Acne Treatment

What Is Acne?

Acne vulgaris is a chronic inflammatory skin condition that occurs when hair follicles become clogged with oil (sebum) and dead skin cells. This creates an environment where Cutibacterium acnes bacteria thrive, triggering inflammation and the characteristic lesions most people recognize as pimples.

Though often thought of as a teenage condition, acne affects people of all ages. According to the American Academy of Dermatology (AAD), 85% of people between the ages of 12 and 24 experience at least minor acne — but adult acne is increasingly common, particularly in women over 25.

Types of Acne

Acne exists on a spectrum from mild to severe, and identifying the type helps determine the right treatment:

• Whiteheads (closed comedones): Pores clogged and sealed beneath the skin surface.
• Blackheads (open comedones): Clogged pores open to the surface; the dark color is oxidized sebum, not dirt.
• Papules: Small, raised, red bumps caused by inflamed or infected hair follicles.
• Pustules: Papules with visible pus at the tip — what most people call a pimple.
• Nodules: Large, solid, painful lumps deep in the skin. Prone to scarring.
• Cystic acne: Large, pus-filled lesions deep beneath the skin. The most severe form and most likely to scar. Requires medical treatment.

What Causes Acne?

Multiple factors contribute to acne formation:

• Excess sebum (oil) production driven by androgens
• Follicular hyperkeratinization (dead skin cells that don't shed properly)
• Overgrowth of Cutibacterium acnes bacteria
• Inflammation triggered by the immune response
• Hormonal fluctuations (puberty, menstrual cycles, pregnancy, PCOS)
• Stress, which elevates cortisol and androgen levels
• Certain medications (corticosteroids, lithium, some birth control)
• Comedogenic skincare, haircare, or cosmetic products
• Genetic predisposition

Acne Treatment at Dermatology of Seattle

Effective acne treatment is not one-size-fits-all. Our dermatologists evaluate your acne type, severity, skin type, and medical history before recommending a personalized plan. Treatment options include:

Topical Medications

• Retinoids (tretinoin, adapalene, tazarotene) — unclog pores and reduce inflammation
• Benzoyl peroxide — kills acne bacteria and prevents antibiotic resistance
• Topical antibiotics (clindamycin, erythromycin) — reduce bacterial load
• Azelaic acid — anti-inflammatory, reduces post-acne dark spots
• Salicylic acid — exfoliates inside pores to prevent clogging
• Dapsone gel — effective for inflammatory acne, especially in adult women

Oral Medications

• Oral antibiotics (doxycycline, minocycline, sarecycline) — for moderate to severe inflammatory acne
• Hormonal therapy (combined oral contraceptives, spironolactone) — for women with hormonal acne
• Isotretinoin (Accutane) — for severe, scarring, or treatment-resistant acne

In-Office Procedures

• Chemical peels — exfoliate and unclog pores, reduce oil production
• Laser and light therapy — targets acne bacteria and reduces inflammation
• Comedone extraction — safe professional removal of stubborn blackheads and whiteheads
• Corticosteroid injections — rapidly reduce large cysts, prevent scarring
• Acne scar treatments — resurfacing and filler options for post-acne scarring