Acne Treatment Options Backed by Science

    It’s a frustrating situation: after finally getting rid of one acne breakout, another one pops up in its place, giving you a fresh set of whiteheads, blackheads and -- if you’re especially unlucky, cystic acne -- to deal with.

    Dealing with acne can be challenging, especially if you’re genetically prone to persistent acne outbreaks.

    Add a confusing, often misleading skincare industry into the equation, bad recommendations from mass media (no, urine will not cure your acne), and fighting back against acne can be a difficult, expensive and tiring process.

    The reality of acne treatments is that while many brands claim to have the answer, only a few products are scientifically proven to remove and prevent acne. Luckily for your wallet, most of these products aren’t the ultra-pricey skin creams you can spot on department store shelves.

    From topical skin creams to hormonal birth control, we’ve listed all of the science-backed acne treatment options below, along with detailed information on how each option can help to treat, improve and prevent your acne for good.

    Retinoids

    Retinoids are some of the most popular medications available for treating acne. They work by speeding up your body’s skin cell turnover process, helping your body get rid of dead skin and replace it with new skin cells faster.

    This prevents acne by stopping dead skin cells from getting caught inside your pores. When old, dead skin cells get trapped inside a pore, they can mix with excess sebum to create a blockage, leading to the development of a whitehead or blackhead.

    When bacteria mixes with a blockage, it can result in infected, inflamed acne. Blockages deep beneath the skin can even cause cystic acne -- the most painful, serious form of acne that can potentially cause long-term scarring.

    Speeding up your skin cell turnover process doesn’t completely eliminate dead skin, but it does make it far less likely for blockages to develop.

    There are numerous retinoids available, all of which are derivatives of vitamin A. The two most commonly used retinoids for acne are tretinoin (a topical retinoid that’s sold as “Retin-A”) and isotretinoin (an oral retinoid that’s sold as “Accutane”).

    Both of these retinoids are backed up by a lot of scientific evidence. One study from 2009 shows that tretinoin significant outperforms a control as a facial acne treatment. A 2015 study of topical acne treatments showed that tretinoin, combined with clindamycin 1% gel, reduced acne lesions from 13.70 ± 4.80 to 1.30 ± 2.95 in 12 weeks.

    In short, tretinoin isn’t just effective anecdotally -- it’s also backed by science. Although tretinoin has some side effects, it’s well tolerated by the vast majority of people that use it for acne, with a good safety record and few interactions.

    Tretinoin cream comes in a variety of strengths, making it easy to adjust your dosage to target your acne. It’s one of three main active ingredients in Hers Acne, alongside other acne-fighting substances such as clindamycin and niacinamide.

    While tretinoin is the most effective topical retinoid, it’s not the only retinoid that’s used to treat and prevent acne. For severe cases of acne, many dermatologists will prescribe isotretinoin -- an oral retinoid that also speeds up the skin cell turnover cycle and targets acne lesions.

    While you might not have heard of isotretinoin before, you’ve probably heard of Accutane. The chemical isotretinoin is the active ingredient in Accutane, and it’s one of the most powerful and effective acne treatments available.

    Studies show that isotretinoin is highly effective at treating acne and keeping it away for good. In a 1984 study, researchers found that isotretinoin caused a significant clinical response in people with severe, nodulocystic acne.

    Other studies of isotretinoin have produced similar findings. Dermatology Times has described isotretinoin as the “best drug for acne,” noting the huge number of scientific studies in its favor, its track record and its high first-treatment success rate.

    Despite its effectiveness, isotretinoin does have some downsides. First, its side effect profile is significantly larger than topical tretinoin’s. Second, because it’s an oral medication, it can affect the liver and is only recommended for use without alcohol.

    This means that you might have to make some changes to your social life while you use an oral retinoid, if you usually drink alcohol.

    Side effect risk aside, isotretinoin works, almost always extremely well. Because of its strength and efficacy, dermatologists usually prescribe isotretinoin for more severe cases of acne, such as cystic acne or recurring hormonal acne that other medications fail to treat.

    Beyond tretinoin and isotretinoin, there are several other retinoids that are marketed as acne treatments. The most common of these is Vitamin A1 -- a retinoid that’s usually included as a dietary supplement ingredient.

    While there’s some scientific evidence that these over-the-counter retinoids can help to treat acne and improve your general skin health, it’s not as solid as the evidence for tretinoin and isotretinoin.

    Antibiotics

    Severe acne is equal parts blockage and bacteria, meaning that antibacterial medication can be highly effective at reducing the severity of a breakout.

    Because of this, oral and topical antibiotics are often used to treat acne. Most dermatologists will prescribe antibiotics in combination with other acne medication, such as a retinoid or hormonal birth control (something we’ve covered in more detail below).

    Antibiotics fight back against acne by targeting the bacteria present inside cystic acne nodules, inflamed pimples and other forms of acne.

    Since antibiotics don’t affect sebum buildup or your body’s skin cell turnover cycle, they won’t prevent acne from developing. However, they can and usually do make your acne outbreaks less severe, especially if you’re prone to painful outbreaks of cystic acne.

    This means that you’ll usually only be prescribed an antibiotic if your acne is inflamed, infected and cystic. For regular hormonal acne, dermatologists will usually stick to a retinoid, possibly in combination with hormonal medication.

    So, which antibiotics are the best for acne? For severe acne, dermatologists usually prescribe tetracycline, doxycycline, erythromycin or minocycline.

    The scientific evidence for these antibiotics varies from one drug to another. Medical studies of topical tetracycline show a reduction in comedones of as much as 55.4%, with studies of other antibiotics such as doxycycline also showing positive results for treating acne.

    For lighter acne, clindamycin gel (one of several active ingredients in Hers Acne) is a common treatment. Clindamycin is linked to an improvement in acne over the course of eight to twelve weeks, making it a powerful and convenient tool in acne treatment.

    Like retinoids, antibiotics can range from over-the-counter topical treatments to prescription-only oral antibiotics. There’s no one “best” antibiotic for treating and preventing acne, meaning you’ll usually be prescribed the best option for your specific symptoms, needs and medical history.

    Hormonal Medication (Birth Control)

    Hormonal birth control medication (also known as combined oral contraceptives, or COCP) such as YAZ, Estrostep and Ortho Tri-Cyclen can be highly effective in treating acne, especially acne that’s caused by hormonal fluctuations.

    As we mentioned earlier, problematic acne is equal parts blockage and bacteria. One key part of the blockage aspect of acne is your production of sebum -- a natural oil that’s used for hydration and skin protection.

    While sebum is essential for healthy skin, too much sebum can contribute to blocked pores and an increase in acne.

    Culprit number one for excessive sebum production? Androgen hormones such as testosterone, which can often fluctuate throughout your menstrual cycle.

    Yes, even as a woman, your body produces small amounts of testosterone and other male sex hormones. Our guide to hormonal acne explains this process in detail, as well as how it affects your acne outbreak risk and general skin health.

    Your body’s production of androgens usually peaks in the days before your period. Because of this, it’s common to experience an increase in acne on your period, as well as during the week before your period.

    Birth control medication can treat and prevent acne by lowering your body’s production of male hormones like testosterone. As your testosterone level decreases, so does your production of sebum, helping to minimize blocked pores and keep your facial skin smooth and acne-free.

    The FDA has only approved three birth control medications for treating acne: YAZ, Estrostep and Ortho Tri-Cyclen. These pills all use a combination of estrogen and a progestin to lower your body’s androgen levels.

    It’s worth noting that other birth control pills, such as progestin-only birth control, might not be effective and shouldn’t be viewed as acne treatments.

    Just like with other acne treatments, there’s no “best” acne prevention birth control pill for every situation. If you’re interested in using birth control to treat your acne, your doctor will choose the best medication for your needs based on your symptoms and health history.

    Want to learn more about using birth control as an acne treatment? Our guide to birth control and acne goes into more detail on how combined oral contraceptive pills can lower androgen levels and improve your skin.

    Benzoyl Peroxide

    Benzoyl peroxide is a topical medication that kills bacteria, lowering your risk of dealing with infected, inflamed acne lesions.

    Although benzoyl peroxide is antibacterial, most doctors don’t place it in the same category as topical antibiotics such as clindamycin. This is because benzoyl peroxide kills bacteria without inducing antibiotic resistance -- a common side effect of long-term antibiotic treatment.

    Benzoyl peroxide is found in a diverse range of over-the-counter acne products, from creams, balms and lotions to facial masks.

    It’s also often formulated in combination with other acne prevention medications. Two common acne prevention formulas are benzoyl peroxide/clindamycin and adapalene/benzoyl peroxide, both of which are widely used in topical prescription acne treatments.

    Dermatologists usually recommend benzoyl peroxide for mild to moderate acne, usually as an alternative to conventional antibiotics.

    Like the other treatments featured above, benzoyl peroxide is well established as a scientifically proven treatment for acne. It’s listed as a common acne treatment in countless reviews, has an excellent safety record and a usage record dating back to the 1930s, making it one of the oldest and most thoroughly studied acne treatments still in use today.

    Topical benzoyl peroxide comes in several strengths and formulas. For mild acne, the 2.5% formula is usually your best best, since it has similar effects to stronger formulas with fewer potential side effects.

    Like all acne treatments, it pays to be patient with benzoyl peroxide -- on average, it takes about eight to 10 weeks to produce a noticeable improvement in your acne symptoms.

    Salicylic Acid

    Another over-the-counter acne treatment, salicylic acid is a beta-hydroxy acid that can help your skin more effectively strip away dead skin cells, preventing the blocked pores that can contribute to acne outbreaks.

    Salicylic acid is neither a retinoid nor an antibiotic. It doesn’t affect sebum production or kill any of the bacteria that can cause blocked pores to become infected. However, there’s some limited scientific evidence that it can help with exfoliation and keep your pores clean and clear.

    This includes a 1992 study of salicylic acid pads, which showed that salicylic acid outperformed benzoyl peroxide as an acne prevention agent. Other studies show that salicylic acid performs significantly better than a placebo in the treatment and prevention of acne.  

    Like benzoyl peroxide, salicylic acid is something you’ll need to take continuously if your goal is to combat acne breakouts. Once you stop using salicylic acid, your skin’s exfoliation process will go back to normal, meaning it’s possible for acne breakouts to occur again.

    Salicylic acid is easy to find -- it’s used as an active ingredient in hundreds of over-the-counter acne products, including facial washes and cleansers.

    Is salicylic acid enough for moderate to severe acne? Possibly, but likely not. However, if you’ve got mild to moderate acne and want a treatment that’s less intense than retinoids and hormonal medication, salicylic acid is certainly worth considering.

    Learn More About Treating Acne

    Looking for proven, effective treatments for your acne? Our guides to tretinoin as a treatment for hormonal acne and cystic acne cover two usages of one of the most effective acne medications available.

    You can also learn more about using birth control medication to treat acne in our guide to birth control, androgens and acne breakouts.

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.