The most reliable way to get rid of acne is to match the treatment to the type of acne you have, use it consistently for about three months, and step up to prescription care if that isn’t enough. For mild acne, that usually means one over-the-counter active, such as benzoyl peroxide, adapalene or salicylic acid, alongside a gentle routine. For moderate acne, it usually means a prescription. And for deep, painful or scarring acne, it means seeing a dermatologist.
One honest caveat up front: acne treatments control acne rather than cure it. They work by stopping new spots from forming, so existing spots fade over weeks and breakouts often return if you stop. The goal is clear-enough skin with a routine you can actually keep up.
This guide walks through the whole process step by step, drawing mainly on the American Academy of Dermatology’s 2024 acne guidelines and the FDA’s rules for over-the-counter acne products. Each step links to a deeper guide.
Step 1: Work out what kind of acne you have
Acne starts in hair follicles (pores). Oil and dead skin cells form a plug, bacteria that normally live on skin (Cutibacterium acnes) multiply inside it, and the body responds with inflammation. Different treatments target different parts of that process, which is why the kind of spots you have matters. For a fuller explanation, see our guide to what acne is and what causes it.
Look at your skin in good light and roughly sort what you see:
- Comedones: blackheads (open pores with a dark center) and whiteheads (small closed bumps). These are non-inflamed.
- Papules and pustules: red, tender bumps, some with a white or yellow top. These are inflamed.
- Nodules and cysts: large, deep, painful lumps under the skin. These are the most likely to scar.
| Roughly | What you might see | Sensible starting point |
|---|---|---|
| Mild | Mostly blackheads and whiteheads, with a few small red pimples | Over-the-counter treatment and a simple routine |
| Moderate | Many red pimples and pustules, often spreading across the face, chest or back | Prescription treatment (in person, or online for adults without red flags) |
| Severe | Nodules or cysts, lots of inflammation, scarring, or acne that affects your mood | In-person dermatologist |
Check that it’s actually acne
Some conditions look like acne but need different treatment. If your bumps are very itchy and all look the same, especially on the chest, back or shoulders, consider fungal acne (Malassezia folliculitis), which is treated with antifungals. Facial redness and flushing with bumps may be rosacea. And a sudden, severe onset in adulthood, especially with irregular periods or extra hair growth, can point to a hormonal condition, which our guide to hormonal acne in adult women covers.
Step 2: Set up a simple, gentle routine
Before you add any treatment, get the basics right. The AAD’s acne skin care advice boils down to a few habits:
- Wash twice a day and after sweating with a gentle, non-abrasive cleanser. Use your fingertips, not a washcloth or scrub.
- Don’t scrub. Harsh scrubbing and over-washing irritate skin and can make acne look worse.
- Moisturize. Acne treatments dry the skin, and a non-comedogenic moisturizer makes them easier to stick with.
- Use sunscreen daily. Several acne treatments make skin more sensitive to the sun.
- Choose products labeled “non-comedogenic” or “won’t clog pores,” including makeup, sunscreen and hair products.
- Hands off. Picking and popping raise the risk of dark marks and scars.
Our acne skincare routine guide lays out a morning and evening starter routine, with a week-by-week plan for introducing a new active.
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Step 3: Choose one over-the-counter treatment
In the US, over-the-counter (OTC) acne drugs are regulated by the FDA. Most follow the acne drug monograph, M006, which sets the active ingredients and strengths a nonprescription acne product may contain. One important exception, adapalene 0.1% gel, reached store shelves through a separate FDA approval.
| Active ingredient | OTC strength | Mainly helps with | Watch out for | Regulatory basis |
|---|---|---|---|---|
| Benzoyl peroxide | 2.5% to 10% | Red, inflamed pimples; reduces acne bacteria | Dryness; bleaches towels, clothes and hair | FDA monograph M006 |
| Adapalene | 0.1% gel | Clogged pores; preventing new spots | Dryness and irritation early on; sun sensitivity | Rx-to-OTC switch (NDA), not the monograph |
| Salicylic acid | 0.5% to 2% | Blackheads and whiteheads | Dryness; weaker evidence for inflamed acne | FDA monograph M006 |
| Sulfur (alone or with resorcinol) | Sulfur 3% to 10% | Mild acne; spot treatments and masks | Smell, dryness; limited high-quality evidence | FDA monograph M006 |
Benzoyl peroxide: the first choice for red pimples
Benzoyl peroxide kills acne bacteria, and bacteria don’t become resistant to it the way they can to antibiotics. The 2024 AAD guidelines give it a strong recommendation, and a 2020 Cochrane review found it more effective than placebo, though many of the trials were of limited quality.
Higher strength isn’t automatically better. Many people do well on 2.5% to 5% with less irritation than 10%. Our benzoyl peroxide concentration guide compares the strengths, and our guide to choosing a benzoyl peroxide face wash covers rinse-off options, which are gentler and useful for sensitive skin.
You may also have seen news about benzene in benzoyl peroxide products. Our article on benzoyl peroxide and benzene explains what FDA testing found, and the benzoyl peroxide benzene tracker lets you check specific products against FDA sources.
Adapalene: a retinoid that prevents new breakouts
Adapalene is a retinoid, a vitamin A–related drug that normalizes how skin cells shed inside the follicle, so fewer pores clog. The FDA approved Differin Gel 0.1% for nonprescription use in 2016 for people aged 12 and older. Topical retinoids get a strong recommendation in the 2024 AAD guidelines and are the backbone of long-term maintenance.
Apply a thin layer to the whole acne-prone area once a day, not just to individual spots. The Differin label warns that acne may seem to get worse in the first weeks. Our guide on purging vs. breakouts explains how to tell a normal adjustment from a reaction. For full instructions, see our adapalene gel guide, and for how it stacks up against prescription tretinoin, read Differin vs. tretinoin.
Salicylic acid: best for blackheads and whiteheads
Salicylic acid is an oil-soluble exfoliant that helps loosen the plugs inside pores. The 2024 AAD guidelines give it only a conditional recommendation because the evidence is weaker, so it’s best seen as a gentle option for comedonal acne or an add-on. Our salicylic acid guide covers how to use it, and our guide to salicylic acid cleansers covers what to look for in a wash.
Sulfur and other ingredients
Sulfur is an older monograph ingredient that some people with mild or sensitive-skinned acne find tolerable. The evidence behind it is thin, which our sulfur for acne guide explains. Azelaic acid is a prescription option in the US that also helps with dark marks; see our azelaic acid guide. Niacinamide is a cosmetic ingredient, not an FDA-recognized acne drug, and has only small studies behind it. Our niacinamide guide sets out what those studies show.
Step 4: Combine carefully and give it time
Dermatologists often combine treatments that work on different parts of acne, because combinations tend to work better than one product alone. The classic over-the-counter pairing is benzoyl peroxide in the morning and adapalene at night. Adapalene is chemically stable alongside benzoyl peroxide, while older forms of tretinoin can be broken down by it. That’s one reason to check before you mix products.
The catch is irritation. Stacking several drying products at once is one of the most common reasons people give up. A few rules help:
- Start one product at a time. Add a second only after two to four weeks, once your skin has settled.
- Start slowly. Use a new retinoid every second or third night for the first couple of weeks.
- Use less, not more. A pea-sized amount of a retinoid covers the face.
- Moisturize and protect your skin from the sun.
How long it takes
According to the AAD, if a treatment is working you should notice some improvement in 4 to 6 weeks, and clearing can take two to three months or longer. Switching products every week or two is a common mistake: you never find out what works, and the constant change irritates your skin. Take a dated photo in the same light every two weeks so you can judge progress honestly.
Step 5: Treat spots without making them worse
Individual pimples will still appear while your main treatment gets going. A few safer ways to handle them:
- Leave them alone. Squeezing pushes material deeper and makes marks and scars more likely.
- Hydrocolloid patches can cover a spot that has come to a head, absorb fluid and stop you picking. See our guide to choosing pimple patches.
- A dab of benzoyl peroxide on a new spot is fine, but spot-treating alone won’t prevent the next breakout. Treat the whole area.
- For a large, painful spot before an important event, a dermatologist can inject a dilute corticosteroid that often calms it within days.
Step 6: Step up to prescription treatment when OTC isn’t enough
If you’ve used an over-the-counter plan consistently for about three months without enough improvement, or your acne is moderate or worse, prescription treatment is the next step. It’s much more effective for moderate and severe acne than anything on a drugstore shelf. The 2024 AAD guidelines describe these main options:
| Treatment | What it is | Things to know |
|---|---|---|
| Topical retinoids | Tretinoin, higher-strength adapalene, tazarotene, trifarotene | Strongly recommended. Tazarotene and oral retinoids must not be used in pregnancy. |
| Topical antibiotics | Clindamycin, erythromycin, minocycline foam | Strongly recommended, but should be paired with benzoyl peroxide rather than used alone, to limit bacterial resistance. |
| Fixed combinations | Gels combining two or three actives, such as a retinoid, benzoyl peroxide and clindamycin | Fewer steps; can be pricier. |
| Clascoterone 1% cream | Topical androgen receptor blocker | Conditionally recommended; approved for ages 12 and up. |
| Oral antibiotics | Doxycycline (strongly recommended); minocycline or sarecycline (conditional) | Used with topical treatment, for as short a time as possible. |
| Hormonal therapy | Combined oral contraceptives, spironolactone | Conditionally recommended for suitable women; spironolactone must not be used in pregnancy. |
| Isotretinoin | Oral retinoid | Strongly recommended for severe, scarring or treatment-resistant acne. Requires the iPLEDGE program in the US. |
A few principles run through the guidelines. Antibiotics, oral or topical, are combined with benzoyl peroxide or a retinoid and kept to the shortest effective course, because acne bacteria can become resistant. Once acne is controlled, a topical retinoid is typically continued for maintenance. And isotretinoin is reserved for severe, scarring or stubborn acne. It’s highly effective but can cause serious birth defects and other side effects, so in the US it’s prescribed only under the FDA-required iPLEDGE program, with regular monitoring. It is never something to buy online without a prescriber relationship.
For the differences between the retinoids, see Differin vs. tretinoin. For women whose acne clusters around the jaw and flares with periods, see hormonal acne in adult women.
Getting a prescription: in person or online
You can get acne prescriptions from a dermatologist, your primary care clinician, or, if you’re an adult with uncomplicated moderate acne, an online dermatology service. Online care can be convenient, but it’s not right for everyone.
Our comparison of online acne treatment services explains how they work, what they typically prescribe and what they cost. If you’re unsure which route fits, our guide on when to see a dermatologist for acne walks through the signs that point to in-person care.
Special situations
Teenagers
Acne is extremely common in teens, and early treatment helps prevent scarring. Benzoyl peroxide, salicylic acid and adapalene 0.1% (labeled for ages 12 and up) are all used in teens, but it’s best to involve a parent or guardian and a pediatrician or dermatologist, especially for moderate acne or if spots are leaving marks.
Pregnancy and breastfeeding
Several acne treatments are unsafe in pregnancy, including isotretinoin, tazarotene, spironolactone and tetracycline antibiotics such as doxycycline. Don’t start or continue any acne treatment, including over-the-counter ones, without checking with your obstetric clinician or a dermatologist. The AAD has a patient guide to acne treatment in pregnancy.
Body acne
Acne on the back, chest and shoulders follows the same rules, but washes are more practical than leave-on creams on hard-to-reach skin. Our body acne guide covers what to do, and our guide to acne body washes covers how to choose one.
Darker skin tones
People with darker skin are more prone to dark marks (post-inflammatory hyperpigmentation) that can outlast the pimple by months. Treating acne early, avoiding picking, choosing less irritating strengths and using sunscreen all help. Azelaic acid and retinoids can help with both acne and dark marks.
Preventing marks and scars
The best way to prevent acne scars is to treat acne early and effectively, especially inflamed and deep acne, and to avoid picking. Flat red or brown marks usually fade over months, while true scars (pitted or raised) are permanent without procedures. Our guide to acne scar types and treatments explains the difference and the in-office options.
What doesn’t help (or makes things worse)
A lot of popular acne advice doesn’t hold up. Here are some of the most common examples:
- Scrubbing harder or washing more. Acne starts under the skin’s surface, and over-washing irritates.
- Toothpaste, lemon juice or rubbing alcohol on spots. These irritate skin and aren’t proven acne treatments.
- Tanning. A tan can temporarily disguise redness, but UV damages skin, and many acne treatments make you burn more easily.
- Cutting out foods without a clear reason. Evidence on diet is mixed, and the AAD’s acne guidelines recommend no specific diet. See acne myths vs evidence.
Our article on acne myths vs. evidence grades these claims and more, including dairy, chocolate and stress, with an evidence level for each.
Once your skin is clear: maintenance
Because treatments prevent new spots rather than permanently changing your skin, acne often returns when you stop everything. Once you’re clear, a common approach is to keep a topical retinoid (such as adapalene) a few nights a week, or whatever your prescriber recommends, and to stop oral antibiotics once topical treatment can keep things under control. If acne comes back, restart what worked before, and see a clinician if it doesn’t respond.
When to see a dermatologist
See a dermatologist or your doctor if:
- you have nodules, cysts or acne that is leaving scars or dark marks;
- about three months of consistent over-the-counter treatment hasn’t helped enough;
- acne is affecting your mood, confidence or daily life;
- you’re pregnant, breastfeeding, trying to conceive, or under 18;
- acne came on suddenly in adulthood or comes with other symptoms, such as irregular periods, excess hair growth, fever or joint pain.
Effective treatment exists for almost everyone, and getting it early is the best protection against scarring. For more detail, read when to see a dermatologist for acne.