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Health Information | 11/30/2021

Managing and Treating Acne

By  Dr. Chelsea Evans
Man looking at acne on his face in a mirror
You have a big event coming up – a job interview, a first date, your class photo – and then it appears…a red, inflamed pimple right in the middle of your face.

Acne is the most common chronic skin disease in the United States and can cause blemishes on the face, chest, and upper back.

Acne typically starts during puberty and is most common among teenagers. However, many adults also suffer from the condition and require some form of treatment. Acne can range in severity, spanning from surface-level blackheads and whiteheads to deeper papules, pustules, nodules, and cysts.

Although it is frustrating and occasionally painful, there are several treatment options for acne.

Causes of Acne

Acne can be caused by many things, including excess skin oil, excess skin bacteria,  and anything that causes inflammation. Medications like Prednisone, Phenytoin to treat seizures, and Lithium to treat bipolar disorder may also cause or exacerbate acne. Genetics is also thought to play a role.

Excess skin oil: The androgens called testosterone and androstenedione are the growth hormones found in both men and women. These hormones increase with puberty and cause the skin’s oil glands to grow. This growth produces more sebum, which can clog pores.

Excess skin bacteria: Certain cosmetics, such as oil-based makeup, cause acne more often than water-based products. Picking, rubbing, touching, and aggressively itching the skin can also irritate it, leading to a breakout.

Inflammation: There are many causes of skin inflammation. These include foods with a high glycemic index (e.g. sugary drinks, starchy foods, highly processed foods), poor sleeping habits, smoking, and stress. Sudden and intense stress leads to a chemical shift in the brain, which can result in increased oil production, sweating, or drying of the skin.

Short and Long-term Treatment Options

There are several different treatments – both short and long-term – for acne.


If time is of the essence, grab an over-the-counter product with benzoyl peroxide, which cleanses the skin, and salicylic acid, which prevents pores from getting plugged. If you choose to use a concealer to cover the pimple, make sure the label includes “oil-free,” “won’t clog pores,” or “non-comedogenic.”

Although it can be tempting, you should not pop a pimple. Popping pimples can increase your chances of infection and scarring.


Topical and oral treatments prescribed by licensed professionals are effective in treating acne. For mild acne, your provider may choose topical retinoids, which are derived from Vitamin A. They work by preventing the formation of whiteheads and blackheads. Some examples include Adapalene/Differin, Tazarotene/Tazorac, and Tretinoin/Retin-A. While these topical treatments are great at clearing up acne, they may also dry out your skin, exacerbating skin irritation and inflammation. For this reason, it’s important to moisturize your skin with a gentle, unscented lotion designed for sensitive skin.

Topical antibiotics are often the next step. These include Clindamycin and Erythromycin. They slow bacteria growth and reduce inflammation.

For moderate to severe acne, oral antibiotics can be used. These include Doxycycline, Erythromycin, and Minocycline. The most common side effects are nausea, vomiting, and diarrhea.

Spironolactone is another medication that some clinicians prescribe for hormonal acne in women. Spironolactone is used to treat high blood pressure and heart disease, but it has been found to block androgen receptors in the body, making it helpful for acne.

Some birth control that contains only progesterone (for example, Micronor pills or the Mirena IUD) may cause or worsen acne, although birth control pills that contain estrogen, as well as progesterone, can be helpful in treating acne.

The most potent medication to treat severe acne is isotretinoin, commonly known as Accutane®. One course of isotretinoin usually lasts from four to five months, and patients are closely monitored throughout the treatment due to the health risks associated with the medication.

Prevention of Acne

While some acne is genetic or caused by hormonal factors, there are things you can do to prevent breakouts before they start.
  • Wash your face with a gentle cleanser designed for your skin type
  • Use moisturizer to hydrate your skin
  • Remove makeup at the end of the day
  • Avoid touching your face, especially with dirty hands
  • Wash pillowcases, sheets, hats, masks, and other clothing that touches your face often
  • Fuel your body with nutritious foods, get enough sleep to feel well-rested, quit smoking, and engage in relaxing activities that decrease your stress levels
Acne, although frustrating, affects almost everyone at some point and is often easily treatable. If you or your child are having trouble treating acne on your own, reach out to your Atrius Health provider to create a treatment plan customized for your skin.

About The Author

Dr. Chelsea Evans

Dr. Chelsea Evans joined Atrius Health in 2021 and is a board-certified family medicine provider at our Post Office Square location. She received her medical degree from Temple University in Philadelphia and completed her residency at the University of Massachusetts Medical School in Worcester. Dr. Evans’ clinical interests include evidence-based medicine, women’s health, and mental health.

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