Getting rid of acne requires matching the right treatment to the type of breakouts you’re dealing with. Mild acne often clears with over-the-counter products alone, while moderate to severe cases may need prescription medications or professional treatments. The approach that works best depends on whether your acne is driven by clogged pores, excess oil, bacteria, hormones, or some combination of all four.
Over-the-Counter Treatments That Work
Benzoyl peroxide and salicylic acid are the two most widely used drugstore acne treatments, and they work in different ways. Benzoyl peroxide kills acne-causing bacteria and is available in concentrations from 2.5% to 10%. Higher percentages aren’t necessarily better. A 2.5% formula is often just as effective as stronger versions but causes less dryness and irritation. Salicylic acid, typically sold at 0.5% to 2%, works by dissolving the dead skin cells and oil plugging your pores. It’s a better fit if your acne is mostly blackheads and whiteheads rather than red, inflamed pimples.
You can use both, but not at the same time of day. Applying benzoyl peroxide in the morning and salicylic acid at night, for example, reduces the chance of over-drying your skin. Either way, give these products at least six to eight weeks of consistent daily use before deciding they aren’t working.
How to Layer Your Products
The order you apply products matters. The American Academy of Dermatology recommends this sequence: wash with a gentle cleanser, apply your acne treatment to clean skin, then follow with moisturizer and sunscreen. Putting moisturizer on top of your treatment, not underneath, ensures the active ingredients make direct contact with your skin. If you wear makeup, that goes on last. Skipping moisturizer because your skin is oily is a common mistake. Acne treatments dry out your skin, and when skin gets too dry, it can compensate by producing even more oil.
Retinoids for Stubborn Acne
Retinoids are vitamin A derivatives that speed up skin cell turnover, preventing dead cells from clogging pores. Adapalene (sold over the counter as Differin) is a good starting point. Prescription-strength tretinoin is more potent. Both typically take two to three weeks to start clearing blemishes, though some people need six weeks or longer to see real improvement.
Retinoids commonly cause a “purging” phase where your skin looks worse before it looks better. This happens because the faster cell turnover pushes tiny, hidden blockages to the surface all at once. You can tell purging apart from a genuine breakout by a few signs: purging shows up in your usual acne-prone areas, produces smaller blemishes that heal quickly, and resolves within four to six weeks. A true breakout appears in new or random spots, includes deeper cysts or slow-healing lesions, and won’t improve on its own timeline. If your skin is still worsening after six weeks on a retinoid, the product may not be right for you.
Hormonal Acne Treatments
If your breakouts cluster along your jawline, chin, and lower cheeks, and tend to flare around your menstrual cycle, hormones are likely involved. Androgens like testosterone trigger overproduction of sebum, the oily substance that clogs pores and feeds bacteria. This is why hormonal acne often shows up as deep, painful cysts rather than surface-level whiteheads.
Spironolactone is one of the most effective options for hormonal acne in women. It works by reducing androgen levels, which in turn cuts down sebum production. Doses typically range from 25 to 200 milligrams per day, though research shows that even a low dose of 50 milligrams daily can be enough. Certain oral contraceptives also help by regulating the hormonal fluctuations that trigger breakouts. These medications take two to three months to show full results, so patience is essential.
Treatment for Severe or Cystic Acne
When topical treatments and oral antibiotics haven’t worked, isotretinoin (formerly known by the brand name Accutane) is often the next step. It’s the most powerful acne medication available, working by dramatically shrinking oil glands and reducing sebum production. A typical course lasts five to seven months. The treatment is closely monitored because of significant side effects, including extreme skin dryness, sensitivity to sun, and potential effects on mood and liver function. Women must use reliable contraception throughout treatment due to serious risks of birth defects.
Despite its intensity, isotretinoin produces long-term or permanent clearance for many people. Some do experience relapse afterward, and the likelihood depends partly on the total amount of medication received over the course of treatment.
Professional In-Office Procedures
Dermatologists offer several procedures that complement daily treatments. Chemical peels use acids to remove the top layer of skin, unclogging pores and reducing inflammation. They’re particularly useful for comedonal acne (blackheads and whiteheads) and mild scarring.
Photodynamic therapy (PDT) uses a light-sensitive solution applied to the skin, then activated by a specific wavelength of light to destroy acne-causing bacteria and shrink oil glands. Results are semi-permanent, typically lasting several months. Recovery takes about two to six weeks. During the first few days your skin will be noticeably red or discolored, and you may experience peeling or itchiness during the first week. Your skin generally returns to normal within one to two weeks.
How Diet Affects Breakouts
Diet alone won’t cure acne, but it can make it noticeably better or worse. High-glycemic foods, those that spike your blood sugar quickly (white bread, sugary drinks, chips, pastries), trigger a chain reaction. Blood sugar spikes cause bodywide inflammation and increase sebum production. Both of those fuel acne. Switching to lower-glycemic options like whole grains, vegetables, and legumes won’t replace your topical routine, but it can reduce the severity of breakouts.
Dairy, particularly skim milk, also has a consistent association with acne in multiple studies. The exact mechanism isn’t fully understood, but hormones naturally present in cow’s milk may promote inflammation that clogs pores. If you suspect dairy is a trigger, try cutting it out for a few months and see whether your skin improves.
Ingredients to Avoid in Your Products
Some skincare and makeup ingredients actively clog pores. Dermatologists rate ingredients on a comedogenicity scale from 0 (won’t clog pores) to 5 (almost certainly will). If you’re acne-prone, watch out for these common offenders:
- Coconut oil: rated 4 out of 5, despite its popularity in natural skincare
- Cocoa butter: rated 4, often found in body lotions and lip products
- Wheat germ oil: rated 5, one of the most comedogenic oils available
- Lanolin: rated 4, common in thick moisturizers and lip balms
- Isopropyl myristate: rated 5, used in many lotions and foundations to improve texture
Safer alternatives include mineral oil (rated 0 to 1) and argan oil (rated 1 to 2). Look for products labeled “non-comedogenic,” but also check the ingredient list yourself, since that label isn’t regulated.
Building a Routine That Sticks
The biggest reason acne treatments fail is inconsistency. Most active ingredients need daily use for weeks before they produce visible results, and stopping too early means starting over. A practical routine for mild to moderate acne looks like this: gentle cleanser twice a day, one active treatment (benzoyl peroxide, salicylic acid, or a retinoid) applied to clean skin, followed by a non-comedogenic moisturizer and sunscreen in the morning.
Start with one active product at a time. Introducing multiple new treatments at once makes it impossible to know what’s working and increases the risk of irritation. Once your skin adjusts to one product over two to four weeks, you can consider adding a second. If over-the-counter options haven’t improved your acne after two to three months of consistent use, that’s a reasonable point to talk to a dermatologist about prescription options.