Acne is one of the most common skin conditions in the world, affecting millions of people. For many, it’s more than just a few sporadic pimples; it can be a persistent condition that profoundly impacts self-esteem. The journey to clear skin often feels overwhelming, with an endless array of acne treatments and products promising miraculous results. At Honeydew, we understand this frustration. We’re on a mission to demystify acne care and make clinically-proven, personalized treatments more accessible, so you can find a path to clearer, healthier skin that actually works.

Understanding Acne: The Root Causes of Breakouts

Before exploring treatments, it’s helpful to understand what causes acne. Common acne, or acne vulgaris, develops when hair follicles become clogged with oil and dead skin cells. This blockage creates an ideal environment for bacteria to thrive, leading to inflammation. Four interconnected factors are at the root of this process:

• Excess Sebum Production: Your sebaceous glands produce a natural oil called sebum. When hormonal fluctuations cause these glands to produce too much oil, it can lead to clogged pores.
• Clogged Hair Follicles: Normally, dead skin cells shed from the skin’s surface. In acne-prone skin, this process is often impaired, causing cells to accumulate and mix with sebum, forming a plug that blocks the follicle.
• Bacterial Growth: The bacteria Cutibacterium acnes (P. acnes) is a normal inhabitant of the skin. In a clogged, oil-rich follicle, these bacteria multiply rapidly.
• Inflammation: Your immune system responds to the bacterial overgrowth by triggering an inflammatory response, which results in the redness, swelling, and tenderness of pimples, cysts, and nodules.

Genetics also play a significant role; if your parents had acne, you are more likely to experience it. Because effective treatments must target one or more of these underlying factors, a one-size-fits-all approach rarely works.

Over-the-Counter (OTC) Topical Treatments

For mild acne characterized by occasional blackheads, whiteheads, and small pimples, over-the-counter (OTC) treatments are often a good first step. These products are available without a prescription and can be effective when used with consistency.

Benzoyl Peroxide

Benzoyl peroxide (BPO) is a powerhouse in acne treatment. Its primary benefit is its potent antibacterial effect against P. acnes, and importantly, bacteria do not develop resistance to it. BPO also helps exfoliate the skin, clearing pores of excess oil and dead cells. While it is available in strengths up to 10%, lower concentrations (2.5% or 5%) are often just as effective but with less potential for irritation, such as dryness and redness.

Adapalene

Adapalene is a type of retinoid that is now available over the counter in a 0.1% concentration. Retinoids work by normalizing skin cell turnover, a process that prevents dead skin cells from building up and clogging follicles. Adapalene is particularly effective for treating comedonal acne (blackheads and whiteheads) and also possesses anti-inflammatory properties. Some users experience initial dryness or a temporary worsening of acne, often called "purging," which typically subsides with consistent use and a good moisturizer.

Salicylic Acid

Salicylic acid is a beta-hydroxy acid (BHA) that is oil-soluble, allowing it to penetrate deep into pores and dissolve the mixture of dead skin cells and sebum. It is most effective for blackheads and whiteheads and has mild anti-inflammatory properties. Found in cleansers, toners, and spot treatments, salicylic acid is generally gentler than benzoyl peroxide.

The Importance of Consistency

When using OTC treatments, patience and consistency are crucial. It can take up to three months of daily application to see significant results. However, if your acne is moderate to severe or doesn't improve after this period, it's time to explore stronger, prescription-based options. If you've found that OTC products aren't delivering the clear skin you want, Honeydew can create a personalized treatment plan with prescription-strength medications tailored to your specific needs.

Prescription Topical Treatments

When OTC products fall short, prescription topical medications offer more powerful solutions. These treatments are prescribed by a licensed medical provider, like the experts at Honeydew, after a thorough evaluation of your skin type, acne severity, and medical history.

Topical Retinoids

Topical retinoids are a cornerstone of prescription acne therapy. As vitamin A derivatives, they are highly effective at normalizing skin cell turnover to prevent clogged pores. They also reduce inflammation, improve skin texture, and can help fade the dark spots left behind by acne. The most common prescription retinoid is Tretinoin, which is well-studied and effective for both inflammatory and non-inflammatory acne. At Honeydew, our providers can prescribe Tretinoin and guide you on how to incorporate it into your routine to maximize benefits while minimizing potential side effects like dryness and sun sensitivity.

Topical Antibiotics

Topical antibiotics work by killing P. acnes bacteria and reducing inflammation. Clindamycin is one of the most frequently prescribed topical antibiotics for acne. To enhance its effectiveness and prevent the development of bacterial resistance, it is almost always prescribed in combination with another agent, typically benzoyl peroxide. Honeydew can prescribe effective combination therapies to target acne from multiple angles.

Other Prescription Topicals

Several other effective prescription topicals are available. Azelaic acid has antibacterial and anti-inflammatory properties and is also effective at lightening post-inflammatory hyperpigmentation, making it a great multi-purpose treatment. Dapsone gel is another anti-inflammatory option that is often well-tolerated and can be particularly beneficial for adult female acne. More recently, clascoterone cream was approved to target the hormonal component of acne directly at the skin level by inhibiting androgen receptors.

Custom Compounding for Personalized Care

One of the challenges with treating acne is that the most effective plans often require using multiple products, which can be complicated and expensive. This is where custom compounding comes in. At Honeydew, we can work with pharmacies to create a single, customized topical medication that combines multiple active ingredients—such as a retinoid, an antibiotic, and an anti-inflammatory agent—in strengths tailored specifically for your skin. This approach not only enhances effectiveness but also simplifies your skincare routine and can improve tolerability.

Oral Medications for Acne

For acne that is widespread, persistent, or severe—especially cystic or nodular acne that is unresponsive to topical treatments—oral medications may be necessary. These medications work systemically from within the body to address the underlying causes of acne.

Oral Antibiotics

Oral antibiotics are used to treat moderate to severe inflammatory acne. They work by reducing P. acnes bacteria and exerting powerful anti-inflammatory effects. Tetracycline antibiotics, such as Doxycycline, are typically the first-choice options. To minimize the risk of antibiotic resistance, they are usually prescribed for the shortest effective duration and are almost always used alongside topical treatments. Honeydew also offers other oral antibiotics, like Duricef, as part of a comprehensive and responsible treatment approach.

Oral Isotretinoin

Oral isotretinoin (found in brands like Accutane and Absorica) is a highly effective medication for any type of acne, especially persistent or scarring acne. As a derivative of vitamin A, it is the only treatment that targets all four major acne-causing factors: it dramatically reduces sebum production, normalizes skin cell turnover, decreases P. acnes bacteria, and has potent anti-inflammatory effects. Due to its strength, isotretinoin requires careful medical monitoring to manage potential side effects, such as dryness and sun sensitivity. At Honeydew, we understand that patients may have concerns about this medication. That's why we specialize in personalized dosing, including innovative low-dose Accutane regimens, which can minimize side effects while still achieving excellent, lasting results. Our providers manage your entire treatment online with regular check-ins to ensure your safety and progress.

Hormonal Agents

For many women, hormonal fluctuations are a primary driver of acne, often appearing as deep, tender lesions along the jawline, chin, and neck. In these cases, hormonal therapies can be extremely effective. Spironolactone is a daily pill that works by blocking the effect of androgen hormones on the oil glands, thereby reducing sebum production. While used off-label for acne, it is a safe and highly effective long-term solution for hormonal acne in women. Honeydew providers can determine if Spironolactone is the right choice for you and manage your treatment virtually.

Comparing Treatment Effectiveness: What the Research Shows

With so many options, it's natural to wonder which treatments are the most effective. A comprehensive meta-analysis of acne studies published in a National Institutes of Health journal provides valuable insights:

• Most Effective Overall: Oral isotretinoin was found to be the most effective treatment for reducing the total number of acne lesions.
• Combination Therapies Reign Supreme: For patients not taking isotretinoin, combination therapies are significantly more effective than using a single medication. A triple therapy approach combining a topical retinoid, benzoyl peroxide, and an oral or topical antibiotic was ranked among the most effective strategies.
• Best for Inflammatory Lesions: After oral isotretinoin, various triple-therapy combinations were most effective at clearing inflamed pimples and cysts.
• Best for Non-inflammatory Lesions: For clogged pores like blackheads and whiteheads, oral isotretinoin was again the top performer. Among topical-only therapies, retinoids were shown to be more effective than antibiotics.

This research underscores that a personalized, multi-faceted approach is key to successfully treating acne. If you are unsatisfied with your current treatment, Honeydew offers personalized treatments designed to maximize results while minimizing side effects. Our providers manage, adjust, and recommend treatments completely online to ensure you get the clear skin you are looking for.

The Future of Acne Treatment: Emerging Therapies

Dermatological research is constantly evolving, leading to new acne treatments with improved efficacy and better tolerability. Recent publications highlight several exciting developments, from novel topical ingredients like minocycline foam to new delivery systems like nitric oxide-releasing nanoparticles. There is also growing exploration into the role of probiotics and biologics in treating severe acne. While biologics are more commonly used for conditions like psoriasis (with treatments such as Skyrizi) and eczema (with treatments like Dupixent), their exploration for acne underscores our commitment to providing the most advanced solutions available across all skin conditions.

A Realistic Look at Natural and Home Remedies

Many people seek "natural" solutions for acne, but it's important to approach these remedies with caution and realistic expectations. While some natural ingredients like tea tree oil, green tea, and zinc have shown mild anti-inflammatory or antibacterial properties in small studies, most lack the robust scientific evidence needed to support their use as standalone treatments. Some remedies, like undiluted apple cider vinegar, can even cause significant skin irritation. These are generally not substitutes for clinically-proven, evidence-based treatments, especially for moderate to severe acne. At Honeydew, our providers can help you understand which, if any, adjunctive therapies are safe to incorporate into your prescribed treatment plan.

The Role of Lifestyle in Managing Acne

While medical treatments are the foundation of an effective acne care plan, certain lifestyle factors can influence acne severity and treatment outcomes. A consistent and gentle skincare routine is fundamental—avoid harsh scrubs and over-washing. While the link between diet and acne is complex, some studies suggest that a low-glycemic diet rich in whole foods may be beneficial. Managing stress, getting regular exercise, and ensuring adequate sleep are also important, as they help regulate hormones and reduce inflammation. These healthy habits are a valuable complement to any medical treatment plan.

When to Seek Professional Help

It's time to seek professional help from a dermatology provider if you experience any of the following:

• Your acne has not improved after several months of using over-the-counter treatments.
• Your acne is persistent, widespread, or includes deep, painful nodules or cysts.
• Your acne is causing significant emotional distress or affecting your self-confidence.
• Your acne is leading to scarring or leaving behind dark spots.

A licensed provider can accurately diagnose your type of acne, evaluate contributing factors, and create a personalized treatment plan. With the right expert guidance, effective treatments are available.

Your Partner in Achieving Clear Skin: Honeydew

Navigating the world of acne treatments can be overwhelming, and we understand the physical and emotional toll it can take when you're struggling to find something that works. At Honeydew, we believe everyone deserves to feel confident in their own skin. We are dedicated to providing effective, evidence-based, and personalized care that fits your life.

If you're frustrated with your current routine or just beginning your journey to clearer skin, our patient-centered approach can help. Here’s how we do it:

• Truly Personalized Treatment Plans: We don't believe in one-size-fits-all solutions. Our expert dermatology providers assess your unique skin, acne type, lifestyle, and goals to create a completely individualized plan.
• Convenient and Accessible Online Care: Our entire process is 100% online. You can meet with your provider, get prescriptions sent to your preferred pharmacy, track your progress, and receive ongoing support from your care team, all from the comfort of home.
• A Wide Range of Proven Treatments: We offer a comprehensive portfolio of the most effective acne treatments available, including prescription topicals like Tretinoin and Clindamycin, and oral medications like Spironolactone and Doxycycline.
• Commitment to Cutting-Edge Solutions: We specialize in advanced treatment strategies designed to maximize results while minimizing side effects. This includes innovative low-dose Accutane regimens and custom-compounded medications that simplify your routine and improve effectiveness.

Finding the right acne treatment is a journey, but you don't have to take it alone. With patience and expert guidance, clear skin is an attainable goal. Learn more about how Honeydew can partner with you to achieve healthier, clearer skin.