Acne is the most common skin condition in the United States, affecting up to 50 million people each year. It develops when hair follicles become clogged with oil and dead skin cells, producing blackheads, whiteheads, red bumps, and, in more severe forms, painful cysts and nodules. Acne is most common in the teenage years but persists or begins in adulthood for many people, especially women, and untreated inflammatory acne is the leading cause of permanent scarring and dark marks on the face.

What causes acne?

Four things together: excess oil production driven by hormones, clogged follicles, the bacterium Cutibacterium acnes, and inflammation. Genetics set the baseline. Hormonal shifts (puberty, menstrual cycles, polycystic ovary syndrome), certain medications (corticosteroids, testosterone, lithium, some antiseizure drugs), high-glycemic diets and whey protein in some people, and heavy or comedogenic skincare can all make it worse. Acne is not caused by dirt, and scrubbing makes it worse.

What are the types of acne?

Comedonal acne is blackheads and whiteheads without much redness. Inflammatory acne is red, tender papules and pustules. Nodulocystic acne is deep, painful lumps that scar. Adult female acne typically sits along the jawline and chin and flares with the cycle. In skin of color, the dark marks left behind (post-inflammatory hyperpigmentation) are often the most persistent problem.

How is acne treated?

Mild acne responds to topical retinoids (adapalene, tretinoin, tazarotene), benzoyl peroxide, and topical antibiotics or clascoterone. Moderate acne adds oral antibiotics for a limited course, or spironolactone or combined oral contraceptives for hormonal acne in women. Severe, scarring, or treatment-resistant acne is treated with isotretinoin, which produces long-term clearance in most patients and is safely managed with monthly monitoring. Chemical peels, extractions, and laser are used for scarring once acne is controlled. Most regimens take eight to twelve weeks to show full effect.

How Tono treats acne

Tono's board-certified dermatologists see patients with acne within days, not months, by video visit in 33 states and in person at Tono clinical centers. Acne is one of the conditions best suited to telehealth: it is diagnosed on examination, and treatment, including isotretinoin with its required monitoring and iPLEDGE enrollment, is managed entirely by video visits and photo follow-up. Our Skin of Color center specializes in acne and dark marks in darker skin tones. Your visit ends with a written plan, prescriptions sent to your pharmacy, and follow-up scheduled with the same dermatologist. Most insurance is accepted and no referral is required.

When should I see a dermatologist for acne?

See a dermatologist if acne has not improved after two to three months of over-the-counter treatment, if you have painful cysts or nodules, if you are developing scars or dark marks, or if acne is affecting your confidence. Scarring is preventable; treat early.