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“If topical treatment alone does not improve acne, or if acne is severe or extensive, oral medications are the best option. If you’ve tried several topical medications without success, or if your condition is severe, oral acne medications are usually the next step in the treatment process. Treatment usually includes oral antibiotics and applying a prescription gel or topical cream to the skin. Depending on people with acne, treatment may include using prescription creams to prevent acne, taking antibiotics to kill bacteria that contribute to acne, or, if acne is severe, taking stronger medications such as like isotretinoin, or even minor surgery. Even if you have tried topical acne treatments such as creams or gels without any lasting results, laser therapy may be the right solution for you. While I would like you to try natural remedies first, if you are not seeing improvement and severe hormonal acne is making your quality of life worse, other treatments can make a real difference. While it may take a while, treating hormonal acne from the inside out until your hormones are in their natural, happy balance will allow your skin to truly heal.

While my approach isn’t an instant solution, and won’t replace everyone’s multi-drug regimen, hormonal acne can be very sensitive to a more holistic approach, which means less medication and more patches. While the studio treatments offered by Carolina Skin Care can be very effective in treating acne, patients should also commit to taking care of their skin at home. Multiple topical treatments, whether it’s steroids for eczema or topical antibiotics for acne, topical treatments may help in the short term, but in the long run, it can damage the skin, making you more likely to take it in the future. In addition to other treatments, you can take the most obvious step to soothe stress-related acne: reduce stress. If the creams and antibiotics you have been prescribed are not working, or if you cannot tolerate the side effects that medications may cause, you may want to consider acne treatments, which can be provided at your doctor’s office. Other treatments include birth control pills to control acne, hormonal drainage and extraction, and laser and phototherapy.”

1. Gentle Cleansing

Why? A clean face helps reduce the buildup of excess oil, dirt, and bacteria, which can clog pores and lead to acne.

What to Use:

• Mild, non-comedogenic cleansers are recommended, especially ones that are designed for acne-prone skin. These will cleanse without stripping the skin of natural oils, which could lead to more oil production and worsen acne.

Examples:

• CeraVe Foaming Facial Cleanser (for normal to oily skin)
• La Roche-Posay Toleriane Purifying Foaming Cleanser

Reference: Cleansing should be gentle to avoid skin irritation, which can exacerbate acne. (American Academy of Dermatology, AAD)

2. Exfoliation

Why? Exfoliating helps remove dead skin cells that may otherwise clog pores, forming blackheads or triggering cystic acne.

What to Use:

• Salicylic acid (a BHA) penetrates deeply into the pores to dissolve blockages like sebum and dead skin cells.
• Glycolic acid (an AHA) helps exfoliate the skin’s surface, improving skin texture.

Examples:

• Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant (salicylic acid)
• The Ordinary Glycolic Acid 7% Toning Solution (glycolic acid)

How Often?

• Start with 2–3 times a week and increase gradually to avoid irritation.

Reference: Salicylic acid can penetrate deep into the pores to treat acne, including blackheads and cysts. (National Institute of Health, NIH)

3. Topical Treatments

A. Salicylic Acid
Why? It works by breaking down the debris inside the pores that causes blackheads and acne. It also has anti-inflammatory properties, which help reduce redness and swelling.

Examples:

• Neutrogena Oil-Free Acne Wash Pink Grapefruit Foaming Scrub (salicylic acid)

Reference: Salicylic acid is particularly effective at reducing the formation of blackheads by exfoliating inside the pore. (AAD)

B. Benzoyl Peroxide
Why?
This topical treatment kills the acne-causing bacteria Propionibacterium acnes and helps to reduce inflammation, especially for cystic acne.

What to Use:

• Start with a lower concentration (2.5% to 5%) and increase if necessary.

Examples:

• PanOxyl Acne Foaming Wash 10% Benzoyl Peroxide

Reference: Benzoyl peroxide has been shown to reduce the number of acne-causing bacteria and inflammation in the skin. (Journal of Clinical and Aesthetic Dermatology)

C. Retinoids (Topical) Why? Retinoids, like adapalene (Differin), promote skin cell turnover, helping to clear pores and prevent the formation of blackheads. Over time, they also prevent the recurrence of cystic acne by reducing the buildup of skin cells that could otherwise clog pores.

Examples:

• Differin Gel 0.1% Adapalene (available over the counter)

How to Use:

• Apply in the evening after cleansing. Start slowly—2–3 times a week to allow your skin to adjust.

Reference: Topical retinoids improve the rate of skin cell turnover, preventing clogged pores that lead to blackheads and cystic acne. (AAD)

4. Don’t Pick or Squeeze

Why?
Picking or squeezing acne can push bacteria further into the skin, increasing the risk of infection, scarring, and more breakouts.

Reference: Squeezing blackheads or cysts can cause them to worsen or lead to scars. (American Academy of Dermatology, AAD)

5. Consider Chemical Peels (Professional Treatments)

Why?
A chemical peel performed by a dermatologist involves applying a chemical solution to exfoliate the skin. It can help reduce the appearance of blackheads, acne scars, and overall skin texture.

Types of Peels:

• Salicylic acid peels: Work best for acne-prone skin.
• Glycolic acid peels: Ideal for skin texture issues, including scars.

Reference: Chemical peels are commonly used by dermatologists to treat blackheads and cystic acne. (Journal of Clinical and Aesthetic Dermatology)

6. Visit a Dermatologist for Professional Treatments

Why?
A dermatologist can perform professional extractions, offer stronger treatments, or prescribe oral medications like antibiotics, oral contraceptives, or even isotretinoin (for severe acne).

Reference: For cystic acne or persistent blackheads, a dermatologist can offer more aggressive treatments such as extractions, cortisone injections, or isotretinoin. (American Academy of Dermatology, AAD)