Acne is a common type of skin inflammation that appears when hair follicles clog with bacteria, oil and dead skin cells. Subtypes of acne include blackheads, whiteheads, hormonal acne, fungal acne, and cystic acne.

Treating acne can be challenging because skin is complex. Acne is influenced by hormones, diet, genetics, and other factors. Your skin is a microbiome, home to a smorgasbord of fungus and bacteria that can lead to breakouts and skin inflammation, especially when things get thrown off balance. 

There’s no one-size-fits-all solution to acne. That’s why we’ve put together this starter guide to help you identify what kind of breakouts you’re having and options for treatment. And if you’re new to skincare, congratulations on taking your first steps on your journey to clear skin! 

The causes of acne, explained 

The first step of stopping your breakouts is identifying potential causes of acne:

• Genetics

• Hormones

• Lifestyle 

• Environmental triggers

• Pore-clogging ingredients

• Skin inflammation

Acne is multifactorial—that’s dermatologist-speak for having multiple, intersecting causes. Genetics play a role, and so do your hormones. Your skin might just be more naturally acne-prone because of this. 

Lifestyle and other causes of acne

In addition to having acne-prone skin, many different environmental and lifestyle factors can contribute to breakouts.

• Diet. Evidence suggests certain foods can trigger acne in some people¹ (while others might help achieve better skin).² 

• Stress. Stress can indirectly cause breakouts because our bodies respond to pressure by releasing certain hormones.³

• Workouts. Working out is good for your health (and your skin), but sweat + friction = breakouts for some. 

• Pillowcases. Just like sweaty workout clothes, pillowcases can harbor dirt, moisture,  and other acne triggers. 

You can accidentally trigger breakouts through face-touching, your smartphone rubbing on your face, or products with potentially pore-clogging ingredients. It can be hard to live a completely acne-free lifestyle. Just be aware of these triggers and do what you can to avoid them!  

How does acne form?

First, it’s important to understand how the pores get clogged.⁴ If the natural skin cell renewal process gets thrown off, the build-up of dead skin cells and sebum (aka oil) can lead to clogged pores and breakouts.⁵ Acne treatments that stabilize your skin cell renewal and help shed dead skin cells are generally the most effective at getting rid of clogged pores.

So—what creates the inflammation we often see with acne? Our skin is a natural microbiome where microorganisms such as bacteria and fungi live. One type of bacteria, Cutibacterium acnes (or C. acnes), can irritate the skin when it feeds off the excess oil in a clogged pore. This inflammatory response is acne. Other potential acne triggers can include comedogenic ingredients in your skincare products, high glycemic foods, and stress.  

What are the different types of acne? 

With so many causes of breakouts, it’s no surprise that there are also many different types of acne. Chances are, your breakouts can be described as one or more of the following. 

• Whiteheads: Small clogged pores that look like a small white bump because of trapped oil and dead skin cells

• Blackheads: Small clogged pores that turn black because the trapped oil and dead skin cells are exposed to the air

• Fungal acne: Small, uniform bumps that tend to spread across a central area—especially on the forehead, jaw, chest, or back

• Papules: Tender bumps with redness and swelling caused by inflammation, usually less than 5mm in size

• Pustules: Large, inflamed pimples that might look like a big whitehead 

• Nodules: Large, firm, reddish lumps without pus that extend deeper than a papule and are often painful 

• Cysts: Large, soft, under-the-skin pimples that go deep under the skin’s surface and may feel swollen and tender

Who can get acne?

Teenagers aren’t the only ones who can suffer from acne. Adults do, too—especially women! Almost half of women in their 20s and a quarter of women in their 30s deal with acne.⁶

Not-so-fun fact: almost 20% of newborns up to three months old, and even infants and small children, face acne problems.⁷

How to treat acne 

So we know acne is complicated—and hard to get rid of. Typically, the best way to treat acne is to take a simple approach. You’ll want a minimalist skincare routine tailored to your specific skin needs while avoiding things that can make acne worse.

How to treat hormonal acne:

Breaking out with hormonal acne is frustrating — especially when you may be dealing with other hormone-related symptoms. To treat or help prevent hormonal acne, you may have to reevaluate your diet, reduce stress, or even directly address your hormones. Here are some treatment options for hormonal acne: 

• Spironolactone is a pill you can take to reduce your levels of acne-causing hormones.⁸

• Birth control pills can potentially help acne if they have the right combination of hormones⁹—talk to your doctor.

• Spearmint tea. Drinking two cups of spearmint tea per day may reduce acne-causing androgens.¹⁰

You’ll also need a gentle, no-clog skincare routine that makes sense for the specific kind of breakout you’re having. A licensed medical provider with training in skincare (like the experts at Curology) can help you come up with a custom treatment plan that makes sense for you. 

How to treat blackheads

One of the best strategies for treating closed comedones like blackheads and whiteheads includes skincare products that unclog pores:

• Tretinoin normalizes the life cycle of skin cells, helping to manage blocked pores.¹¹

• Azelaic acid works to unblock pores and helps reduce post-inflammatory hyperpigmentation.¹²

• Salicylic acid is a beta-hydroxy acid (BHA) that exfoliates the skin, helping to clear out pores.¹³

You can find over-the-counter blackhead treatments, but tretinoin is only available by prescription. 

How to treat fungal acne

If your breakouts are uniform, itchy bumps, you may have fungal acne. Fungal acne is caused by pityrosporum, a type of fungus that naturally lives on our skin. In addition to eliminating potential fungal acne triggers like dirty, sweaty pillowcases, seek out acne treatments with these ingredients:

• Zinc pyrithione has antimicrobial properties that help to stop the growth of acne-causing fungus and bacteria.¹⁴

• Azelaic acid has antimicrobial and anti-inflammatory properties that treat acne by keeping acne-causing bacteria and fungus in check. 

• Ketoconazole treats fungal acne by killing microorganisms that fuel breakouts, while its anti-inflammatory effects help soothe the skin.¹⁵

While these ingredients are available over-the-counter, all three are also available with a prescription if recommended by your medical provider.

How to treat cystic acne

Cystic acne is stubborn to resolve and can even be painful. Some cysts heal on their own, while others require expert care to resolve. Here are some treatments for cystic acne:

• Spot patches (or hydrocolloid bandages) are a good option for a cyst. They can speed healing while shrinking the cyst through absorption of pus and oil.

• A warm compress can help reduce swelling. A steeped-and-cooled bag of green tea is a great compress that may also reduce redness. 

• Cortisone injections will help dissolve a cyst instantly. You can get one from an in-person healthcare professional. 

Definitely DON’T try to pop your cyst. Picking, squeezing, or popping a cystic pimple is the LAST thing you want to do! First of all, it won’t work—it’s too deep beneath the skin. Secondly, messing with it only worsens the inflammation and the pain.

Helping prevent acne

To keep it simple, let’s start with basic tips to make sure you don’t accidentally make acne worse or trigger new breakouts:

1. Don’t overdo it. Be gentle and patient—your skin needs time to heal. Avoid harsh scrubbing, over-exfoliation, and risky at-home hacks.

2. Don’t pop. Even though it’s instant gratification, popping is likely to slow down your healing process and can potentially lead to scarring. 

3. Don’t use hot water. Lukewarm water is best for most (you can damage your skin with burning hot water). Cold water is fine, too, but it’s a myth that it shrinks your pores. 

4. Eat mindfully. Sugar, dairy, and certain carbs can cause breakouts in some people.¹⁶ Keep this in mind when planning meals! Your acne might get triggered by certain foods. 

5. Check your ingredients. Avoid skincare products that contain ingredients that can potentially make acne worse. Skip face wash with sodium lauryl sulfate (SLS) and moisturizers with cocoa butter, along with these other ingredients.

6. Do laundry more often. Like we said earlier, pillowcases, athletic clothes, and other fabrics that repeatedly come into contact with skin can trigger breakouts.

What to do when your acne won’t clear 

For many people, washing your face daily, using a good moisturizer, and avoiding products with pore-clogging and irritating ingredients is enough to clear their acne. 

For the rest of us, we need a simple-yet-effective acne treatment that actually works. If over-the-counter isn’t cutting it, it may be time to talk to a dermatology provider about prescription acne treatments. Reach out to the skin experts at Curology and start your customized acne treatment plan for free. 

Curology’s dermatology providers are here for you

Curology’s medical providers are board-certified doctors, licensed physician assistants, and nurse practitioners who’ve completed specialized training in treating acne in all skin. So when you’re a Curology member, it’s about more than just the products—it’s about getting expert guidance on your journey to clear skin.

You tell us about your skin, and we’ll have one of our in-house dermatology providers evaluate your situation and come up with a treatment plan made to work for you. If Curology is right for you, we’ll send you a Custom Formula, plus any of our recommended skincare products, for free (just pay $4.95 + tax to cover shipping/handling).* 

Get your personalized skincare routine with Curology

Subject to consultation. 30-day trial. Just cover $4.95 in S&H.

The best part? Curology is 100% online, so you can get clear skin without ever having to leave your house (or put on pants). We’re on a mission to make medical-grade skincare accessible to all, so go ahead. Start your Curology free trial today. Cancel anytime. Subject to consultation. Subscription is required. Trial is 30 days + $4.95 shipping and handling.

P.S.

We did the research so you don’t have to:

1. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology.

2. Jung, G. W., et al. Prospective, randomized, open-label trial comparing the safety, efficacy, and tolerability of an acne treatment regimen with and without a probiotic supplement and minocycline in subjects with mild to moderate acne. Journal of cutaneous medicine and surgery. (2013).

3. American Academy of Dermatology. Adult Acne.

4. Toyoda, M., & Morohashi, M. Pathogenesis of acne. Medical electron microscopy : official journal of the Clinical Electron Microscopy Society of Japan. 2001).

5. Mayo Clinic. Acne.

6. Perkins, A. C., et al. Acne vulgaris in women: prevalence across the life span. Journal of women's health. (2012).

7. American Academy of Dermatology. Is that acne on my baby's face?

8. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.

9. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.

10. Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytotherapy research. (2010).

11. Baldwin, H. E., et al. 40 years of topical tretinoin use in review. Journal of drugs in dermatology. (2013).

12. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.

13. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.

14. Gupta, M., et al. Zinc therapy in dermatology: a review. Dermatology research and practice. (2014).

15. Anwar, A., & Kamran Ul Hassan, S. Two Percentage of Ketoconazole Cream for the Treatment of Adult Female Acne: A Placebo-Controlled Trial. Cureus. (2020).

16. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.

Medically reviewed by

Nicole Hangsterfer, PA-C