How To Treat All Types Of Acne: Bacterial, Mild, And Severe

Acne is a skin condition characterized by the presence of pimples, which are raised skin blemishes that occur when a pore becomes blocked.¹ Pimples tend to develop into three distinct types: whiteheads, blackheads, and pustules.

The types of pimples

Whiteheads are pimples with a white top. These are formed when skin cells, bacteria, and sebum build up in a pore. These pimples are not infected, inflamed, or painful.

Blackheads also form through blocked pores, but they have a distinctive black top. The top of the pimple blockage has been exposed to air and oxidized, which accounts for its color. Blackheads are also not inflamed or painful.

Pustules occur when a blocked pore becomes infected. This type of pimple will be red, inflamed, sore, and filled with pus. 

We have pores all over our skin. These tiny holes allow sebum and dead skin cells to travel from deep within the skin, but they can also become blocked and lead to pimples forming. 

How to treat acne

Because pimples form when pores are blocked, acne treatments largely focus on either removing the contents that can block pores, reducing inflammation of pimples, or helping pimples heal.

The following are the three main types of acne treatments.

Prescription medicine

These medications have to be prescribed by a doctor, are likely to be stronger than other skincare options, and can come with some serious side effects depending on the product. 

Over-the-counter treatments

These acne treatment options do not require a prescription and can be purchased at a pharmacy or skincare store. These products tend to have lower ingredient potency than prescription options but can be more easily tolerated.

Natural acne treatments

From diet options and nutritional supplements to natural oils, a wide range of natural products have been found to be effective in combating acne. 

What do acne medications do?

Acne medications largely work by treating the causes of acne, such as:

• Dead skin cell build-up

• Sebum production 

• Bacterial growth 

• Infection

• Inflammation 

A wide range of acne medications of different strengths target different acne issues, so with just a little bit of research, you should be able to find a treatment option that fits your needs. 

How to treat bacterial acne

We all have a type of bacteria living on our skin, the Cutibacterium acnes or C. acnes (formerly called Propionibacterium acnes or P. acnes).² When this bacteria appears in higher amounts or becomes more severe, it can lead to the development and infection of pimples.

The good news is that many treatment options are available to target C. acnes bacteria and help keep your bacterial acne under control. Here are some of them.

Benzoyl peroxide

Benzoyl peroxide is a common over-the-counter topical acne treatment that can be purchased at most pharmacies.³ It is especially useful when treating bacterial acne, thanks to its ability to target C. acnes.

Research into the effect of benzoyl peroxide on acne has found that the treatment can significantly reduce the number of C. acnes bacteria on the skin.

It works slightly differently from antibiotics; instead of altering the structure of the bacteria and its proteins/enzymes, benzoyl peroxide is directly toxic to C. acnes. This is important as it means C. acnes is unlikely to become resistant to benzoyl peroxide as it can be to antibiotics. 

Antibiotics

Certain oral antibiotics can be prescribed for acne treatment. These tend to come from the tetracycline group of antibiotics, such as minocycline and doxycycline.⁴ Antibiotics are an effective option for treating bacterial acne because they target C. acnes, the pimple-causing bacteria.

Oral antibiotics have been used in acne treatment for decades, and they work by targeting and killing the bacteria that lead to acne development. There is some concern that the use of antibiotics for acne treatment could lead to antibiotic resistance. You should discuss this with your doctor before starting a course of antibiotics.

There are other side effects to consider before starting antibiotics for bacterial acne. Antibiotics can make your skin more susceptible to sunburn, so you will have to take suncare precautions if taking an oral antibiotic.

You could also experience nausea, vomiting, or diarrhea. Tetracycline antibiotics, in particular, should be avoided when pregnant due to their ability to impair bone growth. 

Apple cider vinegar

Apple cider vinegar offers a potential natural treatment option for bacterial acne.⁵ This pantry staple has high acidity and has been found to act as an antibacterial. Further research is needed into the effects of apple cider vinegar on C. acnes specifically to determine exactly how it might benefit people with acne. 

To apply apple cider vinegar to the skin, be sure to water it down 3:1 (three parts water to 1 part vinegar) and rinse it off after it has sat on the skin for around 30 seconds. If you haven’t tried apple cider vinegar as a skincare treatment before, you might want to try a test patch on a small area of skin first. 

Tea tree oil

Tea tree oil is an accessible and natural treatment option for bacterial acne. It has demonstrated impressive antibacterial abilities.

A 2017 study found that a tea tree oil product applied to the face twice daily for 12 weeks resulted in significant improvements to acne.⁶ The study also found that tea tree oil was well tolerated, meaning that you’re unlikely to experience any serious side effects. 

A 2019 study further demonstrated tea trees’ acne-reducing abilities.⁷ Researchers compared a herbal extract containing tea tree oil to benzoyl peroxide. They found that the tea tree herbal extract reduced acne lesions at a similar rate to benzoyl peroxide, but the herbal extract was better tolerated. 

You can purchase tea tree oil at a health store or pharmacy. Several skincare products are available that have it as a key ingredient. 

How to treat mild acne

Even mild acne can ruin your day. If you’re struggling to keep your pimples at bay, you might find that these treatments can help clear your skin up. 

Salicylic acid

Salicylic acid is a great treatment option for those wanting to keep mild acne under control.⁸ While it might be harsh to put acid on your face, salicylic acid dissolves dead skin cells, so it can help keep pores unblocked and your skin free from blemishes. Research has shown that regular use of salicylic acid can significantly reduce pimple development. 

While it is safe to use, salicylic acid can make your skin more sensitive. It’s advisable to ease it slowly into your routine, just once or twice a week. It’s also important to note that salicylic acid can make your skin more sensitive to light, so make sure you use sunblock daily, regardless of the weather or season. 

Oral contraceptive medicine

Oral contraceptive medicines are a proven way for women to manage two aspects of their health—birth control and acne.⁹

Birth control pills that contain both estrogen and progestin can help women reduce the appearance of acne. This is because these hormones reduce the production of androgen, which is associated with increased sebum production and pimple development. 

Research tells us that oral contraceptive medicine can significantly reduce acne. One study¹⁵ found that estrogen-progestin birth control effectively reduces both inflammatory and non-inflammatory acne lesions. This means that oral contraceptives could help you manage whiteheads, blackheads, and pustules.

Note that these medications can have side effects such as weight gain, nausea, reduced libido, breast tenderness, and anxiety. Be sure to consult with your doctor about the possible side effects of oral contraceptives before starting treatment. 

Niacinamide

Niacinamide is a type of vitamin B-3 that you can apply to the skin.¹⁰ A common skincare ingredient, niacinamide can offer a lot of hope for people trying to get their mild acne in check. It has been found to:

• Regulate oil production, reducing the amount of oil that can clog your pores and cause pimples

• Hydrate the skin by improving your lipid barrier—a part of the skin that helps it retain moisture and keep it functioning at its best (i.e., not developing pimples) 

• Reduce inflammation, which could help reduce the size of pimples

Blue light therapy

It might just seem like a colored light bulb, but blue-light therapy shows a lot of potential as a treatment for mild acne.¹¹ Blue light therapy involves the use of UVB light in the blue wavelength range, which is readily absorbed by particular antioxidants, allowing them to go forth and destroy acne-causing bacteria.

Studies have shown that blue light therapy can effectively reduce inflammation and the number of pimples.¹²

Blue light therapy is usually done for 15 minutes and repeated twice a week for a four-week period. Many spas and appearance medicine clinics offer blue-light treatments.

How to treat severe acne

Severe acne refers to acne that is persistent, consistent, covers a large area of your body, and is hard to treat with over-the-counter products. Because of the nature of severe acne, you will probably need to consult your doctor or dermatologist about stronger acne treatment options like the ones listed below.

Tretinoin

Also known as retinoic acid, tretinoin is a synthetic form of vitamin A that has shown an impressive ability to improve skin conditions and reduce acne.¹³ You might have come across retinol as an over-the-counter skincare ingredient, but tretinoin is a much stronger version of vitamin A.

Tretinoin works by increasing your skin cell turnover rate, preventing pores from becoming blocked. Studies have shown that tretinoin can be especially effective at treating even severe acne.

There are two ways to take tretinoin—as a topical treatment or an oral medication. Oral tretinoin tends to be much stronger, but both options can have serious side effects like dangers to pregnancy and mental health issues.

Also, in the early stages of use, you can experience “the purge,” where you have more pimples and dry skin as your skin first becomes accustomed to the increased cell turnover. This will pass after a few weeks.

Spironolactone

Spironolactone is another prescription-only option for women wanting to treat their severe acne. This oral medication blocks androgen hormone production, which is a group of male sex hormones that have been linked to acne development. 

Due to its effects on men (feminization), spironolactone is typically only prescribed to women for acne treatment.

Studies have shown that women who received spironolactone to treat their acne saw a dramatic improvement in their skin condition.¹⁴ There were very low rates of patients discontinuing the treatment, indicating that it was both effective and tolerable.

There are some side effects to be aware of, including increased breast size, dizziness, nausea, and headaches. In high doses, it can also spike potassium levels and cause heart palpitations, so be sure to discuss with your doctor how spironolactone might affect you.

When should you see a doctor?

You should see a doctor if your acne is:

• Persistent

• Severe

• Resistant to treatment 

• Impacting your quality of life

Your family doctor can prescribe you some acne medications, refer you to a dermatologist, or you can reach out to a dermatologist directly.

The lowdown

Regardless of the type of acne you have, there are many treatments that should offer you some hope. Bacterial, mild, and severe acne can all be targeted with appropriate treatment.