Acne - Diagnosis and Treatment

Diagnosis

Doctors diagnose acne primarily through a physical examination of the skin. No lab tests are usually necessary unless the acne is severe, resistant to treatment, or suspected to be linked to an underlying health condition.

During the exam, the provider will evaluate the:

Type of acne lesions – such as blackheads (open comedones), whiteheads (closed comedones), papules, pustules, nodules, or cysts.
Location of breakouts – including the face, chest, back, shoulders, and jawline.
Severity – typically categorized as mild, moderate, or severe based on the number and depth of lesions.

Additional Tests (If Needed)

Though rarely, further evaluation may be done when:

Acne is severe or unusual (e.g., adult-onset, resistant, or located in atypical areas)
There’s a possibility of hormonal causes, such as polycystic ovary syndrome (PCOS)

In such cases, a doctor may order:

Hormone level tests
Pelvic ultrasound to check for PCOS
Blood tests to rule out other conditions contributing to acne-like symptoms

Treatment

Medicines You Put on Your Skin

Topical treatments—medicines you put right on your skin—play a big role in acne care. Gels, creams, and lotions are the most common forms.

They work by keeping hair follicles clear, cutting down bacteria, and soothing redness.

Retinoids and Retinoid-like Products
Doctors often suggest topical retinoids for mild to moderate acne. These products help shed dead skin cells faster, which keeps pores from getting clogged. Retinoids can make blackheads, whiteheads, and small pimples less frequent.

Some people notice redness and peeling when they start using retinoids, and the skin might get a bit more sensitive to sunlight. That’s why it’s smart to use them exactly as directed and always use sunscreen.

Topical Antibiotics
Doctors prescribe topical antibiotics to kill the bacteria (Propionibacterium acnes) that cause acne and to calm swelling. Usually, you’ll see these paired with benzoyl peroxide to help prevent antibiotic resistance.

Combinations with Benzoyl Peroxide
Benzoyl peroxide kills bacteria, keeps hair follicles clear, and lowers inflammation. You’ll find it mixed with antibiotics in some products, both over-the-counter and prescription.

Other Topical Agents

Azelaic Acid: This cream or gel kills bacteria and helps unclog pores. Doctors often consider it for pregnant or breastfeeding people. Azelaic acid may also help fade dark spots (hyperpigmentation) that sometimes show up with acne.
Salicylic Acid: By helping to shed dead skin and keep pores open, salicylic acid can reduce blackheads and whiteheads, though it’s usually less powerful than other medicines.
Sulfone: Mostly used for inflamed acne and is more common for women.

Possible Side Effects
People often notice dry or irritated skin, redness, sun sensitivity, or mild stinging with these topical products. Using a gentle moisturizer and sunscreen usually helps.

Topical Medicine	Main Use	How It Works	Common Side Effects
Synthetic Retenoid	Blackheads, whiteheads, papules	Clears pores, speeds cell turn	Redness, dryness
Benzoyl Peroxide	Pimples, redness, bacteria	Kills bacteria, unblocks pores	Dryness, peeling
Lincosamide/Macrolide Antibiotic	Red, swollen acne	Fights bacteria, lowers swelling	Irritation, dryness
Azelaic Acid	Dark spots, mild acne	Kills bacteria, improves color	Itching, redness
Salicylic Acid	Comedones, noninflammatory acne	Removes dead skin, opens pores	Irritation, discolor
Sulfone	Inflammatory lesions	Reduces swelling, fights bacteria	Redness, dryness

Medicines Taken by Mouth

For moderate or severe acne, doctors may add oral medicines to your routine. These target bacteria, oil production, or hormone balance.

Oral Medicine	When Used	Key Benefits	Possible Side Effects
Tetracycline Antibiotics	Moderate to severe	Lowers bacteria, swelling	Stomach upset, sun sensitivity
Macrolide Antibiotics	Cannot take tetracyclines	Fights bacteria, inflammation	Nausea, resistance risk
Anti-Androgen Meds	Women, hormone-related	Blocks androgens, less oil	Breast pain, irregular periods
Birth Control Pills	Women, hormone-related	Balances hormones	Nausea, weight gain, risk of clots/cancer
Retinoids	Severe, resistant acne	Strong overall acne effect	Birth defects, depression, dry skin

Antibiotics
Doctors often prescribe oral antibiotics for moderate to severe acne when topical treatments aren’t enough. These medicines reduce bacteria and calm inflammation.

You should only take them as long as needed to avoid resistance, and they’re usually paired with other products like benzoyl peroxide. Side effects can include an upset stomach or more sun sensitivity.

Birth Control Pills
Some women find relief with oral contraceptives that combine estrogen and progestin, especially if acne gets worse around their periods. These pills balance hormones and lower oil production from the skin’s glands.

It can take a few months to see results. Side effects might include weight gain, tender breasts, or a slightly higher risk of blood clots or certain cancers.

Anti-Androgen Medicines
Doctors sometimes suggest medicines like aldosterone receptor antagonist for women and older girls when antibiotics don’t help. These block male hormones (androgens) that can cause oil glands to go into overdrive.

Side effects include breast pain and changes to periods.

Oral Retinoids
For severe or stubborn acne, oral retinoids might be used. This strong vitamin A medicine cuts down oil production, limits bacteria, and lowers swelling.

Because it can cause serious side effects—like birth defects and mood changes—doctors closely monitor anyone taking it. Women must avoid pregnancy while on this medicine and follow special safety steps.

In-Office Procedures and Special Approaches

Sometimes, medicines alone don’t cut it. In-office procedures can help clear up acne or prevent scarring.

Light and Laser Treatments
These therapies use different kinds of light to kill bacteria or shrink oil glands. You’ll probably need a few sessions for the best results. Some people see fewer breakouts and less redness.

Chemical Exfoliation Solutions
Chemical peels use things like salicylic acid or glycolic acid to remove dead skin and clear pores. They can help mild cases and smooth out skin texture, but the effect doesn’t usually last forever.

Removal of Lesions (Extraction and Drainage)
Dermatologists sometimes use special tools to remove blackheads, whiteheads, or painful cysts if creams or medicines aren’t working. This can improve how skin looks, but there’s a chance of scarring.

Steroid Injections
Doctors might inject a small amount of corticosteroid into deep, painful lumps like nodules or cysts. The lumps usually shrink faster and hurt less.

There’s a slight risk of thinning or color changes where the shot goes in.

Therapy Type	Main Targets	Useful For	Risks/Side Effects
Light/Laser Therapy	Bacteria, swelling	Inflammatory acne	Temporary redness
Chemical Peel	Dead skin, pores	Mild acne, odd texture	Peeling, stinging
Extraction	Blocked pores, cysts	Comedones, large pimples	Scarring, marks
Steroid Injection	Nodules, cysts	Deep, painful acne	Thinning, color change

Physical treatments come in handy when usual medicines don’t work or when big, painful bumps show up.
Light or laser therapies often mean repeat visits.
Only trained professionals should perform these procedures to lower the risk of scarring.

Caring for Acne in Kids and Preteens

Acne isn’t just for teens and adults anymore—more young kids are getting it too. Their skin needs special attention.

Approved Treatments for Younger Ages
Doctors now allow benzoyl peroxide and certain topical retinoids (used under physician supervision) for younger children. These medicines work well and don’t appear to cause more side effects than in older kids.

Note: Benzoyl peroxide is available in over-the-counter and prescription strengths, while topical retinoids like adapalene and tretinoin typically require a prescription, especially at higher concentrations.

Safety and Precautions
Parents need to talk to their child’s doctor or a pediatric dermatologist before starting treatment.

Ask about:

Which medicines are safe for young kids
The right doses
What side effects to watch for
How treatments might affect growth
Some medicines or higher doses aren’t safe for children.
Doctors usually start with lower strengths and adjust as needed.
Harsh creams or gels can make kids’ skin extra dry or irritated.

List of Considerations for Childhood Acne:

Start with Mild Treatments: Begin with low-strength products and only increase if needed.
Supervise Use: Make sure kids use medicine safely and only as prescribed.
Consult Specialists: A pediatric dermatologist can help avoid risky side effects.
Monitor Progress: Watch for skin changes and call the doctor if problems come up.

Note: No matter your age, it’s a good idea to check in regularly with a healthcare provider while treating acne. Most people need ongoing care, and sometimes treatments need to be adjusted as skin or age changes. Scarring, dark spots, and color changes can happen, so early and careful treatment really pays off.

Other Treatment Options

Some people prefer natural ways to manage acne. Certain plant-based products or supplements might help reduce breakouts.

Tea Tree Oil: Gels with at least 5% tea tree oil can help with acne. Results are similar to 5% benzoyl peroxide, but tea tree oil usually takes longer to work. You might notice some itching, burning, redness, or dryness. If you have rosacea, it’s best to skip tea tree oil.

We still need more research on the long-term safety of these and other options, like biofeedback or herbal blends. Always talk to your doctor before starting something new.

Everyday Habits and Simple Tips for Managing Acne

Making small daily changes and sticking to gentle routines can help control mild or moderate acne. Good skin care, healthy habits, and avoiding triggers really do make a difference.

Gentle Skin Cleansing

Wash your face twice a day with a mild cleanser or gentle soap and warm water. It’s better to use your hands—skip rough washcloths or scrubs, which can just make skin angrier. If you need to shave over acne, use a clean, sharp razor and go easy.

Over-the-Counter Products

Many drugstore creams and gels contain ingredients like benzoyl peroxide, adapalene, salicylic acid, or alpha hydroxy acids. These help reduce oil, unclog pores, and prevent breakouts.

Creams are typically gentler than gels or ointments, making them a good starting option. You may experience some dryness or redness early on, but this usually improves within a few weeks.

Choosing the Right Products

Pick makeup, sunscreen, and hair products labeled water-based or noncomedogenic to avoid clogging pores. Oily or greasy products can make acne worse. Go for light lotions instead of thick creams.

Protecting the Skin

Some acne medicines make skin more sensitive to sunlight, which can cause burns or lasting color changes—especially after acne heals. Choose a non-oily moisturizer with sunscreen, and try to avoid too much sun.

Factor	What to Do	Why It Matters
Menstrual cycle	Track your cycle, care for skin around this time	Hormonal shifts can trigger acne
Diet	Limit sugary or oily foods	Certain diets can make acne worse
Polycystic ovary syndrome	See a doctor if acne is severe and periods are irregular	PCOS can cause hormonal acne
Hormonal changes	Stick to your skincare routine	Hormones can increase oil
Dryness/Humidity	Moisturize in dry weather, blot skin in humidity	Weather changes affect skin

Reducing Skin Irritation

Try not to press your phone to your face, wear tight collars or hats, or rest objects against your skin. Friction and pressure can make acne worse. After sweating—especially from exercise—shower soon to wash off oil and sweat.

Avoid Picking

Don’t squeeze, pick, or touch pimples. That usually just leads to more breakouts, scars, or even infections. These self-care steps can make a real difference, especially when you’re also using medical treatment.

Ways to Handle Emotional Effects

It’s totally normal to feel stressed or self-conscious about acne, especially during puberty or as a woman. Support really matters.

Talk with friends or family members
Join a support group
Speak with a counselor if needed

Taking care of your mental health is just as important as treating your skin. Managing stress with hobbies, good sleep, or relaxation exercises can help your confidence and support your treatment.

Getting Ready for Your Visit

Steps You Can Take

Before seeing a dermatologist, it helps to gather your info. Write down any other health issues you’re managing, plus a list of all medicines, supplements, and products you use.

Note any recent life changes or stress—these can affect your skin, too. Get your questions ready for the doctor, especially about treatments, side effects, and what to expect.

Sample Questions to Bring:

Which treatment do you think fits my case best?
What side effects should I watch for?
How long does it usually take to see results?
What’s next if this treatment doesn’t work?
Should I change anything about my diet or daily products?
What self-care steps can I take at home?
How long will I need to take these medicines?
When should I check back in with you?

Having a written list helps you cover everything that’s on your mind and makes your visit more productive. It’s also smart to ask about long-term care and how to prevent acne scars, especially if treatment will last a while.

Information to Bring	Why It Matters
List of all medicines and products	Helps avoid harmful interactions
Overview of recent stressors	Can help identify possible acne triggers
Family history of acne/treatments	Assists in considering genetic factors
List of questions for the dermatologist	Ensures every concern gets discussed

What Your Doctor May Ask

During your visit, the dermatologist will probably ask plenty of questions to get the full picture. They’ll want to know when your acne started, what seems to trigger it (like stress, your period, or new products), and how it affects your life.

They’ll also ask about all the medicines and products you use—soaps, lotions, makeup, sunscreen, you name it. If you’re a girl or woman, they’ll likely ask about birth control, periods, and pregnancy plans, since hormones matter.

Doctors often check how acne impacts your self-esteem and daily life, so they can tailor your treatment. They’ll probably ask if family members have had acne, what treatments you’ve tried, and what worked (including hormone therapy or retinoids).

Being ready with answers helps make the visit more useful. Here’s what might come up:

Areas Your Dermatologist May Cover:

When and how acne outbreaks happen
Treatments you’ve tried so far
How acne affects your mood or confidence
Family history of skin problems
Your daily skincare and product use

This info helps your dermatologist make a solid diagnosis and pick the best plan for your acne.

Acne – Diagnosis and Treatment