Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It doesn't necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
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Combination therapy—using medications of different classes together, each with a different mechanism of action—has been demonstrated to be a more efficacious approach to acne treatment than monotherapy.[10][47] The use of topical benzoyl peroxide and antibiotics together has been shown to be more effective than antibiotics alone.[10] Similarly, using a topical retinoid with an antibiotic clears acne lesions faster than the use of antibiotics alone.[10] Frequently used combinations include the following: antibiotic and benzoyl peroxide, antibiotic and topical retinoid, or topical retinoid and benzoyl peroxide.[47] The pairing of benzoyl peroxide with a retinoid is preferred over the combination of a topical antibiotic with a retinoid since both regimens are effective but benzoyl peroxide does not lead to antibiotic resistance.[10]
But the side effects of targeted breakout cream treatments aren’t always worth it. “So many products instruct consumers to use benzoyl peroxide spot treat red bumps and pustules. I don’t recommend it,” says Dr. Lawrence Green, board-certified dermatologist and assistant clinical professor of dermatology at George Washington University. Such high concentrations of benzoyl peroxide cause added irritation and inflammation to already sensitive skin, so with this in mind, we cut kits that included spot treatments.
Several scales exist to grade the severity of acne vulgaris, but no single technique has been universally accepted as the diagnostic standard.[68][69] Cook's acne grading scale uses photographs to grade severity from 0 to 8 (0 being the least severe and 8 being the most severe). This scale was the first to use a standardized photographic protocol to assess acne severity; since its creation in 1979, the scale has undergone several revisions.[69] The Leeds acne grading technique counts acne lesions on the face, back, and chest and categorizes them as inflammatory or non-inflammatory. Leeds scores range from 0 (least severe) to 10 (most severe) though modified scales have a maximum score of 12.[69][70] The Pillsbury acne grading scale simply classifies the severity of the acne from grade 1 (least severe) to grade 4 (most severe).[68][71]

Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity.[136] In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus.[136] Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B).[136] Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel.[47][136] Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm.[136] Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester.[136] Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy.[137] In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters.[136] Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X).[136] Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects.[1] Finasteride is not recommended as it is highly teratogenic.[1]
Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.
But the side effects of targeted breakout cream treatments aren’t always worth it. “So many products instruct consumers to use benzoyl peroxide spot treat red bumps and pustules. I don’t recommend it,” says Dr. Lawrence Green, board-certified dermatologist and assistant clinical professor of dermatology at George Washington University. Such high concentrations of benzoyl peroxide cause added irritation and inflammation to already sensitive skin, so with this in mind, we cut kits that included spot treatments.
Since benzoyl peroxide is often prescribed in office for handling cystic acne (it kills acne-causing bacteria within the hair follicle), it was the first choice among dermatologists I spoke to as an over-the-counter treatment. There are a couple of different options out there from face washes to topical creams to bodywashes, but dermatologist Ross S. Levy, of CareMount Medical — the director of dermatologic surgery at the Albert Einstein College of Medicine — says that typically “the benzoyl peroxide (5 to 10 percent) topical creams or gels are more effective than the cleansers or washes.” The only danger with benzoyl peroxide to be mindful of is that it will stain clothing and pillowcases. Clean & Clear’s Persa-Gel, which contains 10 percent benzoyl peroxide, is one of Gonzalez’s go-to recommendations for treating cystic acne at home.
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]
Popping pimples seems to be the quickest way to make the red spots on our skin disappear. But it can permanently damage your skin! When you squeeze a pimple, you’re actually forcing the oil substance and dead skin cells deeper into the follicle. The extra pressure exerted will make the follicle wall rupture, and spill the infected materials into the innermost part of our skin. This skin damage will lead to the loss of tissue, and finally cause acne scars.[2]
Efforts to better understand the mechanisms of sebum production are underway. The aim of this research is to develop medications that target and interfere with the hormones that are known to increase sebum production (e.g., IGF-1 and alpha-melanocyte-stimulating hormone).[10] Additional sebum-lowering medications being researched include topical antiandrogens and peroxisome proliferator-activated receptor modulators.[10] Another avenue of early-stage research has focused on how to best use laser and light therapy to selectively destroy sebum-producing glands in the skin's hair follicles in order to reduce sebum production and improve acne appearance.[10]
Complementary therapies have been investigated for treating people with acne.[150] Low-quality evidence suggests topical application of tea tree oil or bee venom may reduce the total number of skin lesions in those with acne.[150] Tea tree oil is thought to be approximately as effective as benzoyl peroxide or salicylic acid, but has been associated with allergic contact dermatitis.[1] Proposed mechanisms for tea tree oil's anti-acne effects include antibacterial action against C. acnes, and anti-inflammatory properties.[65] Numerous other plant-derived therapies have been observed to have positive effects against acne (e.g., basil oil and oligosaccharides from seaweed); however, few studies have been performed, and most have been of lower methodological quality.[151] There is a lack of high-quality evidence for the use of acupuncture, herbal medicine, or cupping therapy for acne.[150]
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Hypertrophic scars are uncommon, and are characterized by increased collagen content after the abnormal healing response.[32] They are described as firm and raised from the skin.[32][34] Hypertrophic scars remain within the original margins of the wound, whereas keloid scars can form scar tissue outside of these borders.[32] Keloid scars from acne occur more often in men and people with darker skin, and usually occur on the trunk of the body.[32]
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Tea tree oil is renowned for being good for your skin. In addition to this, it also contains anti-bacterial and anti-fungal properties, which makes it highly beneficial for acne treatment. In fact, studies that compare tea tree oil to the acne medication benzoyl peroxide shows it to be just as effective. But please remember to dilute tea tree oil before you use it; otherwise, your skin may get irritated.
Misperceptions about acne's causative and aggravating factors are common, and those affected by it are often blamed for their condition.[176] Such blame can worsen the affected person's sense of self-esteem.[176] Until the 20th century, even among dermatologists, the list of causes was believed to include excessive sexual thoughts and masturbation.[165] Dermatology's association with sexually transmitted infections, especially syphilis, contributed to the stigma.[165]
Decreased levels of retinoic acid in the skin may contribute to comedo formation. To address this deficiency, methods to increase the skin's production of retinoid acid are being explored.[10] A vaccine against inflammatory acne has shown promising results in mice and humans.[50][180] Some have voiced concerns about creating a vaccine designed to neutralize a stable community of normal skin bacteria that is known to protect the skin from colonization by more harmful microorganisms.[181]
In women, acne can be improved with the use of any combined birth control pill.[88] These medications contain an estrogen and a progestin.[89] They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduced acne severity.[10][90] First-generation progestins such as norethindrone and norgestrel have androgenic properties and can worsen acne.[15] Although oral estrogens can decrease IGF-1 levels in some situations and this might be expected to additionally contribute to improvement in acne symptoms,[91][92] combined birth control pills appear to have no effect on IGF-1 levels in fertile women.[89][93] However, cyproterone acetate-containing birth control pills have been reported to decrease total and free IGF-1 levels.[94] Combinations containing third- or fourth-generation progestins including desogestrel, dienogest, drospirenone, or norgestimate, as well as birth control pills containing cyproterone acetate or chlormadinone acetate, are preferred for women with acne due to their stronger antiandrogenic effects.[95][96][97] Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills.[90] A 2014 review found that antibiotics by mouth appear to be somewhat more effective than birth control pills at decreasing the number of inflammatory acne lesions at three months.[98] However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions.[98] The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance.[98]
Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.
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