What actually stops acne

Acne stops when you reduce the amount of oil your skin makes, kill the bacteria living in your pores, shed dead skin cells so they don't clog those pores, or reduce inflammation — and most treatments do more than one of these things at once. The method that works depends on how severe your acne is, what type it is, and how your skin responds to different ingredients.

Over-the-counter products can clear mild acne on their own. Moderate to severe acne usually needs a prescription treatment, often combined with an over-the-counter product. The strongest treatments require a dermatologist — a doctor who specializes in skin — because they can cause serious side effects if used wrong.

Key Takeaways

  • Benzoyl peroxide and salicylic acid are the two main over-the-counter ingredients that work for mild acne, and they work differently so you may need to try both to find what your skin tolerates.
  • Prescription treatments like tretinoin, adapalene, and antibiotics are stronger and usually necessary for moderate to severe acne, but they take 6 to 12 weeks to show results.
  • Oral birth control and spironolactone can reduce acne caused by hormones, but only a doctor can determine whether either is right for you.
  • Isotretinoin is the only treatment that can permanently clear severe acne, but it requires monthly blood tests and strict contraception if you can become pregnant.
  • Washing twice daily with a gentle cleanser and using sunscreen every day protects your skin while you treat acne and prevents scars from darkening.

Over-the-counter treatments for mild acne

Benzoyl peroxide kills the bacteria that cause acne and also reduces oil. It comes in strengths from 2.5% to 10%, usually in cleansers, lotions, or gels. Start with 2.5% or 5% — higher strengths are not more effective and cause more dryness and irritation. Use it once or twice daily. Benzoyl peroxide can bleach fabric and hair, so let it dry completely before touching clothes or pillows.

Salicylic acid is an exfoliant, meaning it helps shed dead skin cells so pores don't get clogged. It comes in strengths from 0.5% to 2% in cleansers, toners, and spot treatments. It is gentler than benzoyl peroxide but also slower to work. Use it once or twice daily. If your skin is sensitive, start with a lower strength or use it every other day.

You can use benzoyl peroxide and salicylic acid together — many people use benzoyl peroxide in the morning and salicylic acid at night, or alternate days. If either one makes your skin very red, dry, or irritated, cut back to once daily or every other day. If irritation continues, stop and try the other ingredient instead.

Over-the-counter products take 4 to 8 weeks to show results. If your acne has not improved by week 8, or if you have many deep bumps or cysts, see a dermatologist about prescription options.

Prescription treatments that reduce oil and bacteria

Tretinoin (brand names Retin-A, Atralin, others) is a form of vitamin A that increases skin cell turnover and reduces oil production. It is one of the most effective acne treatments available. You apply it as a cream or gel to clean, dry skin at night, usually starting at the lowest strength (0.025%) and increasing over weeks as your skin adjusts.

Tretinoin causes redness, peeling, and sensitivity for the first 4 to 12 weeks — this is normal and usually improves. You must use sunscreen every day because tretinoin makes your skin more sensitive to sun damage. Do not use it if you are pregnant or trying to become pregnant, because it can harm a developing baby.

Adapalene (brand name Differin) works similarly to tretinoin but is gentler and available over the counter at 0.1% strength. Prescription versions go up to 0.3%. It causes less irritation than tretinoin, making it a good starting point if your skin is sensitive. Apply it to clean, dry skin at night, and use sunscreen daily.

Topical antibiotics like clindamycin or erythromycin kill acne bacteria. They work best when combined with benzoyl peroxide, because bacteria can become resistant to antibiotics alone. Your doctor will prescribe them as a lotion, gel, or solution to apply once or twice daily. Results appear in 3 to 6 weeks.

Oral medications for moderate to severe acne

Oral antibiotics like doxycycline or minocycline reduce bacteria throughout your body and also have anti-inflammatory effects. You take them by mouth, usually twice daily. They work best in the first 3 to 6 months; after that, bacteria can become resistant. Your doctor will usually combine them with a topical treatment like tretinoin or benzoyl peroxide. Do not take doxycycline if you are pregnant or breastfeeding.

Birth control pills can reduce acne in people who menstruate, because they lower androgen levels — hormones that trigger oil production. Pills containing norgestimate or norethindrone with ethinyl estradiol are FDA-approved for acne. Results take 2 to 3 months. Birth control is not an option if you cannot take hormonal contraception for medical reasons.

Spironolactone is a medication that blocks androgens. It is prescribed off-label for acne — meaning the FDA did not originally approve it for this use, but doctors prescribe it anyway because evidence shows it works. You take it by mouth, usually 50 to 100 mg twice daily. It can cause dizziness and requires periodic blood tests to check kidney function and potassium levels. Do not use it if you are pregnant or trying to become pregnant.

Isotretinoin for severe acne that does not respond to other treatments

Isotretinoin (brand name Accutane, also available as generics) is an oral medication derived from vitamin A. It is the only treatment that can permanently clear severe acne — about 70% of people who take it never have significant acne again. You take it once or twice daily for 15 to 20 weeks.

Isotretinoin causes serious side effects. It causes severe birth defects, so if you can become pregnant you must use two forms of contraception and have negative pregnancy tests before starting and monthly during treatment. It can cause depression and suicidal thoughts, so your doctor will monitor your mental health. It dries skin and lips severely, can raise cholesterol and liver enzymes, and requires blood tests every month.

Because of these risks, isotretinoin is prescribed only for acne that has not responded to other treatments, acne that causes severe scarring, or acne that significantly affects mental health. Your dermatologist will refer you to the iPLEDGE program, a registry that tracks who is taking the medication and ensures safety requirements are met. You cannot get isotretinoin without enrolling.

Daily skin care while treating acne

Wash your face twice daily — morning and night — with a gentle, fragrance-free cleanser and lukewarm water. Do not scrub or use rough cloths, because this irritates skin and can make acne worse. Pat dry gently with a clean towel.

Use sunscreen with SPF 30 or higher every day, even on cloudy days and even if you are staying indoors, because many acne treatments make skin more sensitive to sun damage. Sunscreen also prevents acne scars from becoming darker and more noticeable. Choose a sunscreen labeled "non-comedogenic," meaning it will not clog pores.

Avoid picking, squeezing, or touching acne, because this spreads bacteria, increases inflammation, and raises the risk of scarring. If you use makeup, choose products labeled non-comedogenic and remove it completely before bed.

Do not over-wash or over-treat. Using too many products or using them too often irritates skin and can make acne worse. Stick with one or two treatments and give them at least 6 to 8 weeks to work before adding something else.

When to see a dermatologist

See a dermatologist if over-the-counter treatments have not improved your acne after 8 weeks, if you have deep cysts or nodules, if acne is leaving scars, or if acne is affecting your mental health or self-esteem. A dermatologist can prescribe stronger treatments, determine whether your acne is caused by hormones, and monitor you for side effects if you need oral medication.

If you cannot afford a dermatologist visit, start by talking to your primary care doctor. They can prescribe some acne treatments and may refer you to a dermatologist if needed. Community health centers and dermatology schools sometimes offer low-cost or sliding-scale visits.

Frequently Asked Questions

How long does it take for acne treatment to work?

Over-the-counter products take 4 to 8 weeks. Prescription topical treatments like tretinoin take 6 to 12 weeks, and you may see increased irritation before you see improvement. Oral medications take 6 to 12 weeks as well. Isotretinoin takes 15 to 20 weeks but offers permanent results for most people.

Can diet or stress cause acne?

Stress can trigger or worsen acne in some people by increasing hormone levels. High-glycemic foods (white bread, sugary drinks, processed snacks) may worsen acne in some people, though the evidence is mixed. Dairy is linked to acne in some studies. If you notice a pattern, try eliminating the suspected food for a few weeks and see if acne improves.

Is it safe to use multiple acne treatments at once?

Some combinations work well — like benzoyl peroxide in the morning and tretinoin at night. Others cause too much irritation. Start with one treatment, let your skin adjust for 2 to 4 weeks, then add a second if needed. Ask your doctor or pharmacist before combining treatments, especially if one is prescription.

Will acne come back after treatment stops?

For most treatments, acne can return when you stop using them — they control acne but do not permanently change your skin. Isotretinoin is the exception; about 70% of people stay clear long-term. If acne returns after stopping other treatments, you can restart them or try a different one.

Can acne scars be treated?

Yes, but scars are harder to treat than active acne. Options include laser therapy, microneedling, chemical peels, and dermal fillers. A dermatologist can recommend the best option based on the type and depth of your scars. Starting acne treatment early and avoiding picking reduces the risk of scarring.