What REALLY Works To Treat Acne

Illustrated by Elliot Salazar.
Sometimes, when we’re glaring at an out-of-nowhere bump on our nose, we have to wonder whether anything will ever send acne packing for good. And, of the purported "cures" out there, which ones actually lead to the clear complexion we’ve always dreamed of — and which are just a bunch of hokum?
So, we decided to delve into the wild, weird, and often dubious world of acne treatments. From prescription-strength remedies (Retin-A! Accutane!) to kitchen-pantry saviors, such as apple cider vinegar, we’ve evaluated a host of blemish-battling solutions to separate the worthy from the whack. Some of the top dermatologists and aestheticians from coast to coast, each with a strong background in acne, gave us their thoughts on what’s brilliant (and what’s baloney).
While our experts agreed unanimously on some face fixers, their opinions were split on others. All agreed that, with few exceptions, treating acne is almost always a multi-pronged approach — and that it’s often a matter of managing acne, not eradicating it. (They also noted that not all acne is the same; a treatment may work wonders on blackheads, for instance, but do diddley-squat for cysts.)
We’ve rated the treatments accordingly. If it’s a sure, across-the-board yes or no, you’ll know — and as for those “maybe” votes, that’s where the meaty discussion happens.
Read on for straight talk on the real ways to treat acne. Because, if you’re anything like us, you just can’t wait to give those zits the kiss-off.
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Illustrated by Elliot Salazar.
Antibiotics: Yes
There’s a reason so many dermatologists prescribe antibiotics: They work. “They are effective, especially oral antibiotics,” says Dr. Joshua Zeichner, MD, Associate Professor of Dermatology, Icahn School of Medicine at Mount Sinai. But, he notes, patients should watch out for bacterial resistance, which can develop after about a month. That’s why he favors a multi-tiered approach. “The goal is to treat [with oral antibiotics] along with topicals and benzoyl peroxide, which helps minimize the development of resistance,” he says. After three to four months of an oral regimen, Dr. Zeichner recommends maintaining treatment with topical treatments.
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Illustrated by Elliot Salazar.
Acupuncture: Maybe
Could adjusting your qi lead to fewer breakouts? Possibly — but only indirectly. “For some people, high levels of stress can cause acne,” says Dr. Emmy Graber, MD, a dermatologist at Boston Medical Center and an assistant professor at Boston University School of Medicine. “There’s not a good amount of scientific evidence that [acupuncture] cures acne, but it may reduce stress.” So, for people whose skin goes haywire when their cortisol levels rise, acupuncture certainly may help.

But — and you knew there was a but coming — it’s not a magic bullet, says aesthetician Kimberly Yap Tan, founder of SkinSalvation acne clinic in San Francisco. “You can do acupuncture, you can eat well, and manage your stress and meditate,” she explains. “But, if you're still putting on cloggy products or picking your face, you're still going to break out.”
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Illustrated by Elliot Salazar.
Apple Cider Vinegar: No
If the Internet is to trusted, apple cider vinegar — drinking it, applying it, bathing in it — can work miracles. Sadly, clearing acne is not one of them. Dr. Zeichner points out that apple cider vinegar is antibacterial, but he adds, “There is limited data.” Plus, the bacteria-fighting ability isn’t enough to actually, you know, do anything, says Dangene, a former acne sufferer turned aesthetician and founder of Dangene Institute of Skinovation. “It might kill the surface bacteria,” she says, “but you’re never going to get inside of all of those pores.”
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Illustrated by Elliot Salazar.
Spironolactone: Yes
Better known by its nickname, Spiro, this prescription-only pill is largely effective in treating hormonal acne. (If you’re solely dealing with blackheads and whiteheads, don’t even bother.) This anti-androgen drug works by limiting hormonal fluctuations, which in turn reduces the number of breakouts. “It’s not a hormone, and it doesn’t change anyone’s hormonal levels,” says Dr. Graber. “It just makes it so the hormone can’t attack the skin.” Plus, it’s safe to use for years, says Dr. Graber. One caveat: If you’re planning to get pregnant, you’ll need to stop using spiro.
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Illustrated by Elliot Salazar.
Accutane: Yes
Otherwise known as the nuclear option for acne, Accutane can be life-changing, says Dr. Graber. “It is the only medication we have that can cure acne,” says Dr. Graber. “Eighty percent of people who take it are cured for good... For someone who has severe acne to go to no acne at all, we know it works better than anything else we have.”

Still, as effective as Accutane (or isotretinoin) is for most people, it’s not an easy drug to take. “There are a lot of potential side effects, especially depression,” says Dr. Zeichner. Dangene, who used Accutane for 15 years, does not recommend its use for this reason. Severely dry skin, itching, nosebleeds, and joint pain are some of the drug’s common side effects.

That’s why Drs. Zeichner and Graber agree that Accutane is best used by people with severe acne — think deep nodules and painful cysts that stick around for months. “It should be used in the appropriate patient with severe, nodular acne that is resistant to other therapies,” Dr. Zeichner says. “However, with proper monitoring and correct use, it is safe.”

Accutane, he adds, is not good for people with mild acne; it also isn’t the right treatment for women who experience hormonal flare-ups, pregnant women, and women who are unwilling to use two forms of contraception. “It has to be [prescribed for] the right patient,” says Dr. Graber, “and it has to be prescribed by a doctor who knows what they’re doing.”

In other words, see your dermatologist.
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Illustrated by Elliot Salazar.
Toothpaste: No
Most of us have heard that when you’ve got a big ol’ honker on your nose, a dab of Crest will fix it overnight. Not really, says Dr. Graber. “It feels like you’re healing the pimple because a lot of times there’s baking soda in the toothpaste, and that draws out the pus,” she explains. “So, you feel like it’s getting more dry, but it’s not necessarily making the pimple go away any faster.”

Furthermore, many toothpaste formulas have sodium lauryl sulfate (SLS), a comedogenic ingredient that can trigger acne. “SLS could irritate the skin around the pimple and make the pimple look more red,” Dr. Graber adds. Best to leave the toothpaste where it belongs: making your mouth minty fresh.
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Illustrated by Elliot Salazar.
Quitting Dairy: Maybe
The link between diet and acne isn’t rock solid — yet — but that’s changing. Last year, the American Academy of Dermatology highlighted “growing evidence” that dairy and high-glycemic foods (such as white bread and chips) may worsen acne. And, Dr. Zeichner says, it would be wise for acne-prone people to avoid these triggering foods.

“Avoid cow’s milk, especially skim milk,” he advises. “The hormones or growth factors in milk may stimulate the oil gland. Also, avoid high glycemic index foods, which have been associated with acne flares.”

For her part, Yap Tan asks clients to avoid eating dairy, soy, peanuts, coffee, and other potential acne triggers. “Dairy in general is inflammatory,” she explains. “Acne is a combination of excess oil production and excess dead skin cells collecting in the pore. Toss inflammation into the mix, and you have acne. This is the big hot-button issue right now in the skin-care community, and, since there isn't any hard scientific evidence yet, it's difficult to say a hard yay or nay to this one. Our take? Pay attention to your body. If you notice you break out less when you avoid dairy, then avoid it. If it doesn't seem to have an effect, then by all means, keep on indulging your love of Brie.
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Illustrated by Elliot Salazar.
Benzoyl Peroxide & Salicylic Acid: Yes
These classic over-the-counter treatments treat acne by destroying bacteria and keeping pores clear. “Those ingredients are great, and I recommend them a lot,” Dr. Graber says.

The key is to understand the kind of acne they can help. “For people who don’t have red pimples or deep bumps, and just have flat [acne], salicylic acid would be better,” she says. “For red, inflamed acne, go with benzoyl peroxide.”

Knowing how to use these ingredients is important, says Yap Tan, who believes that many people make the mistake of using these topicals as spot treatments. “They’re better as a preventative part of your skin-care regimen,” she explains.

If you have sensitive skin, though, you may want to try another option. “Benzoyl peroxide is way too drying,” Dangene says. “You could burn yourself — even if you have beautiful, gorgeous skin.”
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Illustrated by Elliot Salazar.
Chemical Peels: Maybe
“Peels can be incredible,” Dangene says, adding that they can keep pores clear while eliminating dead skin cells. Likewise, Yap Tan often pairs peels with extractions for her clients. Both aestheticians emphasize that peels are part of their treatment process, but not the whole shebang. And, Dr. Graber agrees. “Some light chemical peels can be helpful, especially for people who have a lot of blackheads. It’s not a cure, but it can temporarily make things better.”

The takeaway: Getting a peel can be a step toward clearing acne, but it’s only one part of the process.
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Illustrated by Elliot Salazar.
Birth Control Pill: Yes
Many women who go on the pill see a marked improvement in their acne, thanks to the hormone-regulating powers of oral contraceptives. “[For women on the pill,] their skin has less oil and shine,” says Dr. Zeichner. “Their acne improves.”

As long as your doctor green-lights the use of the pill, it’s a fine way to treat acne. After age 35, there may be a higher risk of blood clots, though. “When I have patients above that age,” Dr. Graber says, “I ask them to talk with their gynecologist to see if staying on the pill is okay.” Those of us who vividly remember the Reagan years should take note.
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Illustrated by Elliot Salazar.
Tretinoin: Yes
Better known by its brand names such as Retin-A, tretinoin is a topical form of vitamin A. “It reduces inflammation, normalizes sticky skin cells around the follicles, and opens clogged pores,” explains Dr. Zeichner.

And, says Dr. Graber, there’s a reason it’s widely prescribed. “It works very well for blackheads and whiteheads,” she says. “It can prevent pimples from coming up.”

Tretinoin is not a spot treatment, nor does it work overnight. “It usually takes weeks to start to see improvement,” Dr. Zeichner says. “Sometimes acne flares in the beginning as the skin purges itself of the oil in the pimples.” So, if you’re trying tretinoin, be patient — things may get worse before they get better, but they will get better.
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Illustrated by Elliot Salazar.
Coconut Oil: No
Ah, coconut oil. So tasty! So natural! So totally-going-to-break-you-out. Sorry, folks, but rubbing coconut oil into your skin is a big ol’ nope when it comes to acne. “Time and time again, we’ll have clients doing the coconut-oil thing,” Yap Tan laments. “Once they stop, they clear up.” That’s because coconut oil is comedogenic, so every time you apply it, it’s like spackling your pores. Yap Tan adds that she even sees around-the-mouth breakouts in some of her clients who cook with coconut oil.

As for the dermatologist’s point of view on this so-called “cure,” Dr. Graber has just one word: “No.”
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Illustrated by Elliot Salazar.
UV Rays: No
Getting a bit of sun can “dry up” oily, shiny pimples, right? Maybe, but baking in UV rays isn’t a good idea, says Dr. Graber. Aside from the obvious dangers of photoexposure — including accelerated aging and increased risk of skin cancer — there’s also the simple fact that there are better ways of using light to treat acne.

“Certain types of light can help acne,” Dr. Graber explains. “But sunlight contains a lot of different types of UV rays, and the complications can wind up being worse than the acne. Light rays can be helpful, but you can deliver those types of rays by machines at doctors’ offices.” Which leads us to…
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Illustrated by Elliot Salazar.
LED Light Therapy: Maybe
Talk about a blue-light special. Blue LED light is often praised for its ability to destroy the P.acnes bacteria that cause pimples. And, it can do that, but there’s just one problem, says Dr. Graber. The results could last for months, but they could also last for only a couple of weeks. “It can help, but it's not a cure, and it doesn't help for everyone,” she says. “It's tough to predict what the results might be — or if it will help at all.”

Dangene, who uses her own LED machine every other day, says this is why she uses a variety of wavelengths when treating her clients. “A broad spectrum of colors is best,” she says. “A blue light might not work on everyone, but the green one might, or the red or yellow, depending on what I want to accomplish.”
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Illustrated by Elliot Salazar.
Aspirin Mask: Maybe
Aspirin is salicylic acid, and salicylic acid attacks clogged pores. So, shouldn’t an aspirin mask clear up acne?

This one gets a “meh” from Dangene and Yap Tan. “Salicylic acid is slightly antibacterial, and it can be anti-inflammatory,” Yap Tan says. “If you crush up an aspirin pill, it might help a little bit. But, that aspirin pill is not designed to penetrate the pore and get in there like a salicylic-acid treatment can. It can work in a pinch, but it's not as well-formulated.”

Dangene agrees: “It might work if you’re talking about one little, tiny pimple, and all you want to do is dry it up, but it wouldn’t work for severe acne.”

So, while the tried-and-true aspirin mask can improve symptoms, it’s not truly going to eradicate acne.
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Illustrated by Elliot Salazar.
Honey: Maybe
So many women have gone searching for the land of milky skin and honey — our beauty director among them. The sweet stuff naturally combats inflammation and bacteria, which is why many people use it as an acne mask.

For serious flare-ups, though, don’t expect honey to fix everything. “Honey is incredible for your skin, but not for acne,” says Dangene. “If someone has bad acne and puts honey all over their face, it’s not going to do that much.”

Yap Tan agrees. “Certain natural ingredients work great,” she says. “But, if you bring that ingredient into a responsible lab and have them create chirally correct formulations on the molecular level, they will optimize the ingredients into a formula that’s even better for your skin.”
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Illustrated by Elliot Salazar.
Zinc: Yes
Surprise! Both Dr. Zeichner and Dangene agree that although it’s not a cure-all, zinc can improve acneic skin — whether used topically or internally. “Zinc is probably one of the greatest minerals you could get your hands on,” says Dangene, who recommends a zinc-oatmeal mask to calm angry, acne-ridden skin.

Eating zinc is another way to improve a blemish-prone complexion. “Zinc has been shown to help treat acne,” adds Dr. Zeichner. “It’s best as adjunctive therapy to use along with your regimen.” Foods such as sunflower seeds, nuts, oysters, and beef liver are naturally rich in the mineral; talk with a doctor before taking zinc supplements, as excessive zinc intake can lead to copper deficiency.
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Illustrated by Elliot Salazar.
Cold & Hot Compress: Yes and No
The late Dr. James Fulton, who co-created Retin-A, referred to ice as the “poor man’s antibiotic” because of its ability to quickly reduce inflammation. “Icing is great because it’s attacking the acne right at the topical site,” says Yap Tan, who asks clients to briskly rub ice on their faces after cleansing. “Another side benefit of ice is that it creates micro-fissures in the epidermis, which allow active ingredients (like the mandelic acid in our toner) to penetrate deeper into the pore instead of just sitting on top of inflamed skin.” Not too shabby for a little hunk of frozen water.

As for heat, it’s true steam can help tight and tiny pores release their clogs. Otherwise, though, it’s better to keep skin cool. “Heat inflames the skin and swells up those tender, already-stressed pores,” Yap Tan explains. “Contrary to popular belief, heat can actually swell follicles shut.”
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Illustrated by Elliot Salazar.
Tea Tree Oil: Maybe
It’s not a terrible idea to use products with tea tree oil, but set your expectations accordingly. “It’s antibacterial, and I like to use it post-extractions on inflamed acne,” says Yap Tan. “But, you still need a good extraction or exfoliation to get the 'seed'" — otherwise known as the gunk that’s clogging your pore — "out."

Although this essential oil can indeed kill acne bacteria and reduce inflammation, there is relatively little clinical research around its efficacy. (A 2007 study suggested that a 5% tea-tree-oil gel was more effective than placebo in treating mild to moderate acne, but the sample was only 60 people.)

If you do incorporate the oil into your regimen, don’t apply it at full concentration. If applied undiluted, tea tree oil can cause irritation, redness, peeling, and drying — some of the worst things to do to acne-prone skin. Bottom line: Acne is a complex and temperamental skin disease. No one thing works for every person, so if you've had any success with any of the cures in this feature, then more power to you. For those of us still looking for our magic bullet, a little bit of trial and error is needed. We recommend trying the derm- and aesthetician-approved methods first, and seeing how you do.
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