Acne: what the treatment guidelines actually recommend

Why acne happens

Acne starts in the hair follicle and its oil gland. Four things combine: excess oil, dead cells that clog the follicle, bacteria that normally live on the skin, and inflammation. Blackheads and whiteheads are clogged follicles; red bumps and pus-filled spots are the inflamed version; deep, painful nodules are the severe end.

What the guidelines put first

The American Academy of Dermatology's guidelines put treatments applied to the skin first for mild to moderate acne, and several of them are medicines. Which one fits, and at what strength, is a question for a pharmacist or a dermatologist rather than for an app. Salicylic acid and azelaic acid are among the options also found in cosmetics.

For moderate to severe or scarring acne, a doctor has further options, including tablets. That decision belongs with them.

A sensible start without a prescription

Start with the basics: a gentle cleanser twice a day, a light non-comedogenic moisturizer and daily sunscreen. Salicylic acid cleansers help with blackheads, niacinamide is well tolerated by most acne-prone skin, and azelaic acid helps with both spots and the dark marks they leave behind. Ask a pharmacist about over-the-counter options for breakouts if the basics aren't enough.

Add one product at a time, apply it to the whole area where you break out rather than only to individual spots, and pair it with a plain moisturizer and sunscreen.

What makes it worse

Squeezing and picking push inflammation deeper and raise the risk of scars and long-lasting marks. Harsh scrubs, alcohol-heavy toners and over-washing irritate the skin without clearing pores. Heavy, greasy products on the face and along the hairline can clog follicles; look for products labelled non-comedogenic.

Give it twelve weeks

Acne treatments take time: most need eight to twelve weeks of consistent use before you can judge them, and the first weeks can look worse before they look better. Switching products every fortnight resets the clock each time.

Does diet matter?

Possibly, for some people. In a randomized trial in young men, a low-glycemic-load diet — fewer refined carbohydrates and sugary foods — reduced acne lesions over 12 weeks compared with a control diet. It was a small study, and diet is a supporting measure, not a replacement for treatment.

When to see a doctor

See a dermatologist for painful deep nodules or cysts, acne that leaves scars or dark marks, acne that affects your mood, or acne that hasn't improved after three months of consistent treatment. Sudden adult acne together with irregular periods or unwanted hair growth can have a hormonal cause worth checking.

Existing scars are a different problem from active acne: they respond to in-clinic treatments such as microneedling, not to creams.