

Symptoms of Acne

The common symptoms of acne can vary depending on your condition, and could include:

  • Blackheads, plugged pores
  • Whiteheads, closed plugged pores
  • Persistent pimples
  • Papules, red swellings or lumps that are filled with pus
  • Nodules or lumps under the skin that are inflamed.
  • Cystic lesions, painful lumps filled with pus beneath the surface of the skin

When to See a Doctor for Your Acne

  • If your acne makes you unhappy or uncomfortable
  • Your acne is producing scars
  • Your acne is causing dark patches
  • Your acne is severe causing nodules under your skin and persistent pimples
  • Your acne does not respond to over-the-counter treatment options
  • If you are an older adult a sudden onset of acne could be a symptom of an underlying medical condition

Where To Get Treatment For Acne Online

  • PlushCare
  • Dermatica
  • Alpha Medical
  • Hims
  • SteadyMD
  • SkyMD
  • Strut
  • Curology
  • Nuimage Medical
  • Dermatologistoncall
  • Roman
  • 98point6
  • DermaCare
  • Dear Brightly
  • Lemonaid
  • Apostrophe
  • MeMD
  • Trulee
  • Blink Health
  • CallonDoc
  • FaceRx/Musely

Treatment Options For Acne

There are many treatment options available for treating acne. Depending on your acne severity, acne treatment can range from non-prescription treatments to prescription-strength treatments and topical or oral treatments. The best acne treatments reduce oil production and limit bacterial growth while encouraging sedding of skin cells to help unclog your pores. The treatment regimen your doctor recommends will depend on your age, the type of acne you have, the severity of your acne, and a process you are willing to commit to. Many acne treatment regimens could require you to wash and apply medications to your skin twice a day for many weeks.

Nonprescription Acne Treatments

  • Soap and water - gently cleansing your face with soap and water twice daily can help with acne.
  • Cleansers - there are many over the counter cleansers advertised for treating acne, they frequently contain benzoyl peroxide, glycolic acid, salicylic acid, or sulfur to help treat acne.
  • Benzoyl peroxide - for mild cases of acne treatment with a nonprescription treatment that contains benzoyl peroxide might be recommended. Benzoyl peroxide works to stop the bacteria that causes acne. It often takes at least 4 weeks to work and must be used continuously to help keep acne at bay. Benzoyl peroxide comes in many forms: creams, lotions, washes, foams, cleansing pads, and gels. Benzoyl peroxide can cause dry skin and can bleach fabrics, so be careful when applying this product.
  • Salicylic acid - for mild cases of acne salicylic acid can help to unclog pores and resolve and prevent lesions. Salicylic acid does not have an effect on oil production and does not kill bacteria. Salicylic acid comes in many forms: lotions, creams, and pads that are either wash off or leave-on products.
  • Sulfur - Sulfur is a component in many over the counter acne medications and is typically combined with other substances like alcohol and salicylic acid. It is not clear how sulfur works and is only shown to provide marginal benefits in treating acne.
  • Topical retinol - Retinol works to prevent pimples from forming. It works to increase cell turnover which helps to unblock pores. Often times your acne may appear to get worse before it gets better because it starts by working on the pimples that are already forming under your skin. You may need to use retinol products for 8-12 weeks before you start seeing results. Retinol is typically only prescription strength, however, Differin Gel is the only over the counter topical retinoid approved to treat acne.
  • Alcohol and acetone - Alcohol is an anti-bacterial agent and acetone helps to remove oils from the skin. These substances are combined in several over the counter products. They do dry out the skin and have little known effect on treating acne.

Prescription Acne Treatments

  • Antibiotics - antibiotics can either be used on the skin as a topical treatment or taken orally. Antibiotics work by killing off acne-causing bacteria and reduce inflammation. Topical antibiotics are limited in the ability to penetrate the skin and clear deep acne and are typically recommended alongside other acne treatments. Oral antibiotics are able to circulate through your body and target sebaceous glands and are typically recommended for more severe cases of acne. Oral antibiotics have more side effects than topical antibiotics. Topical antibiotics can increase the risk for antibiotic resistance in skin bacteria, but when used with benzoyl peroxide you may reduce the chances of antibiotic resistance.
    • Topical Antibiotics - clindamycin (Cleocin T, Clinda-Derm) and erythromycin (Ilotycin) are the most common and effective antibiotics to treat acne. These substances should be used with a benzoyl peroxide or topical retinoid product.
    • Oral Antibiotics - doxycycline, minocycline, and tetracycline are the most common and effective oral antibiotics to treat acne.
  • Retinoids/vitamin A derivatives - this medication is available both topically and orally. Retinoids should not be used by women who are pregnant or nursing.
    • Topical retinoids work to increase skin cell turnover and are used to clear up moderate-to-severe acne. Some side effects of topical retinoids could include redness, dryness, and itchy skin.
    • Oral retinoids are used for severe cases of cystic acne. The drug isotretinoin (Absorica, Accutane, Amnesteem, Claravis, Sotret) is the most effective oral retinoid because it is the only drug that works to treat all causes of acne. Side effects of this drug could include severe birth defects, depression, suicide, inflammatory bowel disease, dry skin/lips, muscle/joint pain, headache, elevated triglyceride levels, elevated liver enzymes, and temporary hair shedding.
  • Azelaic acid - this is a topical treatment that comes in the form of a gel, cream, or foam and contains antibacterial and anti-inflammatory properties. The most common use of azelaic acid is the treatment of rosacea, but it can also help mild cases of acne. Side effects could include skin discoloration and minor skin irritation.
  • Dapsone - is a topical gel that contains antibacterial and anti-inflammatory properties. Side effects could include redness and dryness.
  • Oral contraceptives - birth control pills are used to treat acne in female patients. They contain the female hormones estrogen and progestin that work to fight hormonal acne. It may take up to 4 months to see results. Possible side effects include nausea, weight gain, breast tenderness, blood clots, and spotting.
  • Anti-androgen agent - the drug spironolactone (Aldactone) is used to treat acne in women and adolescent girls. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness and painful periods.

Skin Therapies

  • Laser and photodynamic therapy - there are a variety of light therapies that have been successful in treating acne. These therapies require more study to determine the best method, light source, and dose.
  • Chemical peel - Chemical peels work by using repeated applications of a chemical solution like salicylic acid, glycolic acid, or retinoic acid to treat acne. 
  • Extraction of whiteheads and blackheads - your doctor can use a special tool to remove whiteheads and blackheads that have not responded to topical treatments. This procedure may cause scarring.
  • Steroid injection - this technique is typically used for nodular and cystic lesions and is treated by injection a steroid drug directly into the affected area. This technique works to improve acne and decrease pain. Side effects may include thinning of the skin in the treated area.

It is important to understand the possible side effects of the acne medication you decide to use and how they might interact with other medications you may be taking.

How to Prevent Acne Breakouts

Many health care professionals believe that there is no way to prevent acne because of fluctuating hormones and genetic factors. Good hygiene and diet are not associated with preventing acne, but a sensible skincare routine is recommended including bathing and washing your face daily. Some tips that could help prevent future breakouts include:

  • Using non-comedogenic skin products to reduce the chance of new lesions and reduce skin irritation
  • Use a mild facial cleanser twice daily
  • Avoid using products that contain scrubbing particles as these products can irritate the skin and lead to breakouts
  • Use a non-comedogenic moisturizer and sunscreen daily
  • Use makeup that is non-comedogenic
  • Avoid picking, squeezing, and popping pimples as this leads to scarring and possible skin infection.

Acne is a skin condition that affects most people at some point in their lives and doctors don’t fully understand why some people get acne or what increases the risk for acne. Acne is not typically a serious health threat, but it can be uncomfortable and embarrassing. But there is good news, with the use of telemedicine, you can receive treatment for your acne from the comfort of your own home. There are many online clinics that can easily diagnose and treat your acne through virtual video visits or by simply uploading photos of your skin. We have created a list of the top online doctors that provide treatment for acne. Check out the list here today!