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Acne is one of the most common skin conditions in the United States. Although it can be very frustrating, there are multiple effective treatments. Treatment starts with choosing the right skin care products. Treatment may also include changes to your diet and lifestyle. For more severe or persistent cases, treatment may include prescription medicated creams and gels, or even medications by mouth.

Melanocytes are the cells in your body that help produce melanin, and they're found throughout your skin. Melanin is the pigment in your skin that helps determine your skin tone, and it’s usually distributed pretty evenly over the surface of your skin.

The key factors in determining how much skin pigment you have in your skin are:

  • The activity of your melanocytes

  • The type of melanin in your skin

  • Where that melanin is distributed in your skin

Too much melanin concentrated in one area can produce solar lentigos, also known as sun-induced freckles or dark spots. It can also produce post-inflammatory hyperpigmentation (PIH) after an injury or an insult to the skin in one area. Too much melanin can also produce dark patches over certain areas of the face due to hormone fluctuations, known as melasma. 


If your skin is prone to acne, you do need to make several adjustments to your skin care regimen. You’ll need to think about the types of active ingredients to include in your regimen. The choice of vehicle, which is another word for the skin care product formulation, is also very important. Finally, you also need to think about what types of ingredients to avoid.


Acne is what we call a multi-factorial condition. This means that there several different factors that play a role in your tendency to develop acne. 

The two major causes are genetics and hormonal factors. Environmental factors, stress levels, the foods that you eat, and the skin care products that you use can also play a role. 

Some of these other factors probably impact acne because of their effects on hormones. For example, certain foods, such as added sugars and refined carbohydrates, can change the level of hormones in your bloodstream. Some of these hormones, including one called IGF-1 (insulin-like growth factor 1) have been shown in research studies to increase oil production and skin inflammation, both of which contribute to acne.


Genetics, hormonal changes, and other environmental and lifestyle factors can lead to certain changes in the skin. The skin changes seen in people with acne can include:

  • An increase in oil production (sebum)

  • An increase in skin inflammation

  • Hyperkeratosis. Many people with acne have “stickier” skin cells that don't slough off the surface of the skin normally. These can start to clog pores. 

  • The presence of bacteria on the surface of the skin (Propionibacterium acnes) which can worsen skin inflammation

These skin findings can produce the clinical skin findings seen in acne. 


For example, if you’re an adolescent, the hormone changes of puberty will usually lead to an increase in oil production on the skin. At the same time, these skin cells can become "stickier". What that means is that your pores are more likely to be clogged with oil and dead skin cells. On your skin, that can produce whiteheads and blackheads (in medical terms these are known as open and closed comedones). Sometimes these clogged pores (and the substances within) can be irritating to the skin, which produces inflammation, which can produce red pimples on the skin surface. Bacteria may also contribute, further worsening the redness and inflammation of the skin.


In general, the type of skin lesions that we see in acne break down into:


  • Whiteheads and blackheads, also known as open and closed comedones

  • Papules, which are the inflamed red bumps of acne

  • Pustules, which are pus-filled skin lesions

  • Cysts, which are inflamed lesions underneath the surface of the skin

  • Nodules, which are larger and deeper acne lesions

Treatment with topical medications will often help reduce the number and severity of blackheads and whiteheads. Certain topical medications can also be effective against papules and pustules, or at least partially effective.

For patients with cysts and nodules, it’s very important to talk to your dermatologist about treatments, since over-the-counter products or medications typically won't be strong enough. It's also really important to see your dermatologist if you’re using topical products but are not seeing any improvement in your acne, especially if you're starting to develop scarring.


Active ingredients are the ingredients that help a product achieve its goals. Vehicles, just like their name suggests, are the formulation that carries the active ingredient.

If you’re prone to acne, it’s really important to pay attention to the vehicle. In general, you want to look for products that are labeled as "non-comedogenic" (although that label isn’t perfect).

  • If you have oily skin and are prone to acne, it’s important to avoid thicker, heavier formulations. In general, you’ll look more for lotions, gels, and possibly alcohol-based gels and toners.

  • If you have sensitive skin, you should avoid gels and toners that contain alcohol.

  • If you have dry skin, you should avoid alcohol.


Since oil-containing moisturizers and cosmetics may worsen acne, you should examine labels and use only those that are “non-comedogenic” (although this label isn't perfect).  This applies to moisturizers, foundation, powder, and blush.  


Makeup is fine as long as you're careful and choose the right products.  You can also use moisturizers if your skin feels dry, as long as you're careful with product choices. Also be careful with oily hair products, such as mousses or gels, and avoid getting them on your forehead or on your pillow. 


There are several active ingredients that are available over-the-counter and that have been shown to be effective for the treatment of milder forms of acne. Each of these ingredients, though, can cause redness, irritation, and stinging, so they're not recommended for everyone. Combining products that contain these ingredients can also be challenging, since that can just worsen overall irritation of the skin. 


Although products that contain these ingredients may help in milder cases of acne, it can take up to 8 weeks of use to see improvement.

  • Salicylic acid

  • Benzoyl peroxide

  • Retinoids


Salicylic acid is what's known as a chemical exfoliator. It helps to loosen dead skin cells from the surface of the skin, and keep them from clogging pores. While this ingredient may be found in cleansers, spot treatments, or chemical peels, many patients start with a medicated cleanser that contains salicylic acid. Although this is a milder treatment, it may still cause irritation. 


Benzoyl peroxide (BP) has been used as a treatment for acne for decades. It has anti-inflammatory and antibacterial properties, but it can also cause several side effects. These include drying of the skin, redness, irritation, and even bleaching of pillowcases. When it comes to BP, the formulation is extremely important. You need to find a formulation that doesn't irritate your skin, but that's still effective. And although rare, some people become allergic to BP. 


  • These are sold under different brand names, and come in different strengths

  • Options include 2.5%, 5%, or 10%

  • The higher the strength, the more effective the medication. However, note that the higher strengths are also more likely to cause dry skin and irritation. 

  • Those with oily skin may prefer a gel formulation

  • Those with dry or normal skin may prefer a lotion or cream formulation

  • Benzoyl peroxide is sold under different brand names 


In general, we recommend applying a thin layer [to the entire area that tends to break out] at bedtime. If you do this consistently over 4-8 weeks, it can prevent new acne bumps. Be careful, though, because BP can cause irritation in some people and can bleach out dark pillowcases.

Some people with oily skin choose to use BP creams in conjunction with a medicated cleanser. (Cleanse first, pat skin and wait for it to dry completely, then use the BP cream.)  However, this combination has a higher risk of irritation, meaning it can cause more redness and peeling. 


In general, for acne on the back, dermatologists recommend starting with a medicated acne wash that contains benzoyl peroxide. Lather up, leave on the back for 5-10 minutes in the shower, then wash off. Most products come in a 5% or 10% concentration. 


If the wash is not too irritating, but isn't helping after 4 weeks, then we usually recommend adding a BP cream that you leave overnight on the back. As always, these can cause irritation and bleach out clothing and bedsheets.


Retinoids are very effective for comedonal acne and mild papulopustular acne, but the strength of the active ingredient and the formulation is very important. While retinoids can be very effective, they can also cause redness, stinging, and skin irritation. That's why it's so important to use them properly. Since these medications cause sensitivity to sunlight, they are used at bedtime, and sun protection is recommended the next morning. It's also important to remember that it can take up to 8 weeks of use to see results. 

Sensitive Skin
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Oily Skin
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Dry Skin
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Normal Skin
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