Acne Basics: What Actually Works

What causes acne

In the usual textbook picture, acne starts in the hair follicle, where four things combine:

1. Excess oil (sebum) produced under the influence of hormones.
2. Dead skin cells that do not shed properly and clog the pore.
3. Bacteria (Cutibacterium acnes) that thrive in the blocked follicle.
4. Inflammation, which turns a clogged pore into a red, swollen spot.

The guideline we cite below is about treatment rather than causes, so we describe the causes only in outline. Hormonal shifts are widely linked with flare-ups, and a doctor can help if you suspect that is behind yours.

Types of spots

Mild comedonal acne is often managed at home, while nodular or cystic acne can scar and usually needs prescription care. The treatments in the table follow the recommendations in the American Academy of Dermatology guideline (Reynolds et al., 2024).

The over-the-counter toolkit

Benzoyl peroxide

Strongly recommended by the American Academy of Dermatology guideline (Reynolds et al., 2024). Start at a low strength (products commonly begin around 2.5 to 5 percent), once daily on affected areas, and build up if tolerated. It can bleach fabrics, so use white towels and pillowcases.

Salicylic acid

A beta-hydroxy acid that exfoliates inside the pore. The guideline lists it as a conditional recommendation, meaning the supporting evidence is weaker (Reynolds et al., 2024).

Adapalene

A topical retinoid available without a prescription in many countries. Topical retinoids are strongly recommended in the guideline (Reynolds et al., 2024). They take weeks to work and commonly cause irritation at first (Mukherjee et al., 2006). See retinoids for beginners.

Azelaic acid

Listed in the guideline as a conditional option for acne (Reynolds et al., 2024). People also use it for redness and post-spot dark marks, but we cite no trial for those uses here.

Building a routine without burning your face

• Cleanse gently twice daily. Over-washing adds irritation.
• Moisturise even if you are oily, which helps actives feel more comfortable. See the skin barrier.
• Use sunscreen daily. Retinoids commonly cause irritation (Mukherjee et al., 2006), and daily sunscreen has the best evidence for protecting skin (Hughes et al., 2013). See sunscreen 101.
• Introduce one active at a time, two weeks apart.
• Apply treatments to the whole area prone to breakouts, not only to existing spots, to prevent new ones.

A pea-sized amount is enough for the whole face. More does not mean faster results and it does increase irritation.

Habits that help, and myths that do not

Helpful

• Resist picking or squeezing, which can prolong healing and leave marks.
• Change pillowcases weekly and clean your phone screen.
• Rinse after sweaty exercise and remove sweaty headwear.
• Choose non-comedogenic skincare and makeup, and remove makeup nightly.
• If certain foods seem to flare your skin, you could try cutting back for several weeks and note any change. The evidence is limited: higher dairy intake was linked with somewhat higher odds of acne, but only in observational studies that cannot show cause (Juhl et al., 2018), and young men on a 12-week low-glycaemic-load diet had fewer lesions but also lost weight (Smith et al., 2007).

Myths

• Acne means you are dirty. Acne is a skin condition, not a hygiene failure, and scrubbing is not among the treatments the guideline recommends (Reynolds et al., 2024).
• Toothpaste dries out spots. It is not a recognised treatment and can irritate skin.
• Sun clears acne. Tanning can mask redness for a while, but a sun-seeking history was linked with more wrinkles, sagging and uneven pigment (Flament et al., 2013).
• Strong DIY mixes such as lemon juice or baking soda work. They are not recognised treatments and can burn or irritate.
• Teenagers outgrow it. Many do, but acne can appear or continue in adulthood and does not mean you are doing something wrong.

Marks and scars

After a spot heals, a flat red or brown mark can linger. A flat mark is different from a scar, and a dermatologist can tell you which you have. Picking less and protecting skin from the sun are sensible steps; in one small study of darker skin, visible light caused darker, longer-lasting pigmentation (Mahmoud et al., 2010). We cite no trial on products that speed fading, so ask a dermatologist. Textured, pitted or raised scars are different and may need in-clinic treatments such as microneedling, peels or lasers, which should be done by trained professionals.

Avoid DIY dermarolling and aggressive peels at home. They can spread infection and cause new scarring.

When to see a professional

Book an appointment with a GP or dermatologist if:

• Acne is painful, deep or cystic.
• You are leaving scars or dark marks.
• Eight to twelve weeks of a consistent routine has not helped.
• It appears suddenly in adulthood with other symptoms such as irregular periods or excess hair growth.
• It is affecting your confidence or mood.

Prescription options a doctor may discuss include stronger topical treatments, antibiotics for a limited time, hormonal therapy for some patients and isotretinoin for severe cases, all under medical supervision. Seeking help early is a sensible step, not an overreaction.

LookFlex looks at skin zones like texture, redness and blemishes and shows which changes across scans beat the measurement margin. Try a free scan on your iPhone to see your baseline, then retake it every few weeks under the same light to judge your routine fairly.