Best acne treatments, according to the guidelines

Doctors judge acne treatments by the evidence behind each ingredient. Two guidelines publish that judgment: the 2024 acne guideline from the American Academy of Dermatology (AAD), published in its journal, and the UK guideline from NICE, the body that writes clinical guidance for England. This guide sets out what each one says, which treatment fits which type of acne, and where a doctor comes in. For the full step by step plan, start with how to get rid of acne.

How the 2024 US guideline rates each treatment

The AAD guideline was built from a systematic review of the research, and it gives each treatment a grade. A strong recommendation is its highest grade. A conditional recommendation is one step lower: the treatment can help, and the guideline leaves more of the choice to the doctor and patient.

Rating	Treatments
Strong	Benzoyl peroxide, topical retinoids (such as adapalene and tretinoin), topical antibiotics, oral doxycycline
Strong, for severe or scarring acne	Oral isotretinoin
Conditional	Salicylic acid, azelaic acid, clascoterone, oral minocycline, sarecycline, combined birth control pills, spironolactone
Good practice	Combining treatments with different actions, limiting antibiotic pills, pairing antibiotic pills with creams or gels, steroid injections for large lumps

The guideline covers adults, teens and children from age 9. Two of the strong options are sold without a prescription in the US. Benzoyl peroxide is on every drugstore shelf. Adapalene 0.1 percent is the one retinoid you can buy without a prescription. The AAD says it is best to start benzoyl peroxide at 2.5 percent, although products go up to 10 percent.

Salicylic acid sits one step lower. It still helps, and the AAD says it works best on whiteheads and blackheads. Salicylic acid vs benzoyl peroxide compares the two in detail.

The first choices in the UK guideline

NICE gives doctors a short list and asks them to offer one option for a 12-week course. Every option is a pair of medicines.

Acne severity	First-line option
Any severity	Adapalene with benzoyl peroxide, in one gel
Any severity	Tretinoin with clindamycin (an antibiotic), in one gel
Mild to moderate	Benzoyl peroxide with clindamycin, in one gel
Moderate to severe	Adapalene with benzoyl peroxide, plus an antibiotic pill (lymecycline or doxycycline)
Moderate to severe	Azelaic acid, plus an antibiotic pill (lymecycline or doxycycline)

NICE defines mild to moderate acne as any number of blackheads and whiteheads, up to 34 red or pus-filled spots, and up to 2 nodules (deep, painful lumps). Moderate to severe means 35 or more red spots, or 3 or more nodules. For a person who wants to avoid retinoids and antibiotics, NICE suggests benzoyl peroxide on its own.

NICE also lists what not to do: never an antibiotic cream on its own, never an antibiotic pill on its own, and never an antibiotic cream together with an antibiotic pill. Used alone, antibiotics can stop working because bacteria become resistant to them.

Which treatment fits which type of acne

The two guidelines agree on the main idea: match the treatment to what you see on your skin. The AAD says a dermatologist diagnoses acne by looking at the breakouts, noting which types are present and where they appear, because different types of acne often need different treatment. You can do a rough version of the same check in a mirror, in daylight.

• Blackheads and whiteheads. These are clogged pores with little redness. The AAD recommends a retinoid to unclog them, and adds that a benzoyl peroxide wash helps. Salicylic acid is a second choice.
• Red pimples and pus-filled spots. The AAD suggests a wash with benzoyl peroxide or salicylic acid. Benzoyl peroxide reduces the bacteria that make acne red.
• Deep, painful lumps (nodules and cysts). The AAD says these often leave permanent scars and need a dermatologist. Store-bought products are unlikely to clear them.
• Acne on the lower face in adult women, with flares before periods. A dermatologist may add a birth control pill or spironolactone. Hormonal acne vs regular acne explains the pattern.

Why two treatments often work better than one

Acne has four main causes: extra oil, clogged pores, bacteria and inflammation. One ingredient rarely covers all four. The AAD says benzoyl peroxide is most effective when used with a second treatment that works on the other causes. That is why the guideline calls combined treatment good practice, and why every NICE first-line option is a pair.

Combining has a second benefit. When a doctor prescribes an antibiotic for acne, the AAD says it should be used together with benzoyl peroxide, which lowers the risk that bacteria become resistant.

Starting two products on the same night has a cost, though. The FDA requires every over-the-counter acne product to warn that irritation and dryness are more likely when you use another acne medicine on your skin at the same time. The AAD's advice for people treating themselves is to start with one product, and to add a second one only if there is no improvement after 4 to 6 weeks. The second product should work on a different cause.

Treatments with weaker support

Some popular treatments have less evidence behind them.

• Laser and light. The AAD says laser or light therapy may be part of a plan for mild to moderate acne. The US National Institute of Arthritis and Musculoskeletal and Skin Diseases says researchers are still studying the best types of light and the amount needed. NICE suggests one light treatment, photodynamic therapy, only for adults with moderate to severe acne when other treatments have failed or cannot be used.
• Natural remedies. A few have small studies behind them. How to get rid of acne naturally goes through what the evidence shows.
• Special diets. NICE advises that there is not enough evidence to support specific diets for treating acne. Does diet cause acne? covers dairy and sugar.

Side effects of the top treatments

Every treatment with a strong rating has side effects worth knowing before you start.

• Benzoyl peroxide. The FDA requires its label to warn that it can bleach hair and dyed fabric, and to tell users to avoid unnecessary sun and use sunscreen. Redness, burning, itching and peeling can happen. The label says irritation may be reduced by using the product less often or at a lower strength.
• Adapalene. Its Drug Facts label says redness, itching, dryness and burning are more likely in the first few weeks and usually lessen with continued use. It also says to limit sun exposure and use sunscreen outdoors.
• Antibiotic pills. NICE warns that they may cause side effects in the whole body and can lead to resistance, and that doxycycline and lymecycline can make skin more sensitive to sun.

NICE's advice for creams and gels is to start with every other day, or to wash the product off after an hour, and to move to normal use once the skin copes. The AAD adds that a daily moisturizer can help skin tolerate acne medicines.

Pregnancy changes the list

The best treatment for a pregnant person is a different list. NICE says topical retinoids and tetracycline antibiotic pills, such as doxycycline, should not be used during pregnancy or while planning one. The AAD advises anyone who is pregnant or trying to get pregnant to see a dermatologist before treating acne on their own, because some store-bought acne treatments are not safe in pregnancy. Retinoids during pregnancy and breastfeeding sets out what each label says.

How long any treatment needs

The best treatment still needs time. The AAD says it takes at least 6 to 8 weeks before breakouts start to drop. NICE builds its plan in 12-week courses and reviews the result at week 12. The adapalene Drug Facts label says results can take up to 3 months of once-daily use. A fair test of any treatment on this page is 12 weeks of use every day.

Where Skinli's plan fits

Skinli's plan uses two gels: adapalene 0.1 percent and benzoyl peroxide 2.5 percent. That is the same pair as NICE's first option for acne of any severity, and both ingredients carry the AAD's strongest rating. The plan starts every other night for two weeks, then moves to every night, which follows NICE's advice to start benzoyl peroxide and retinoids on alternate days to limit irritation. Over-the-counter acne treatments explains how to find each one on a store shelf.

When the best treatment needs a prescription

For some acne, the best option is one you cannot buy in a store. The AAD says large, painful pimples that sit deep in the skin, and acne that leaves a scar when it clears, need a dermatologist. The 2024 guideline strongly recommends isotretinoin, a prescription pill, for acne that is severe, causing scars or distress, or not responding to standard treatment. Prescription retinoids for acne covers the creams a doctor can prescribe, and severe acne and when to see a dermatologist covers the rest.