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JAMA Patient Page
November 23/30, 2021

Acne Treatment

Author Affiliations
  • 1Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
JAMA. 2021;326(20):2087. doi:10.1001/jama.2021.16599

Acne is a chronic skin condition involving inflammation (redness, swelling, pain) of the skin on the face, neck, chest, or back.

Acne can take many forms, including whiteheads, blackheads, pimples, deep nodules, and cysts. Acne may be caused by decreased skin turnover and shedding, increased production of sebum (an oily, waxy substance produced by glands to lubricate the skin), and certain types of skin bacteria. Other factors include genetics, hormones, mechanical stimulation (friction, rubbing, picking, squeezing), certain drugs (such as corticosteroids), and skin care products and cosmetics. Untreated acne can lead to skin color changes, scars, and psychosocial and emotional distress.

Medications to Treat Acne

Mild acne is treated with topical (applied to the skin) medications, some of which are available without a prescription. Topical treatments are often used in combination. Side effects may include skin dryness, redness, and irritation. Patients with acne should discuss treatment options with their primary care doctor or a dermatologist. Topical antimicrobials target certain types of skin bacteria. Examples include benzoyl peroxide, clindamycin, erythromycin, and azelaic acid. Topical retinoids increase skin cell turnover and shedding and decrease sebum production and other causes of inflammation. Examples include adapalene, tretinoin, tazarotene, and trifarotene. Other acne treatments include topical dapsone, sulfur, and salicylic acid.

Moderate and severe acne, along with mild acne that does not respond to the above treatments, can be treated with stronger medications, many of which are taken orally. Antibiotics target certain types of skin bacteria and are available in topical (minocycline) and oral (doxycycline, minocycline, sarecycline) forms. Hormonal treatments target hormone receptors and reduce sebum production. They are available in topical (clascoterone) and oral (spironolactone, certain birth control pills) forms. Oral retinoids (isotretinoin) are reserved for the most severe and treatment-resistant forms of acne.

In general, oral medications have more side effects than topical treatments. Many acne treatments cannot be used while breastfeeding or pregnant, and some, such as isotretinoin, require blood tests to monitor for harmful side effects. Basic skin care can also be helpful for acne management, including gentle skin cleansers, noncomedogenic (non–pore blocking) skin care products, and avoidance of skin scrubbing and picking.

Other Acne Treatments

Select physical skin treatments can be used for all stages of acne, although there is less evidence for these compared with topical and oral medications. Treatments include chemical peels, microdermabrasion (physical exfoliation of the outer layer of skin), and laser or light-based treatments.

What to Expect After Treatment

Treatment success involves both resolution of current acne lesions and prevention of new flares. Two to 3 months of consistent treatment is usually needed to assess treatment success. Because everyone responds differently to medications, acne treatment plans can change over time, may involve different combinations of treatments, and may require different treatment strategies for acute flares versus long-term maintenance of clear skin.

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Article Information

Conflict of Interest Disclosures: Dr Chovatiya reported receiving personal fees for advisory boards, consulting, and/or speaking from AbbVie, Arcutis, Incyte, Regeneron, and Sanofi-Genzyme.

Source: Thiboutot DM, Dréno B, Abanmi A, et al. Practical management of acne for clinicians. J Am Acad Dermatol. 2018;78(2 suppl 1):S1-S23. doi:10.1016/j.jaad.2017.09.078

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