treatment,availability,type,used_for,guideline_position,certainty_of_evidence,time_to_effect,what_the_evidence_says,the_catch,pregnancy_breastfeeding,sources,guide_url
Adapalene + benzoyl peroxide (fixed dose),OTC and prescription strengths,Over-the-counter topical,"Red inflamed spots, Blackheads & whiteheads, Back & chest",Strong recommendation,Moderate,4–12 weeks,"A separate strong, moderate-certainty recommendation for fixed-dose topical retinoid with benzoyl peroxide. Adapalene is chemically stable next to benzoyl peroxide, which is why this combination exists as a single product.",More irritating than either alone. Bleaches fabric.,Avoid in pregnancy because of the retinoid.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: Epiduo (adapalene 0.1%/BP 2.5%) gel label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a0610f87-3b39-458a-afa3-66be1fefd1de",https://tipsforacne.com/adapalene-differin/
Adapalene 0.1% (OTC retinoid),Over the counter,Over-the-counter topical,"Blackheads & whiteheads, Red inflamed spots, Keeping it clear",Strong recommendation,Moderate,"8–12 weeks, often worse before better","Covered by the guideline's strong, moderate-certainty recommendation for topical retinoids as a class. Adapalene is the only retinoid available without a prescription in the US and is the most photostable of the four.","Purging, dryness and peeling in the first 4–8 weeks are typical. The guideline gives no retinoid superiority over another.",Avoid in pregnancy: topical retinoids are not recommended.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: adapalene gel 0.1% OTC Drug Facts label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=24e0fd2f-05dc-4ff4-838f-ee022a3a9c20",https://tipsforacne.com/adapalene-differin/
Benzoyl peroxide,Over the counter,Over-the-counter topical,"Red inflamed spots, Blackheads & whiteheads, Back & chest, Keeping it clear",Strong recommendation,Moderate,4–12 weeks,"One of only two topical classes the AAD gives a strong recommendation with moderate-certainty evidence. It is also the only acne active with no documented Cutibacterium acnes resistance, which is why guidelines pair it with every antibiotic.","Bleaches towels, pillowcases and hair. Drying at higher strengths; 2.5% works about as well as 10% for most people.",Generally considered compatible with pregnancy; confirm with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Ghannoum M et al. Criticality of benzoyl peroxide and antibiotic fixed combinations, Clin Cosmet Investig Dermatol 2025 — https://www.dovepress.com/criticality-of-benzoyl-peroxide-and-antibiotic-fixed-combinations-in-c-peer-reviewed-fulltext-article-CCID",https://tipsforacne.com/benzoyl-peroxide-for-acne/
Clindamycin + benzoyl peroxide (fixed dose),Prescription,Prescription topical,"Red inflamed spots, Back & chest",Strong recommendation,Moderate,6–12 weeks,"Its own strong, moderate-certainty recommendation, separate from the individual ingredients. The pairing is what prevents the antibiotic resistance that clindamycin alone causes.",Bleaches fabric. Some formulations need refrigeration.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/clindamycin-for-acne/
Clindamycin + tretinoin (fixed dose),Prescription,Prescription topical,"Red inflamed spots, Blackheads & whiteheads",Strong recommendation,Moderate,8–12 weeks,"Strong, moderate-certainty recommendation for fixed-dose topical retinoid with topical antibiotic, with an explicit remark that concomitant benzoyl peroxide is recommended to prevent resistance.","Contains no benzoyl peroxide, so the guideline says to add one separately for resistance control. Label warns against combining with erythromycin-containing products.","Not listed as a pregnancy contraindication on the FDA label, but pregnancy data are insufficient and topical retinoids are generally avoided – discuss with your clinician.","AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: Ziana (clindamycin 1.2%/tretinoin 0.025%) gel label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78c329f9-f0c9-486d-9e54-0123699fb9e1",https://tipsforacne.com/tretinoin-for-acne/
Oral doxycycline,Prescription,Oral medication,"Red inflamed spots, Deep / cystic, Back & chest",Strong recommendation,Moderate,6–12 weeks; usually capped at 3–4 months,"The only oral antibiotic with a strong, moderate-certainty recommendation, and conditionally preferred over azithromycin (low certainty). Two of the guideline's five good practice statements are about limiting systemic antibiotics and always pairing them with benzoyl peroxide and other topicals.","Photosensitivity, oesophageal irritation, stomach upset. Must be paired with topicals and time-limited.",Contraindicated in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: doxycycline hyclate tablets label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f234f419-42da-4a6d-82c6-92106cd77c67",https://tipsforacne.com/doxycycline-for-acne/
Tazarotene,Prescription,Prescription topical,"Blackheads & whiteheads, Red inflamed spots",Strong recommendation,Moderate,8–12 weeks,"Covered by the strong, moderate-certainty class recommendation for topical retinoids. No drug-specific recommendation exists.",Often the most irritating of the four retinoids.,Contraindicated in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: tazarotene cream 0.05% and 0.1% label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fa5caf83-29d5-8229-b125-d7736928f132",https://tipsforacne.com/retinol-vs-retinoids/
Topical clindamycin,Prescription,Prescription topical,Red inflamed spots,Strong recommendation,Moderate,6–12 weeks,"Strong, moderate-certainty recommendation for topical antibiotics as a class, with an explicit remark that monotherapy is not recommended. In one clinical comparison, clindamycin-resistant C. acnes counts rose to over 1600% of baseline on monotherapy but stayed at or below baseline when paired with benzoyl peroxide.","Never use it alone. Monotherapy breeds resistant bacteria, so pair it with benzoyl peroxide every time.",Often used in pregnancy; confirm with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Ghannoum M et al. Clin Cosmet Investig Dermatol 2025 — https://www.dovepress.com/criticality-of-benzoyl-peroxide-and-antibiotic-fixed-combinations-in-c-peer-reviewed-fulltext-article-CCID",https://tipsforacne.com/clindamycin-for-acne/
Topical dapsone,Prescription,Prescription topical,Red inflamed spots,Strong recommendation,Moderate,8–12 weeks,"Folded into the strong, moderate-certainty topical antibiotic class recommendation rather than graded separately. The guideline makes two practical points about it: no G6PD screening needed, and the benzoyl peroxide discoloration.",Turns skin and facial hair orange-brown if layered directly with benzoyl peroxide. G6PD screening is not required.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Dubina MI, Fleischer AB. Interaction of topical sulfacetamide and dapsone with benzoyl peroxide, Arch Dermatol 2009 — https://jamanetwork.com/journals/jamadermatology/fullarticle/712184",
Topical erythromycin,Prescription,Prescription topical,Red inflamed spots,Strong recommendation,Moderate,6–12 weeks,"Within the strong, moderate-certainty topical antibiotic class recommendation. The guideline does not compare erythromycin against clindamycin directly.",Higher background resistance than clindamycin in most regions. Never use alone.,Often used in pregnancy; confirm with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/clindamycin-for-acne/
Topical minocycline foam,Prescription,Prescription topical,Red inflamed spots,Strong recommendation,Moderate,8–12 weeks,"Within the strong, moderate-certainty topical antibiotic class recommendation. FDA-approved from age 9.",Expensive. Same stewardship rule: pair with benzoyl peroxide.,Avoid: tetracycline class.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Tretinoin,Prescription,Prescription topical,"Blackheads & whiteheads, Red inflamed spots, Keeping it clear, Dark marks",Strong recommendation,Moderate,"8–12 weeks, often worse before better","Covered by the strong, moderate-certainty class recommendation for topical retinoids. The guideline states plainly that existing comparative data do not show one topical retinoid to be superior to another. Tretinoin also has separate randomised evidence for post-inflammatory hyperpigmentation in darker skin.",Degrades in light and next to benzoyl peroxide in older gel formulations. Purging is common.,Contraindicated in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Bulengo-Ransby SM et al. Tretinoin for post-inflammatory hyperpigmentation, N Engl J Med 1993 — https://pubmed.ncbi.nlm.nih.gov/8479462/",https://tipsforacne.com/tretinoin-for-acne/
"Tretinoin + benzoyl peroxide (encapsulated, Twyneo)",Prescription,Prescription topical,"Red inflamed spots, Blackheads & whiteheads",Strong recommendation,Moderate,8–12 weeks,"Covered by the strong, moderate-certainty recommendation for fixed-dose retinoid plus benzoyl peroxide. It is worth knowing why this product needed inventing: tretinoin and benzoyl peroxide genuinely do degrade each other in a shared film, so the two actives are separately micro-encapsulated in silica shells.",Bleaches fabric. Retinoid irritation still applies.,Contraindicated in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: Twyneo (tretinoin 0.1%/BP 3%) cream label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=27208dff-e376-4c18-b56e-0a260f685a39",https://tipsforacne.com/tretinoin-for-acne/
Trifarotene,Prescription,Prescription topical,"Blackheads & whiteheads, Red inflamed spots, Back & chest",Strong recommendation,Moderate,8–12 weeks,"Covered by the strong, moderate-certainty class recommendation for topical retinoids. Its distinguishing feature is trial data on truncal acne, not superiority on the face.",Newest and usually the most expensive retinoid. Studied on the trunk as well as the face.,Contraindicated in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/retinol-vs-retinoids/
Intralesional corticosteroid injection,In clinic,In-clinic procedure,Deep / cystic,Good practice statement,—,24–72 hours for one lesion,"A good practice statement rather than a graded recommendation: recommended as adjuvant therapy for larger papules or nodules, used judiciously, at lower concentration and volume to limit local steroid side effects.","Can leave a temporary dent or a pale patch. It treats one lesion, not the disease.",Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/cystic-acne/
Oral isotretinoin,"Prescription, with a pregnancy prevention programme",Oral medication,"Deep / cystic, Red inflamed spots, Back & chest, Scars",Good practice statement,—,4–6 months for a typical course; improvement often continues after stopping,"Worth reading carefully: isotretinoin's core recommendation is a good practice statement, not a graded strong recommendation; the panel considered the case so clear that formal grading was not applied. The same statement says patients with psychosocial burden or scarring should be treated as having severe acne, and that population-based studies have NOT identified an increased risk of neuropsychiatric conditions or inflammatory bowel disease.",Absolutely contraindicated in pregnancy. Monitoring of liver function and lipids should be considered; routine blood-count monitoring is not needed in healthy patients. Avoid waxing and resurfacing during treatment and for six months after.,Absolutely contraindicated. Pregnancy prevention is mandatory.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: Accutane (isotretinoin) capsules label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5b524a51-a16b-496e-b764-11c98c479c36",https://tipsforacne.com/isotretinoin-accutane/
Clascoterone 1% cream (Winlevi),Prescription,Prescription topical,"Hormonal pattern, Red inflamed spots",Conditional recommendation,High,12 weeks,"This is the most misread row in the guideline. Clascoterone has HIGH certainty evidence (the highest of any acne topical), yet only a conditional recommendation. The guideline's own footnote says the downgrade was made because the cost 'may impact equitable acne treatment access'. It is the first topical androgen-receptor blocker, and the only one usable by men.","The conditional rating is about price, not performance. Listed at roughly $590–$671 per tube at the time of the guideline.",Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Rosette C et al. Cortexolone 17α-propionate, J Drugs Dermatol 2019 — https://jddonline.com/articles/cortexolone-17a-propionate-clascoterone-is-a-novel-androgen-receptor-antagonist-that-inhibits-produc-S1545961619P0412X/",https://tipsforacne.com/clascoterone-winlevi/
Oral sarecycline,Prescription,Oral medication,"Red inflamed spots, Deep / cystic",Conditional recommendation,High,12 weeks,"High-certainty evidence, conditional recommendation. The guideline's footnote is explicit that the downgrade for sarecycline and clascoterone was made 'due to high current cost of treatment that may impact equitable acne treatment access'. Its narrower spectrum is the theoretical advantage.","Like clascoterone, downgraded to conditional on cost grounds rather than on evidence.",Contraindicated in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/doxycycline-for-acne/
Azelaic acid,OTC 10% and prescription 15–20%,Over-the-counter topical,"Red inflamed spots, Blackheads & whiteheads, Dark marks",Conditional recommendation,Moderate,4–12 weeks; longer for marks,"Conditional recommendation on moderate-certainty evidence. Its distinctive feature is that it also lightens post-inflammatory hyperpigmentation, which benzoyl peroxide and retinoids do not do directly.",Cochrane found it probably works less well than benzoyl peroxide. Can sting for the first week or two.,"One of the few acne actives commonly used in pregnancy, but still confirm with your clinician.","AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Cochrane 2020: azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, AHA for acne (Liu H et al.) — https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011368.pub2/full | King S et al. Systematic review of azelaic acid, J Cosmet Dermatol 2023 — https://pubmed.ncbi.nlm.nih.gov/37550898/",https://tipsforacne.com/azelaic-acid-for-acne/
Combined oral contraceptive pills,Prescription,Oral medication,"Hormonal pattern, Red inflamed spots",Conditional recommendation,Moderate,3–6 months,"Conditional recommendation on moderate-certainty evidence, with a footnote saying the downgrade is 'due to the variability in patient values and preferences related to contraception and hormonal medications': a values judgement, not an evidence one.","The conditional rating reflects variability in what people want from a contraceptive, not weak efficacy. Clotting and blood-pressure considerations apply.",Not applicable.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/birth-control-for-acne/
Oral minocycline,Prescription,Oral medication,"Red inflamed spots, Deep / cystic",Conditional recommendation,Moderate,6–12 weeks,"Conditional recommendation on moderate-certainty evidence, a step below doxycycline, which is strong. The side-effect profile is the reason most guidelines now lead with doxycycline.","Rare but real risks doxycycline does not carry: drug-induced lupus, hyperpigmentation, vestibular side effects.",Contraindicated in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/doxycycline-for-acne/
Spironolactone,Prescription,Oral medication,"Hormonal pattern, Red inflamed spots",Conditional recommendation,Moderate,3–6 months,"Conditional recommendation on moderate-certainty evidence, with a remark most people have not heard: 'Potassium monitoring is not needed in healthy patients.' That reflects direct research finding routine potassium checks of low usefulness in healthy young women. Testing is still appropriate with older age, kidney or heart disease, or other potassium-raising drugs.",Fetal risk means reliable contraception matters. Breast tenderness and irregular periods are common early on.,Avoid in pregnancy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Plovanich M et al. Low usefulness of potassium monitoring, JAMA Dermatol 2015 — https://pubmed.ncbi.nlm.nih.gov/25796182/",https://tipsforacne.com/spironolactone-for-acne/
Salicylic acid,Over the counter,Over-the-counter topical,"Blackheads & whiteheads, Keeping it clear",Conditional recommendation,Low,4–8 weeks,"Conditionally recommended on low-certainty evidence. Cochrane found little or no difference between salicylic acid and tretinoin in treatment response, but rated that comparison low certainty too.",Low-certainty evidence. Better for blackheads and whiteheads than for deep inflamed lesions.,Topical use on limited areas is generally considered acceptable; confirm with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Cochrane 2020: azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, AHA for acne (Liu H et al.) — https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011368.pub2/full",https://tipsforacne.com/salicylic-acid-for-acne/
Low-glycaemic-load diet,Self-directed,Diet & supplements,"Red inflamed spots, Blackheads & whiteheads",Evidence called conflicting,—,10–12 weeks in the trials,"The guideline reviewed four randomised trials: three favourable, one null. Rather than 'insufficient', it describes the evidence as conflicting and makes no recommendation. That is the most honest summary available of the diet question.","The guideline calls this evidence conflicting, not insufficient: a meaningful distinction.",No concern with a balanced version.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/diet-and-acne/
Chemical peels for active acne,In clinic,In-clinic procedure,"Blackheads & whiteheads, Red inflamed spots, Dark marks",Evidence judged insufficient,—,A series of 3–6 sessions,"The guideline names glycolic, trichloroacetic, salicylic, Jessner's and mandelic acid peels together in its insufficient-evidence statement for acne treatment. Systematic reviews of peels exist but did not meet the threshold the panel used.","Insufficient evidence per the guideline, for active acne. Peels for pigmentation are a different question.",Discuss with your clinician; some agents are avoided.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Chen X et al. Chemical peels for acne vulgaris: systematic review and meta-analysis, BMJ Open 2018 — https://bmjopen.bmj.com/content/8/4/e019607",https://tipsforacne.com/chemical-peels-for-acne/
Chocolate avoidance,Self-directed,Diet & supplements,Red inflamed spots,Evidence judged insufficient,—,Unclear,Named explicitly in the guideline's insufficient-evidence statement on diet. The most famous acne food rule has no guideline-grade evidence behind it.,"Insufficient evidence per the guideline, in either direction.",No concern.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/diet-and-acne/
Comedo extraction,In clinic,In-clinic procedure,Blackheads & whiteheads,Evidence judged insufficient,—,Immediate for the lesion extracted,Named in the guideline's insufficient-evidence statement on procedural treatments.,Insufficient evidence per the guideline. Done badly it causes the scarring it is meant to avoid.,No systemic concern.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/should-you-pop-pimples/
Flutamide,Prescription,Oral medication,Hormonal pattern,Evidence judged insufficient,—,Unclear,Named in the guideline's insufficient-evidence statement. Rarely used for acne in current practice.,"Insufficient evidence per the guideline, and it carries a risk of liver injury.",Avoid.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Lasers and light devices for active acne,In clinic,In-clinic procedure,Red inflamed spots,Evidence judged insufficient,—,A series of sessions,"The guideline lists the devices it reviewed by wavelength (pulsed dye, Nd:YAG, 1450 diode, KTP, infrared LED, red light, blue-and-red light combinations, intense pulsed light) and concludes the evidence is insufficient for all of them for acne treatment. Note this is about active acne, not scars.","Insufficient evidence per the guideline, across a long list of specific devices. Expensive, rarely covered by insurance.",Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Low-dairy or low-whey diet,Self-directed,Diet & supplements,Red inflamed spots,Evidence judged insufficient,—,Unclear,"Named explicitly in the guideline's insufficient-evidence statement on diet, alongside omega-3 fatty acids and chocolate.",Insufficient evidence per the guideline. Observational associations are not the same as a trial.,Watch calcium intake if you cut dairy.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/diet-and-acne/
Metformin,Prescription,Oral medication,Hormonal pattern,Evidence judged insufficient,—,Unclear for acne,"Named explicitly in the guideline's insufficient-evidence statement, alongside oral corticosteroids and flutamide. Its role in PCOS is a separate question from its effect on acne lesion counts.","Insufficient evidence for acne specifically, even though it is widely used in PCOS.",A clinician decision.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/hormonal-acne-in-adults/
Omega-3 fatty acid supplements,Over the counter,Diet & supplements,Red inflamed spots,Evidence judged insufficient,—,Unclear,Named in the guideline's insufficient-evidence statement on diet for acne treatment.,Insufficient evidence per the guideline.,Generally considered safe; check with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",https://tipsforacne.com/diet-and-acne/
Oral azithromycin,Prescription,Oral medication,Red inflamed spots,Evidence judged insufficient,—,Variable,"The guideline found the evidence insufficient to recommend azithromycin on its own, and separately made a conditional, low-certainty recommendation for doxycycline over azithromycin.","Doxycycline is conditionally preferred over it, on low-certainty evidence.",Sometimes used when a macrolide is needed in pregnancy; a clinician decision.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Oral corticosteroids,Prescription,Oral medication,Deep / cystic,Evidence judged insufficient,—,"Days, for flares",Named in the guideline's insufficient-evidence statement for acne treatment.,"Insufficient evidence per the guideline. Short-term rescue use only, and steroids can themselves cause an acneiform eruption.",A clinician decision.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Oral or topical zinc,Over the counter,Diet & supplements,Red inflamed spots,Evidence judged insufficient,—,Unclear,Named explicitly in the guideline's insufficient-evidence statement. Cochrane reviewed zinc too and did not find a basis for confident conclusions.,Insufficient evidence per the guideline. High-dose oral zinc causes nausea and can affect copper absorption.,Stay within recommended daily amounts.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Cochrane 2020: azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, AHA for acne (Liu H et al.) — https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011368.pub2/full",
Oral pantothenic acid (vitamin B5),Over the counter,Diet & supplements,Red inflamed spots,Evidence judged insufficient,—,Unclear,Named explicitly in the guideline's insufficient-evidence statement for acne treatment.,Insufficient evidence per the guideline.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Photodynamic therapy,In clinic,In-clinic procedure,"Red inflamed spots, Deep / cystic",Evidence judged insufficient,—,A series of sessions,"Named in the guideline's insufficient-evidence statement on procedural treatments, specifically photodynamic therapy with aminolevulinic acid.",Insufficient evidence per the guideline. Significant downtime and photosensitivity after treatment.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Resorcinol,Over the counter,Over-the-counter topical,Blackheads & whiteheads,Evidence judged insufficient,—,Unclear,"Named in the guideline's insufficient-evidence statement. It survives mainly as a legacy US OTC monograph ingredient, permitted only in combination with sulfur.",Insufficient evidence per the guideline. Largely superseded.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | FDA OTC Monograph M006, topical acne drug products — https://www.accessdata.fda.gov/drugsatfda_docs/omuf/monographs/OTC%20Monograph_M006-Topical%20Acne%20drug%20products%20for%20OTC%20Human%20Use%2011.23.2021.pdf",
Sodium sulfacetamide,OTC and prescription,Over-the-counter topical,Red inflamed spots,Evidence judged insufficient,—,Unclear,"Named in the guideline's insufficient-evidence statement. Long-standing clinical use, thin modern trial base.",Insufficient evidence per the guideline. Turns skin and facial hair orange when layered with benzoyl peroxide.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | DailyMed: sodium sulfacetamide 10% / sulfur 5% label — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1926eadd-d11f-44fa-971f-0041060f7589",
Sulfur,Over the counter,Over-the-counter topical,"Red inflamed spots, Blackheads & whiteheads",Evidence judged insufficient,—,Unclear,"Named in the guideline's insufficient-evidence statement alongside glycolic acid, sodium sulfacetamide and resorcinol. Cochrane likewise found sulphur lacked adequate trial data for conclusions.","The guideline found the evidence insufficient. Smells of sulfur, because it is sulfur.",Generally considered low-risk topically; confirm with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Cochrane 2020: azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, AHA for acne (Liu H et al.) — https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011368.pub2/full",https://tipsforacne.com/sulfur-for-acne/
Tea tree oil,Over the counter,Over-the-counter topical,Red inflamed spots,Evidence judged insufficient,—,Slower than benzoyl peroxide in the one comparison trial,"Named in the guideline's insufficient-evidence statement. The single most-cited study, Bassett 1990, compared 5% tea tree oil against 5% benzoyl peroxide: both improved acne, tea tree oil more slowly and with fewer side effects. One small single-blind trial is not a basis for a recommendation.","Insufficient evidence per the guideline. A common contact allergen, and oxidised (old) tea tree oil is substantially more sensitising.",Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Bassett IB et al. Tea-tree oil vs benzoyl peroxide, Med J Aust 1990 — https://pubmed.ncbi.nlm.nih.gov/2145499/",https://tipsforacne.com/tea-tree-oil-for-acne/
Topical glycolic acid,Over the counter,Over-the-counter topical,"Blackheads & whiteheads, Dark marks",Evidence judged insufficient,—,Unclear,Named explicitly in the guideline's insufficient-evidence statement for acne treatment. Most of its reputation comes from peel studies and from pigmentation rather than from acne lesion counts.,Insufficient evidence for acne per the guideline. Increases sun sensitivity.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Cochrane 2020: azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, AHA for acne (Liu H et al.) — https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011368.pub2/full",
Topical green tea,Over the counter,Over-the-counter topical,Red inflamed spots,Evidence judged insufficient,—,Unclear,Named explicitly in the guideline's insufficient-evidence statement for acne.,Insufficient evidence per the guideline.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Topical niacinamide,Over the counter,Over-the-counter topical,"Red inflamed spots, Dark marks",Evidence judged insufficient,—,8–12 weeks if at all,"Named explicitly in the guideline's insufficient-evidence statement. Smaller studies suggest benefit for barrier support and pigmentation, and a split-face trial found 5% niacinamide added to 2.5% benzoyl peroxide beat benzoyl peroxide alone, but this is not guideline-grade evidence.","The guideline found the evidence insufficient to make any recommendation, for oral or topical.",No known pregnancy concern.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/ | Cochrane 2020: azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, AHA for acne (Liu H et al.) — https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011368.pub2/full | Kaewsanit T et al. BP 2.5% + niacinamide 5% vs BP alone, J Clin Aesthet Dermatol 2021 — https://jcadonline.com/comparison-benzoyl-peroxide-niacinamide-acne/",https://tipsforacne.com/niacinamide-for-acne/
Trimethoprim/sulfamethoxazole,Prescription,Oral medication,"Red inflamed spots, Deep / cystic",Evidence judged insufficient,—,Variable,Named explicitly in the guideline's insufficient-evidence statement. It persists as a second- or third-line option in practice rather than on the strength of the acne evidence.,Insufficient evidence per the guideline. Carries a rare risk of severe cutaneous reactions.,Avoid; discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Witch hazel,Over the counter,Over-the-counter topical,Red inflamed spots,Evidence judged insufficient,—,Unclear,Named explicitly in the guideline's insufficient-evidence statement for acne.,Insufficient evidence per the guideline. Alcohol-containing formulations can be drying.,Discuss with your clinician.,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Azelaic acid for post-inflammatory hyperpigmentation,OTC 10% and prescription 15–20%,Scars & marks,Dark marks,Not assessed in the guideline,Moderate,8–16 weeks,"Has direct trial evidence for post-inflammatory hyperpigmentation as well as for acne itself, which is a rare combination among acne actives.","The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position.",Commonly used in pregnancy; confirm with your clinician.,"Kircik LH. Azelaic acid gel 15% for post-inflammatory hyperpigmentation, J Drugs Dermatol 2011 — https://jddonline.com/articles/efficacy-and-safety-of-azelaic-acid-aza-gel-15-in-the-treatment-of-post-inflammatory-hyperpigmentati-S1545961611P0586X",https://tipsforacne.com/how-to-fade-acne-marks/
Fractional laser resurfacing for acne scars,In clinic,Scars & marks,Scars,Not assessed in the guideline,Moderate,3–5 sessions; months of remodelling after,"A network meta-analysis compared six photoelectric therapies for atrophic acne scars head to head, one of the better evidence bases in scar treatment, though still built on small trials. Non-ablative fractional resurfacing in skin of colour has its own evidence-based review.","The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position. Downtime, cost, and a real risk of post-inflammatory hyperpigmentation in skin of colour: non-ablative settings and an experienced operator matter.",Discuss with your clinician.,"Wang Y et al. Network meta-analysis of six photoelectric therapies for atrophic acne scars, IJDVL — https://ijdvl.com/comparative-efficacy-and-safety-of-six-photoelectric-therapies-for-the-atrophic-acne-scars-a-network-meta-analysis/ | Kaushik SB, Alexis AF. Nonablative fractional laser resurfacing in skin of color, J Clin Aesthet Dermatol — https://jcadonline.com/nonablative-fractional-laser-resurfacing-in-skin-of-color-evidence-based-review/",https://tipsforacne.com/laser-treatment-for-acne-scars/
Sunscreen for post-inflammatory hyperpigmentation,Over the counter,Scars & marks,Dark marks,Not assessed in the guideline,Moderate,Prevention; months to see the difference,The least glamorous and best-supported thing you can do for dark marks: UV and visible light both drive the pigment that makes them last. Iron-oxide-containing formulations have direct evidence against visible-light-induced pigmentation in skin of colour.,"The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position. Tinted sunscreens containing iron oxides also block visible light, which matters in darker skin tones.",No concern with mineral filters.,"Dumbuya H et al. Iron-oxide containing formulations against visible-light-induced pigmentation, J Drugs Dermatol 2020 — https://jddonline.com/articles/impact-of-iron-oxide-containing-formulations-against-visible-light-induced-skin-pigmentation-in-skin-S1545961620P0712X/",https://tipsforacne.com/post-inflammatory-hyperpigmentation/
Topical tretinoin for post-inflammatory hyperpigmentation,Prescription,Scars & marks,Dark marks,Not assessed in the guideline,Moderate,10–40 weeks,"Has a randomised controlled trial specifically in Black patients with post-inflammatory hyperpigmentation: unusually good evidence for a pigmentation treatment, and in the population where it matters most.","The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position. Retinoid irritation can itself cause more pigmentation in darker skin, so start slow.",Contraindicated in pregnancy.,Bulengo-Ransby SM et al. N Engl J Med 1993 — https://pubmed.ncbi.nlm.nih.gov/8479462/,https://tipsforacne.com/post-inflammatory-hyperpigmentation/
"Hydroquinone (with tretinoin and a steroid, Kligman-type)",Prescription,Scars & marks,Dark marks,Not assessed in the guideline,Low,"8–12 weeks, short-term use","The classic triple formula dates to Kligman and Willis in 1975 and there is an FDA-approved product for melasma. But a 2025 meta-analysis found no statistically significant advantage over alternative treatments on standard pigmentation scores, with high heterogeneity, and the melasma evidence does not transfer automatically to acne marks.","The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position. Short-term, clinician-supervised only. Prolonged use risks exogenous ochronosis, a blue-black darkening that should prompt stopping. Do not layer with benzoyl peroxide.",Avoid in pregnancy.,"Kligman AM, Willis I. A new formula for depigmenting human skin, Arch Dermatol 1975 — https://pubmed.ncbi.nlm.nih.gov/1119822/ | Alghamdi SM et al. Kligman's formula meta-analysis, Arch Dermatol Res 2025 — https://link.springer.com/article/10.1007/s00403-025-04369-7",https://tipsforacne.com/how-to-fade-acne-marks/
Microneedling for atrophic acne scars,In clinic,Scars & marks,Scars,Not assessed in the guideline,Low,"3–6 sessions, months apart","A systematic review and meta-analysis of microneedling monotherapy found benefit for atrophic scars, with the usual caveats of small trials and subjective scar scales. Adding platelet-rich plasma has been studied and reviewed separately.","The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position. Expect improvement, not erasure. Higher risk of post-inflammatory pigmentation in darker skin.",Discuss with your clinician.,"Shen YC et al. Microneedling monotherapy for acne scar: systematic review and meta-analysis, Aesthetic Plast Surg 2022 — https://link.springer.com/article/10.1007/s00266-022-02845-3",https://tipsforacne.com/microneedling-for-acne-scars/
Subcision for tethered (rolling) scars,In clinic,Scars & marks,Scars,Not assessed in the guideline,Low,1–3 sessions,"Evidence is mostly small comparative studies rather than large randomised trials, often combined with microneedling. It is the one technique that targets the fibrous tether pulling the scar down, which no topical can reach.","The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position. Bruising is expected. Works on tethered rolling scars, not on ice-pick scars.",Discuss with your clinician.,"Bhargava S et al. Subcision and microneedling as an inexpensive and safe combination, J Clin Aesthet Dermatol 2019 — https://jcadonline.com/acne-scars-august-2019/",https://tipsforacne.com/acne-scar-treatments/
TCA CROSS for ice-pick scars,In clinic,Scars & marks,Scars,Not assessed in the guideline,Very low,"3–6 sessions, weeks apart","Widely used for narrow deep scars that lasers cannot reach, but the published evidence is largely case series rather than controlled trials.","The 2024 AAD acne guideline covers acne treatment, not scar or pigmentation treatment. There is no equivalent graded guideline for these, so the evidence rating here is our reading of the named systematic review, not a guideline position. Deliberately injures the scar base. Operator skill matters enormously; pigmentation risk in darker skin.",Discuss with your clinician.,DermNet: TCA CROSS — https://dermnetnz.org/topics/tca-cross,https://tipsforacne.com/acne-scar-treatments/
"Clindamycin + adapalene + benzoyl peroxide (triple, Cabtreo)",Prescription,Prescription topical,"Red inflamed spots, Blackheads & whiteheads, Back & chest",Not assessed in the guideline,—,8–12 weeks,"Not addressed by the 2024 guideline; recommendations 1.8 to 1.10 cover two-drug fixed-dose combinations only. Each of its three components is individually recommended, but the specific triple product was not reviewed. That is an absence of assessment, not a negative finding.","Postdates the guideline's evidence review, so it has no graded recommendation at all.","Not listed as a pregnancy contraindication on the FDA label, but pregnancy data are insufficient and topical retinoids are generally avoided – discuss with your clinician.","AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",
Hydrocolloid pimple patches,Over the counter,Over-the-counter topical,Red inflamed spots,Not assessed in the guideline,—,6–24 hours per lesion,"The AAD guideline does not address them. The plausible mechanism (occlusive moist-wound dressing plus a physical barrier against picking) is well established in wound care, but there is no acne trial evidence of the quality the guideline requires.",Not assessed by the guideline. They manage one existing spot; they do not treat acne.,No systemic exposure.,Cleveland Clinic: How do pimple patches work? — https://health.clevelandclinic.org/how-do-pimple-patches-work,https://tipsforacne.com/pimple-patches/
Moisturiser and broad-spectrum sunscreen,Over the counter,Over-the-counter topical,"Keeping it clear, Dark marks",Not assessed in the guideline,—,"Supportive, not curative","Not a graded recommendation, because it is adjunctive. There is direct trial evidence that adding a cleanser and an SPF 30 moisturiser to benzoyl peroxide 5% did not blunt its antibacterial effect, and reduced irritation. Sunscreen is also the single best-evidenced way to stop post-inflammatory marks from darkening.",Not a treatment. It is what lets you keep using the treatments that work.,No concern with mineral filters; discuss chemical filters if you prefer.,"Kim MR, Kerrouche N. BP 5% gel with cleanser and SPF 30 moisturiser, J Dermatolog Treat 2018 — https://pubmed.ncbi.nlm.nih.gov/28678647/ | Draelos ZD et al. Ceramide-containing adjunctive skin care during acne treatment, J Drugs Dermatol 2023 — https://jddonline.com/articles/ceramide-containing-adjunctive-skin-care-for-skin-barrier-restoration-during-acne-vulgaris-treatment-S1545961623P0554X/",https://tipsforacne.com/moisturizer-and-sunscreen-for-acne/
Pneumatic broadband light added to adapalene 0.3%,In clinic,In-clinic procedure,Red inflamed spots,Conditional recommendation AGAINST,Low,n/a,"A conditional recommendation AGAINST, on low-certainty evidence. It is the single negative recommendation in the 2024 guideline, and worth knowing precisely because device marketing rarely mentions it.",The only thing in the entire guideline recommended against.,n/a,"AAD 2024 acne guideline (Reynolds RV et al., JAAD) — https://pubmed.ncbi.nlm.nih.gov/38300170/",