But the milder cases can benefit from some topical over-the-counter treatments, too: “OTC options should be limited to when you have only one or two cysts,” though, says dermatologist Noelani Gonzalez, the director of cosmetic dermatology at Mount Sinai West. “Otherwise you should go see your dermatologist sooner than later to avoid any scarring.” Here, we spoke with three dermatologists to hear more about the most effective cystic-acne treatments to use at home.
Chemical peels can be used to reduce the appearance of acne scars.[32] Mild peels include those using glycolic acid, lactic acid, salicylic acid, Jessner's solution, or a lower concentrations (20%) of trichloroacetic acid. These peels only affect the epidermal layer of the skin and can be useful in the treatment of superficial acne scars as well as skin pigmentation changes from inflammatory acne.[32] Higher concentrations of trichloroacetic acid (30–40%) are considered to be medium-strength peels and affect skin as deep as the papillary dermis.[32] Formulations of trichloroacetic acid concentrated to 50% or more are considered to be deep chemical peels.[32] Medium-strength and deep-strength chemical peels are more effective for deeper atrophic scars, but are more likely to cause side effects such as skin pigmentation changes, infection, and small white superficial cysts known as milia.[32]
Hormonal activity, such as occurs during menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in sex hormones called androgens causes the skin follicle glands to grow larger and make more oily sebum.[12] Several hormones have been linked to acne, including the androgens testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA); high levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) have also been associated with worsened acne.[42] Both androgens and IGF-1 seem to be essential for acne to occur, as acne does not develop in individuals with complete androgen insensitivity syndrome (CAIS) or Laron syndrome (insensitivity to GH, resulting in very low IGF-1 levels).[43][44]
Wear sunscreen everyday and do not tan. Ultraviolet Radiation is the number one cause of premature aging. It also leads to skin cancer in high enough doses. Treat the sun like the death ray that it is. Exposing your skin to harmful UVA and UVB rays damages skin and prolongs post inflammatory erythema(PIE)--red acne marks, as the sunlight stimulates pigment-producing cells.

Antiandrogens such as cyproterone acetate and spironolactone have been used successfully to treat acne, especially in women with signs of excessive androgen production such as increased hairiness or skin production of sebum, or baldness.[10][47] Spironolactone is an effective treatment for acne in adult women, but unlike combined birth control pills, is not approved by the United States Food and Drug Administration for this purpose.[1][36][99] The medication is primarily used as an aldosterone antagonist and is thought to be a useful acne treatment due to its ability to additionally block the androgen receptor at higher doses.[36] Alone or in combination with a birth control pill, spironolactone has shown a 33 to 85% reduction in acne lesions in women.[90] The effectiveness of spironolactone for acne appears to be dose-dependent.[90] High-dose cyproterone acetate alone has been found to decrease symptoms of acne in women by 75 to 90% within 3 months.[100] It is usually combined with an estrogen to avoid menstrual irregularities and estrogen deficiency.[101] The medication has also been found to be effective in the treatment of acne in males, with one study finding that a high dosage reduced inflammatory acne lesions by 73%.[102][103] However, the side effects of cyproterone acetate in males, such as gynecomastia, sexual dysfunction, and decreased bone mineral density, make its use for acne in this sex impractical in most cases.[102][103][104] Hormonal therapies should not be used to treat acne during pregnancy or lactation as they have been associated with birth disorders such as hypospadias, and feminization of the male babies.[47] In addition, women who are sexually active and who can or may become pregnant should use an effective method of contraception to prevent pregnancy while taking an antiandrogen.[105] Antiandrogens are often combined with birth control pills for this reason, which can result in additive efficacy.[36][106]
Contrary to popular belief, acne isn't caused by a harmful diet, poor hygiene, or an uncontrolled sex drive. The simple truth is that heredity and hormones are behind most forms of acne. Swearing off chocolate or scrubbing your face 10 times a day won't change your predisposition to this unsightly, sometimes painful, and often embarrassing skin problem.
Shower twice a day. Take a shower or bath in the morning and at night. Alternatively, take a shower in the morning and then again after physical activity, like exercise, or sweating. Wash your entire body with a mild cleanser and use shampoos that limit oil production in your hair. Be sure to always shower after exercising to remove the dead skin cells your body has sloughed off through sweating.
Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It's even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.
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