Doctor, my pimples just won’t go away. What is the most effective acne treatment?

The optimal treatment for acne involves the use of oral antibiotics or Isotretinoin, along with topical applications of benzoyl peroxide and Differin gel. However, it’s worth noting that many patients experience a recurrence of pimples after discontinuing these treatments, and prolonged reliance on anti-acne medications alone is not practical.

If you desire clear, pimple-free skin with minimum medication use, consider participating in a three-month acne-free diet and skincare challenge designed to eliminate acne. This approach has been successfully implemented for hundreds of acne patients in our clinic, yielding positive results.

Before starting the regimen, it’s essential to identify the specific type of acne you have.

Identifying the Type of Acne:

Acne can manifest in three primary ways: comedones (blackheads and whiteheads), red or pus-filled pimples, and cystic lesions. Dermatologists recommend different anti-acne products based on the type of acne.

Comedones (Blackheads/Whiteheads):

Comedones arise from uncontrolled oil secretions, the use of thick occlusive creams, or excessive layering of products. In both cases, the oil gland openings become blocked by cellular debris, resulting in black and whiteheads.

Red or Pus-Filled Pimples:

These pimples occur when the bacteria Propionibacterium acnes overgrows in clogged pores. Over-the-counter products with ingredients like neem, tea tree oil, liquorice, and niacinamide may provide some relief.

Cyst or Nodular Acne:

When the battle between your immune system and bacteria remains unchecked, small red pimples may evolve into large nodules or cysts. Immediate dermatological treatment is highly recommended to prevent scarring after healing.

Now let us breakdown acne skin care regime for you!

Morning regime

Step 1: Face wash

Washing face 2-3 times is absolutely essential in acne prone skin. Use face wash that remove excess oils without disturbing the skin barrier. If your skin feels dry, flaky or irritated, then you should switch to milder face wash.

Do not use a harsh face wash that makes your skin over-dry. I see a lot of patients who first use harsh face wash and then put a cream to moisturise. Well, that’s a disaster for acne-prone skin. Instead, use a face wash that removes excess oils from skin, so that skin feels soft and supple, rather than dry or stretched.

Brand recommendations: We have listed the face wash for oily skin order of oil controlling capacity in this article, Best face wash for oily skin type

Step 2: Rose water

Pat dry your face after washing and spray rose water. Massage rose water until it gets absorbed. Rose water hydrates and soothe your skin without clogging your pores. Click on this link to find the best pure organic Rosewater.

Step 3: Anti-acne Serum

In the morning you can choose from the following agents based on key skin concern:

Niacinamide for sensitive skin: 

It is the first choice for red pimples with dark spots in sensitive skin types. Niacinamide at a concentration of 10% has skin lightening effect, anti-inflammatory, and anti-acne action.

The Ordinary Niacinamide 10% + Zinc 1% has the advantage of zinc PCA along with niacinamide which has anti-acne action. It is available on Amazon.in and Amazon.com.

Salicylic acid for comedones: 

Salicylic acid is star ingredient for reducing black/white heads and open pores. It also reduces oil secretion. Go for salicylic acid 2% serum if your skin is very oily with open pores and comedones. Do not combine salicylic acid with Adapalene or retinoids, because both have similar action and combination is too drying.

The Ordinary Salicylic Acid 2% Solution comes with the advantage of witch hazel extracts that has anti-microbial action on acne. It is available on Amazon.in and Amazon.com.

Azelaic acid for post acne dark spots: 

Azelaic acid is one of my favorite ingredients. It soothes sensitive skin, prevents acne, and reduces dark spots. It can be applied for 2-3 months without side effects. However, avoid Azelaic acid if your skin is dry, red, irritated, or burning.

Sesderma Azelac Ru Serum is a liposomal preparation that delivers the actives near skin cells. This contains many active ingredients-Azelaic acid, 4-butylresorcinol, Tranexamic acid, Glycyrrhetinic acid, Retinol encapsulated in liposomes, Niacinamide, Vitamin C and Morus alba extract. Therefore, this serum is a complete package because it has anti-acne, anti-aging, anti-tanning and anti-inflammatory benefits. It is available on Amazon.in and Amazon.com

Step 4: Sunscreen

Sunscreen tends to clog pores and trigger pimples. Therefore, it is pertinent to use a lightweight sunscreen in gel/lotion/fluid preparation that has water as the first ingredient. Avoid silicon-based sunscreen because it occludes pores by forming a thick layer on top.

Make sure you apply at least a coin-size amount on the full face 30 minutes before going out in the sun.

Cetaphil PRO Oil Control Moisturising Lotion SPF 30 is a good option for acne-prone skin. It has anti-agent(zinc gluconate), Anti-oxidant (Vitamin E), and anti-inflammatory agents(allantoin and panthenol). Checkout its availability on Amazon.in and Amazon.com.

Step 5: Make-up

Make-up sits on the top of all the products. If you use makeup daily, then make sure you use a thin fluid based product. Even better is to use a compact powder that gives coverage of foundation and absorbs extra oil.

Noon Skin Care

Most of you would look greasy and dark by mid-day. In this case, wash your face again. If you can’t wash your face at the workplace, then wipe your face with micellar water. This removes excess oils and gives an instant matt look. Put on your sunscreen.

Night Skin Care

Night skin care begins by removing make-up (if needed) with micellar water, followed by face wash and rose water. At night, you can use the most effective anti-acne agents because they tend to react with the sun. The choice of agent depends on your key skin concern.

Red pimples

Benzoyl peroxide, neem, tea tree oil etc are few OTC effective agents that can be tried for Red pimples at home.

Brand recommendations in India:

Mamaearth Tea Tree Spot Gel Pimple Removal cream can be applied on red pimples at night until they dry. It reduces pimples with the anti-bacterial action of tea tree oil and the oil-controlling action of salicylic acid. It also prevents the development of dark spots after healing with the help of skin lightening and the anti-inflammatory action of licorice.

Spot patch is a Korean product that has a hydrocolloid dressing. This patch camouflages your pimples and sucks oils from pimples. In addition, Centella Asiatica helps in healing by promoting collagen repair.

Homemade anti-acne spot treatment can reduce big red pimples overnight.

Dr. Sheth’s Neem & Bha Spot Clarifying Serum can be used for full-face at night for reducing both comedones and red pimples. It is a good option for non-sensitive oily skin types. It can both reduce clogging pores with help of salicylic acid, and prevent bacteria to grow with the help of neem and tea tree oil.

Brand recommendations for United States:

Spot Pacth is a Korean product that has a hydrocolloid dressing. This patch camouflages your pimples and sucks oils from pimples. In addition, Centella Asiatica helps in healing by promoting collagen repair.

TreeActiv Invisible Acne Spot Treatment can be applied to pimples at night in non-sensitive skin. It has 2% Salicylic Acid, Aloe Vera, Peppermint Water & Oil, Tea Tree Oil, Clove Flower Oil, Eucalyptus Oil, Lemon Oil, Grapefruit Seed Oil, Orange Oil, Tamanu Oil, and Lemongrass Oil to reduce the pimple.

Benzoyl peroxide works primary on red or pus filled pimples. Put it only as spot treatment on pimples at night. It is available OTC in United States. Click below to buy:

Comedones

White heads and blackheads can be take care by Retinoids or salicylic acid. We recommend every acne patient to use retinoids at night because they prevent clogging pores, reduce oil secretion and prevent acne.

Retinol or Retinaldehyde help in oil control, open pores and comedones. If you breakout once in a while due to greasy skin, then this is best choice for acne above 30’s. Dermatocare team has reviewed the retinol cream available across the globe, click here to know the best retinol or retinaldehyde cream recommended by Dermatologist.

Adapalene: Adapalene is the most commonly used medicine to reduce acne. It is available on prescription in India. However, it is OTC in the United States by the name of Differing gel.

Tretinoin: It is most potent retinoid. It is prescribed by dermatologist if Adapalene does not show results or if patient has lot of black/whiteheads.

Retinoid looks like a good choice. But, they work by drying your skin and exfoliating the dead skin cells. It is important to start them gradually especially if your skin is on dry side, or get irritated easily. Here are the steps:

• First night: Apply adapalene/tretinoin gel only on pimples at night.
• Second night: Put on the area where you are getting pimples.
• Third night: If you don’t notice any dryness, redness, irritation, peeling or stiffness, then apply on full face except the under eye area, and area around the nose and mouth.
• Every night before applying adapalene or tretinoin, looks for subtle signs of retinoid dermatitis like dryness, redness, irritation, peeling or stiffness. In this case, put a non-comedogenic moisturiser first on dry skin and then put adapalene or tretinoin on active pimples. Skip if these signs become worse.
• Stop adapalene/tretinoin for a few days if you notice rash, itching, or bumps. Restart gradually once the skin feels better.

Post-acne dark spots

Glycolic acid is worth trying for stubborn post- acne dark spots. It  reduces acne, dark spots, tanning and dull skin. It is available OTC in various countries in concentration ranging from 3 % to 10 %.

Start with 3% if your skin sensitive, dry or irritated. Move on to 10% if your skin tolerates lower concentration. Glycolic acid might not suit sensitive skin, In this case you can try azelaic acid or Kojic acid based product. We have listed recommended brands below:

• Mars by GHC Skin Correct Gel For Acne Scar

• Pilgrim Salicylic Acid 1% + Glycolic Acid 3% Anti Acne Serum

• Murad Environmental Shield Vita-C Glycolic Brightening Serum

• Paula’s Choice SKIN PERFECTING 8% AHA Gel

Multivitamins

We at our clinic prescribe multivitamins rich in Zinc and Vitamin D for 3 months in acne patients. A lot of studies support the role of Zinc in acne. Tab Perfectil is one of our favorite brands. It is available on Amazon.in and Amazon.com

When to consult dermatologist?

Well, I don’t  want to raise false hope for this who are not ready for this 3 month pimples challenge. You are ready to enter this challenge if:

• Your have less than 5-10 red or pus pimples on face at this moment.
• Blackheads/white heads do not cover more than 30% of face.
• Black/whiteheads are not more than 0.5 cm in diameter. Macro-comedones can be removed by dermatologist by RF machine.
• No cystic or nodular acne.

In this case consult, near be dermatologist. You can still embark on this challenge for a month if you don’t want to consult a dermatologist immediately. If you wish to consult Dr Surbhi, MD, click here.