Dapsone has shown efficacy against inflammatory acne but is generally not a first-line topical antibiotic due to higher cost and lack of clear superiority over other antibiotics.[1][15] It is sometimes a preferred therapy in women or for people with sensitive or darker toned skin.[15] Topical dapsone is not recommended for use with benzoyl peroxide due to yellow-orange skin discoloration with this combination.[10] While minocycline is shown to be an effective acne treatment, it is no longer recommended as a first-line antibiotic due to a lack of evidence that it is better than other treatments, and concerns of safety compared to other tetracyclines.[87]
The Strategist is designed to surface the most useful, expert recommendations for things to buy across the vast e-commerce landscape. Some of our latest conquests include the best acne treatments, rolling luggage, pillows for side sleepers, natural anxiety remedies, and bath towels. We update links when possible, but note that deals can expire and all prices are subject to change.
Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.

Ablative lasers deliver an intense wavelength of light to the skin, removing thin outer layers of the skin (epidermis). In addition, collagen production is stimulated in the underlying layer (the dermis). Patients are typically numbed with local anesthetic and the ablation is done as an outpatient procedure. CO2 and erbium are the ablative lasers most often used for acne scar treatment.
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Azelaic acid has been shown to be effective for mild to moderate acne when applied topically at a 20% concentration.[66][128] Treatment twice daily for six months is necessary, and is as effective as topical benzoyl peroxide 5%, isotretinoin 0.05%, and erythromycin 2%.[129] Azelaic acid is thought to be an effective acne treatment due to its ability to reduce skin cell accumulation in the follicle, and its antibacterial and anti-inflammatory properties.[66] It has a slight skin-lightening effect due to its ability to inhibit melanin synthesis, and is therefore useful in treating of individuals with acne who are also affected by postinflammatory hyperpigmentation.[1] Azelaic acid may cause skin irritation but is otherwise very safe.[130] It is less effective and more expensive than retinoids.[1]
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.
Scarring from severe cystic acne can have harmful effects on a person's self esteem, happiness and mental health. Thankfully, there are many different acne scar treatment options available, ranging from chemical peels and skin fillers to dermabrasion and laser resurfacing. According to the American Academy of Dermatology, these are all safe and effective acne scar treatment methods. However, Baldwin says it's important to first clarify what you mean by "scar." "Many people point to red or brown spots leftover from old zits and call them scars," she says. "These are marks, not scars and they'll fade with time. Scars have textural changes and are not flush with the surface of the skin. There are two types of acne scars—innies and outies. Outies can be injected with corticosteroids and flattened. Innies can be either deep and narrow or broad, sloping and relatively shallow. Deep and narrow scars need to be cut out, but broader sloping scars can be made better by fillers, laser resurfacing and dermabrasion."
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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.
Acne vulgaris and its resultant scars have been associated with significant social and academic difficulties that can last into adulthood, including difficulties obtaining employment.[31][177] Until the 1930s, it was largely seen as a trivial problem among middle-class girls – a trivial problem, because, unlike smallpox and tuberculosis, no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it.[165] During the Great Depression, dermatologists discovered that young men with acne had difficulty obtaining jobs, and during World War II, some soldiers in tropical climates developed such severe and widespread tropical acne on their bodies that they were declared medically unfit for duty.[165]
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When regular light is used immediately following the application of a sensitizing substance to the skin such as aminolevulinic acid or methyl aminolevulinate, the treatment is referred to as photodynamic therapy (PDT).[10][128] Many different types of nonablative lasers (i.e., lasers that do not vaporize the top layer of the skin but rather induce a physiologic response in the skin from the light) have been used to treat acne, including those that use infrared wavelengths of light. Ablative lasers (such as CO2 and fractional types) have also been used to treat active acne and its scars. When ablative lasers are used, the treatment is often referred to as laser resurfacing because, as mentioned previously, the entire upper layers of the skin are vaporized.[142] Ablative lasers are associated with higher rates of adverse effects compared with nonablative lasers, with examples being postinflammatory hyperpigmentation, persistent facial redness, and persistent pain.[8][143][144] Physiologically, certain wavelengths of light, used with or without accompanying topical chemicals, are thought to kill bacteria and decrease the size and activity of the glands that produce sebum.[128] Disadvantages of light therapy can include its cost, the need for multiple visits, time required to complete the procedure(s), and pain associated with some of the treatment modalities.[10] Typical side effects include skin peeling, temporary reddening of the skin, swelling, and postinflammatory hyperpigmentation.[10]
The side effects depend on the type of treatment you use. Generally, for topical, over-the-counter creams, you can watch out for stinging, redness, irritation and peeling — these side effects usually don’t go any deeper than the skin. Others, like oral antibiotics or hormonal medications, could come with new sets of complications, so we suggest talking to your doctor before pursuing the treatment.

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Every expert we spoke with said the most critical part of combating acne is combating it every day. “The only way to make any medication work is to use it on a daily basis,” says Dr. Green. Aesthetician and Rodan + Fields Consultant, Jessica Fitz Patrick emphasizes that it really comes down to what you can maintain for the long term: “Kits are great because they take out all the guesswork -- you just follow the instructions. But if four steps is going to be too many for you to keep up week after week, you’ll be better off finding one that has fewer treatments.”
Accutane is especially good for cystic acne in women and body acne in men. “Oral vitamin A basically shuts down your sebaceous glands. If you suppress [them] for a long enough period, you can cure someone of their acne, and about 50 percent do hit that cure rate,” says Linkner. A course of Accutane can take about six to nine months. Sometimes patients need to repeat the course at a higher dosage in order to truly eliminate acne.
Even better than one stand-alone cream is a multipronged combination of acne treatments. “A good place to start is to use a combination of salicylic acid, benzoyl peroxide, and a topical retinoid,” says Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. “Salicylic acid helps remove excess oil from the surface of the skin and exfoliate the dead cells, while benzoyl peroxide kills acne-causing bacteria and helps reduce inflammation.”
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
Scarring from severe cystic acne can have harmful effects on a person's self esteem, happiness and mental health. Thankfully, there are many different acne scar treatment options available, ranging from chemical peels and skin fillers to dermabrasion and laser resurfacing. According to the American Academy of Dermatology, these are all safe and effective acne scar treatment methods. However, Baldwin says it's important to first clarify what you mean by "scar." "Many people point to red or brown spots leftover from old zits and call them scars," she says. "These are marks, not scars and they'll fade with time. Scars have textural changes and are not flush with the surface of the skin. There are two types of acne scars—innies and outies. Outies can be injected with corticosteroids and flattened. Innies can be either deep and narrow or broad, sloping and relatively shallow. Deep and narrow scars need to be cut out, but broader sloping scars can be made better by fillers, laser resurfacing and dermabrasion."
It starts when greasy secretions from the skin's sebaceous glands (oil glands) plug the tiny openings for hair follicles (plugged pores). If the openings are large, the clogs take the form of blackheads: small, flat spots with dark centers. If the openings stay small, the clogs take the form of whiteheads: small, flesh-colored bumps. Both types of plugged pores can develop into swollen, tender inflammations or pimples or deeper lumps or nodules. Nodules associated with severe cases of acne (cystic acne) are firm swellings below the skin's surface that become inflamed, tender, and sometimes infected.
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