Acne: Types, Causes, and Topical vs. Oral Treatments

Written By Derick Mugambi Tagged As acne types topical acne treatment oral acne treatment hormonal acne cystic acne

Acne isn’t just a teenage problem. It’s a skin condition that affects 50 million Americans every year - and nearly half of them are adults. If you’ve ever stared at a red, painful bump on your chin and wondered why it won’t go away, you’re not alone. Acne doesn’t care if you’re 14 or 44. It shows up when your skin’s natural processes go off track: too much oil, clogged pores, bacteria, and inflammation team up to create blemishes that can feel personal, frustrating, and even embarrassing.

What Are the Different Types of Acne?

Not all acne looks the same. The way it appears tells you what’s going on underneath. The main types fall into three categories: comedonal, inflammatory, and nodular/cystic.

Comedonal acne is the mildest form. It includes whiteheads and blackheads. Whiteheads are closed pores filled with oil and dead skin - they look like small, flesh-colored or white bumps. Blackheads are open pores where the plug has oxidized and turned dark. These don’t hurt. They just sit there, stubborn and visible. You’ll often see them on the forehead, nose, and chin - the T-zone.

Inflammatory acne is where things get red and angry. Papules are small, tender, red bumps without pus. Pustules are similar but have a white or yellow center filled with pus. These are the ones you want to pop - but don’t. Squeezing them makes inflammation worse and can lead to scars.

The most severe forms are nodules and cysts. Nodules are hard, deep, painful lumps under the skin. Cysts are softer, filled with pus or fluid, and can be the size of a pea or bigger. These aren’t just blemishes - they’re mini infections deep in the skin. They’re the ones that leave permanent scars if not treated properly.

Then there are the less common but still important types:

Hormonal acne: Deep cysts along the jawline, chin, and neck. They flare up before your period, during pregnancy, or around menopause. This isn’t about dirt - it’s about hormones like androgens spiking.
Fungal acne (malassezia folliculitis): Tiny, itchy, uniform bumps on the chest, back, or forehead. It’s not acne at all - it’s yeast overgrowth. Antibiotics won’t help. Antifungals will.
Mechanical acne: Caused by friction. Helmets, tight collars, phone pressure on the cheek - anything that rubs the skin can trigger breakouts.
Acne conglobata: A rare, severe form where nodules connect under the skin, forming tunnels of infection. It needs strong medical intervention.

What Causes Acne?

Acne doesn’t come from eating chocolate or not washing your face enough. It’s a biological chain reaction. Four main things go wrong:

Too much sebum: Your sebaceous glands make oil to protect your skin. When hormones like testosterone rise - especially during puberty - these glands go into overdrive. Eighty-five percent of teens experience this.
Clogged pores: Skin cells that should shed every 28 days stick together because of excess keratin. They mix with oil and block the follicle.
Bacteria: Cutibacterium acnes (formerly Propionibacterium acnes) lives on your skin. When it’s trapped in a clogged pore, it multiplies and triggers inflammation.
Inflammation: Your body attacks the bacteria, causing redness, swelling, and pain. This is what turns a blackhead into a pustule or cyst.

Hormones are the biggest trigger. But other factors play a role too:

Genetics: If both your parents had acne, your risk goes up by 50%.
Medications: Steroids, lithium, and testosterone can cause breakouts in 30% of users.
Insulin spikes: High-sugar diets and processed carbs raise insulin, which boosts oil production and hormone levels.
Stress: Cortisol increases sebum production. Not the main cause, but it can make things worse.

Topical Treatments: What Actually Works?

For mild to moderate acne, topical treatments are the first line of defense. They work right where the problem starts - on your skin.

Benzoyl peroxide is the gold standard. It kills acne bacteria, reduces inflammation, and helps clear clogged pores. A 2.5% concentration is just as effective as 10%, with far less irritation. Studies show it cuts bacteria by 90% in four weeks.

Salicylic acid is your best friend for blackheads and whiteheads. It’s a beta hydroxy acid that dissolves oil and sheds dead skin. Look for 0.5-2% in cleansers or spot treatments. It takes 8 weeks to see clear results, but it’s gentle enough for daily use.

Retinoids like tretinoin and adapalene (Differin) are prescription and over-the-counter powerhouses. They don’t kill bacteria - they fix the root problem: clogged pores. Retinoids speed up skin cell turnover so dead cells don’t stick around. After 12 weeks, users see a 70% drop in inflammatory lesions. The catch? You’ll likely experience purging - a temporary flare-up in the first 2-4 weeks. It’s not making things worse. It’s bringing hidden clogs to the surface.

Combination products like benzoyl peroxide + clindamycin (an antibiotic) work better than either alone. They clear 65-80% of inflammatory acne, compared to 40-50% with single ingredients.

But here’s the reality: most people give up too soon. Dermatologists say 70% of users stop topical treatments within 6 weeks because of dryness, redness, or no immediate results. Acne doesn’t vanish overnight. It takes 8-12 weeks. Consistency is everything.

Split image: girl with cystic acne crying in mirror, then smiling with isotretinoin bottle in sunlight.

Oral Treatments: When Topicals Aren’t Enough

If your acne is moderate to severe - deep cysts, widespread breakouts, or scarring - topicals alone won’t cut it. That’s where oral treatments come in.

Antibiotics like doxycycline or minocycline are common. They reduce bacteria and inflammation. Most people see improvement in 6-8 weeks. But here’s the catch: 25% of users develop antibiotic resistance after 3-4 months. That’s why doctors now limit them to 3-6 months and always pair them with benzoyl peroxide to prevent resistance.

Oral contraceptives are a game-changer for women with hormonal acne. Pills with ethinyl estradiol and a progestin (like drospirenone) lower androgen levels. Studies show 50-60% improvement after 3-6 months. They’re not just birth control - they’re acne treatment.

Spironolactone is another option for women. It blocks androgen receptors, reducing oil production. Many see 40-60% improvement after 3 months. Side effects? Dizziness, menstrual changes, or increased urination. Not everyone tolerates it, but for hormonal acne, it’s often the most effective option.

Isotretinoin (Accutane) is the nuclear option. It shrinks oil glands, reduces bacteria, and prevents clogging. It clears 80-90% of severe cystic acne. Sixty percent of users stay clear for good after one course. But it’s not simple. It requires monthly blood tests, strict pregnancy prevention (it causes severe birth defects), and can cause dry skin, lips, and mood changes. Still, for people with scarring cystic acne, it’s life-changing.

What Doesn’t Work (And Why)

There’s a lot of noise out there. Natural remedies, DIY scrubs, tea tree oil - they all promise miracles. But science doesn’t back most of them.

Tea tree oil? It has some antibacterial properties. But clinical trials show it’s only 40% as effective as benzoyl peroxide. It might help with one or two whiteheads - not cysts. And it can irritate sensitive skin.

Washing your face 5 times a day? That strips your skin, triggers more oil, and makes acne worse. Gentle cleansing twice a day is enough.

Spot-treating with toothpaste? No. It dries out the skin and can cause chemical burns.

And don’t fall for “miracle” supplements. Zinc (30mg daily) shows modest benefit when added to conventional treatment - about 25% extra improvement. But it’s not a standalone fix.

Dermatologist's office as a magical library with glowing acne treatment bottles and floating paper cranes.

Real People, Real Results

Look at Reddit communities like r/SkincareAddiction. In a survey of 5,342 posts, users with comedonal acne reported 78% satisfaction with adapalene (Differin) after 12 weeks. But those with cystic acne? Only 42% were happy with topicals alone. They needed oral meds.

On r/AdultAcne, 65% of women with hormonal acne saw improvement with spironolactone. But 32% quit because of side effects. That’s why working with a dermatologist matters - you need to find the right balance.

Amazon reviews tell a similar story. La Roche-Posay Effaclar Duo has a 4.2/5 rating. People love it for blackheads - 68% of positive reviews mention that. But 72% of negative reviews say it did nothing for their cysts.

On Drugs.com, 58% of users say antibiotics helped within 6 weeks. But 34% reported resistance or rebound breakouts after stopping. That’s why dermatologists now avoid long-term antibiotics unless paired with other treatments.

What to Do Next

If you’re struggling with acne, here’s your simple roadmap:

Identify your type. Are you getting blackheads? Hormonal cysts? Itchy bumps? This tells you what treatment to try.
Start gentle. Use a non-comedogenic cleanser, a 2.5% benzoyl peroxide gel, and a moisturizer. Wait 8 weeks.
If no change, add a retinoid like adapalene. Still no progress after 12 weeks? See a dermatologist.
For hormonal acne, ask about oral contraceptives or spironolactone. Don’t assume it’s just ‘stress’.
For cystic acne, don’t wait. Isotretinoin is the most effective long-term solution. The side effects are serious - but so is scarring.

And remember: acne treatment isn’t about perfection. It’s about progress. Some days will be better than others. Your skin doesn’t respond like a light switch. But with the right plan, patience, and professional guidance, clear skin is possible - no matter your age.

Can acne be cured permanently?

For many people, especially with cystic or hormonal acne, isotretinoin can lead to permanent remission in about 60% of cases. Other types of acne can be controlled long-term with maintenance treatments like low-dose retinoids or hormonal therapy, but they usually require ongoing care. Acne isn’t always ‘cured’ - but it can be managed so effectively that it no longer impacts daily life.

How long does it take for acne treatments to work?

Most topical treatments take 6-8 weeks to show noticeable improvement. Oral medications like antibiotics or birth control pills usually take 3-6 months. Retinoids often cause a purge in the first 2-4 weeks, which can feel like things are getting worse before they get better. Patience is critical. Stopping too early is the #1 reason treatments fail.

Is it safe to use multiple acne products at once?

Combining treatments can be effective - but only if done right. Using benzoyl peroxide with a retinoid is safe and recommended. But layering multiple exfoliants (like salicylic acid, glycolic acid, and retinoids) can irritate your skin and make acne worse. Always start slow. Introduce one new product every 2-3 weeks. Let your skin adjust.

Does diet affect acne?

Diet isn’t the main cause, but it can trigger flare-ups in some people. High-glycemic foods (sugar, white bread, soda) raise insulin, which boosts oil production. Dairy - especially skim milk - has been linked to acne in studies, though the evidence isn’t strong for everyone. Cutting out chocolate won’t clear your skin, but reducing processed carbs and sugary drinks might help. Focus on whole foods, not elimination diets.

Why does acne come back after stopping antibiotics?

Antibiotics treat inflammation and bacteria, but they don’t fix the root causes: clogged pores and excess oil. Once you stop, those underlying issues return. That’s why dermatologists combine antibiotics with benzoyl peroxide or retinoids - to keep pores clear even after the antibiotic is gone. Stopping antibiotics without a maintenance plan almost always leads to rebound acne.

Can I use acne treatments while pregnant?

No isotretinoin - it causes severe birth defects. Avoid oral tetracycline antibiotics (doxycycline, minocycline) and high-dose retinoids. Safe options include topical benzoyl peroxide, azelaic acid, and low-dose salicylic acid. Oral contraceptives and spironolactone are not safe during pregnancy. Always consult your dermatologist and OB-GYN before starting or stopping any treatment while pregnant.

What’s the difference between fungal acne and regular acne?

Fungal acne (malassezia folliculitis) looks like tiny, itchy, uniform bumps - often on the chest, back, or forehead. It’s caused by yeast overgrowth, not bacteria. Regular acne is red, inflamed, and may have pus. Fungal acne doesn’t respond to antibiotics or benzoyl peroxide. It needs antifungal treatments like ketoconazole shampoo used as a body wash or oral antifungals. Misdiagnosing it as regular acne leads to failed treatments and frustration.

Are over-the-counter acne products enough?

For mild, occasional breakouts - yes. But if you have deep cysts, widespread inflammation, or breakouts that last more than 3 months, OTC products won’t be enough. Prescription treatments like retinoids, antibiotics, or hormonal therapies are far more effective. Delaying professional care increases your risk of scarring. Don’t wait six months to see a dermatologist if your skin isn’t improving.

There are 14 Comments

Allie Lehto

i just wanna say i used to think acne was from not washing my face enough... until i started getting cysts at 32 and realized my skin was just betraying me 😭
Henry Jenkins

The biological cascade behind acne is actually a brilliant example of homeostatic failure. Sebum overproduction isn't a flaw-it's an evolutionary adaptation gone rogue in modern environments with high-glycemic diets and chronic stress. The real tragedy is that we treat the symptom with benzoyl peroxide while ignoring the systemic triggers. It's like putting a bandaid on a leaking dam.
Renia Pyles

lol so you're telling me my 3am face scrub routine with lemon juice and baking soda was just making it worse? i feel seen and also deeply embarrassed
Nicholas Miter

i’ve been using adapalene for 10 weeks now. purging was brutal. felt like my face was on fire for 3 weeks. but now? my skin is smoother than it’s been since high school. just… don’t quit at week 4. it’s not magic. it’s biology.
Suresh Kumar Govindan

This is a Western medical reductionist approach. In Traditional Chinese Medicine, acne is viewed as damp-heat in the Spleen and Stomach meridians. Topical agents merely suppress symptoms. Acupuncture and herbal decoctions address root imbalances. Why are we ignoring millennia of holistic wisdom?
Ashley Karanja

I just want to acknowledge how emotionally exhausting chronic acne can be-it’s not just a skin issue, it’s a psychological burden. The shame spiral, the social anxiety, the feeling of being visibly ‘other’... and then the internet tells you to ‘just use tea tree oil’ like it’s a vibe check. The science here is so validating. Thank you for naming the invisible weight.
Karen Droege

I tried spironolactone and it was like my skin finally got a hug. But the dizziness? The constant need to pee? I felt like a robot on a water diet. Still worth it. My jawline hasn’t looked this calm since 2015. If you have hormonal acne and haven’t tried it-ask your derm. Don’t let fear of side effects keep you stuck in the cycle of despair.
Shweta Deshpande

hi! i’m from india and i had fungal acne for 2 years thinking it was regular acne. i was using all these harsh products and it got worse. then my cousin told me to wash my hair with ketoconazole shampoo and use it on my chest. it cleared up in 2 weeks. no one talks about this enough!!
Jessica Knuteson

The entire skincare industry is a scam built on fear and false promises. You don’t need 10 products. You don’t need to spend $200 on serums. Your skin doesn’t need ‘repair’. It needs space. And silence. And less marketing.
Ashley Porter

The 2.5% benzoyl peroxide vs 10% data is solid. Studies show no significant difference in efficacy but drastically lower irritation rates. It’s one of those rare cases where less is actually more. Shame more brands don’t push the lower concentration.
Peter Sharplin

I’ve been a derm assistant for 12 years. The #1 mistake people make? They treat acne like a bug to be exterminated. It’s not. It’s your body signaling something’s off. Fix the trigger-diet, stress, hormones-and the skin follows. Topicals are maintenance, not cure.
Kipper Pickens

In Japan, they use a lot of niacinamide and rice bran extracts. Less aggressive. More about balance. Their acne rates are lower not because they wash more, but because their diets are lower glycemic and skincare is minimalist. Maybe we’re overcomplicating this.
Joanna Domżalska

Isotretinoin is not a miracle. It’s a chemical lobotomy. You lose your natural oil production. Your lips are permanently cracked. Your mood tanks. And then you’re stuck with dry, sensitive skin for life. They sell it as salvation but it’s just swapping one problem for ten.
Josh josh

just used differin for 3 months and my skin is actually not trash anymore. also stopped drinking milk. no joke. the cysts on my jaw vanished. weird but true