One of the biggest misconceptions about acne treatment is that every acne medication does the same thing.

In reality, different acne treatments target different parts of the acne process. A treatment that works beautifully for blackheads and clogged pores may not be the best choice for someone with red, inflamed pimples or hormonally driven breakouts.

That’s why identifying your type of acne is an important first step in choosing the right treatment.

At Rangel Dermatology, I often combine several acne treatments because they work in different ways. Here is a breakdown of some of the most common options and when I use them.

Retinoids: One of the Best All-Around Acne Treatments

Best for: Comedonal acne, inflammatory acne, blackheads, whiteheads, and acne prevention

Topical retinoids are one of the cornerstones of acne treatment—and one of my most frequently prescribed acne medications.

Retinoids help normalize the way skin cells turn over inside the hair follicle. This helps prevent pores from becoming clogged in the first place.

They are particularly helpful for:

• Blackheads
• Whiteheads
• Clogged pores
• Inflammatory acne
• Preventing new breakouts

Common topical retinoids include tretinoin, adapalene, and tazarotene.

Because retinoids help prevent the earliest stage of acne formation, I frequently incorporate one into a patient’s long-term acne regimen.

They can initially cause dryness, peeling, or irritation, so I usually recommend starting gradually and increasing use as the skin adjusts.

Benzoyl Peroxide

Best for: Red, inflamed pimples and pustules

Benzoyl peroxide is particularly useful for inflammatory acne.

It decreases acne-associated bacteria on the skin and helps reduce inflammation, making it especially useful for patients with red pimples and pustules.

I often recommend benzoyl peroxide as a wash, particularly when acne involves the face, chest, or back.

One practical tip: benzoyl peroxide can bleach towels, pillowcases, and clothing, so be careful with your favorite linens!

Topical Clindamycin

Best for: Pustules and inflammatory acne

Clindamycin is a topical antibiotic that can help reduce the bacteria and inflammation involved in acne.

I use it primarily for patients who have red inflammatory pimples and pustules, rather than patients whose main concern is blackheads or whiteheads.

Importantly, topical antibiotics such as clindamycin generally should not be used alone for long periods of time because of the risk of bacterial resistance.

For this reason, clindamycin is commonly paired with benzoyl peroxide.

Azelaic Acid

Best for: Inflammatory acne + the dark marks acne leaves behind

Azelaic acid is one of my favorite multitasking acne ingredients.

It can help reduce acne and inflammation while also improving post-inflammatory hyperpigmentation—the brown marks that pimples can leave behind after they heal.

This makes azelaic acid particularly useful for patients who tell me:

“The pimple goes away, but the mark stays for months.”

Azelaic acid is available in both over-the-counter and prescription strengths.

Winlevi (Clascoterone)

Best for: Hormonally influenced acne

Winlevi is a newer prescription topical medication that works differently from many traditional acne treatments.

It blocks the effects of androgens within the skin. Androgens are hormones that can stimulate the oil glands and contribute to acne.

This makes Winlevi an especially interesting option when acne appears to have a hormonal component.

Because it is topical, it also gives us another way to target hormonal pathways in the skin without using an oral medication.

Spironolactone

Best for: Hormonal acne in women

Spironolactone is one of my most commonly used oral medications for women with hormonally driven acne.

Hormonal acne often presents with:

• Breakouts along the jawline or lower face
• Flares around the menstrual cycle
• Persistent acne into adulthood
• Deep or tender inflammatory pimples

Spironolactone works by decreasing the effect of androgen hormones on the skin and oil glands.

It can be extremely effective in the right patient, particularly for women whose acne continues despite a good topical regimen.

Spironolactone is not appropriate during pregnancy, so pregnancy plans are an important part of the discussion before starting treatment.

Oral Doxycycline

Best for: Moderate to severe inflammatory acne

When acne is very inflamed, topical medications alone may not initially be enough.

Doxycycline is an oral antibiotic that can help reduce both acne-associated bacteria and inflammation.

I may use it for patients with:

• Numerous red inflammatory pimples
• Pustules
• Deeper inflammatory lesions
• Acne affecting larger areas such as the chest or back

Doxycycline is generally used as a temporary treatment to get inflammation under control, rather than as a permanent acne medication.

A good topical regimen is typically used alongside it so that acne can remain controlled after the oral antibiotic is discontinued.

Birth Control Pills

Best for: Hormonal acne in women

Certain combined oral contraceptive pills can improve hormonally influenced acne by reducing the effects of androgens.

They may be particularly helpful for women who notice acne flares around their menstrual cycle or have other signs that hormones are contributing to their breakouts.

For some patients, an oral contraceptive can address both contraception and acne treatment at the same time.

The choice of birth control pill should always take into account the patient’s medical history and individual risk factors.

Salicylic Acid

Best for: Blackheads, whiteheads, clogged pores, and oily skin

Salicylic acid is an oil-soluble exfoliating acid, which allows it to penetrate into oily, clogged pores.

For this reason, I think salicylic acid is most useful for comedonal acne, particularly:

• Blackheads
• Whiteheads
• Congested pores
• Very oily skin

Despite being marketed in countless acne spot treatments, salicylic acid is not necessarily my first choice for an angry, red inflammatory pimple. In some patients, repeatedly applying acids to an already inflamed lesion can simply create more irritation.

I tend to prefer salicylic acid in cleansers or as a professional chemical peel for patients with oily, comedonal acne.

Salicylic Acid Chemical Peels

Best for: Comedonal acne, clogged pores, and oily skin

For patients with significant congestion and oiliness, salicylic acid can also be used at higher concentrations as an in-office chemical peel.

Because salicylic acid is oil soluble, it is particularly well suited for acne-prone skin.

A series of chemical peels may help improve:

• Blackheads
• Whiteheads
• Clogged pores
• Excess oil
• Overall skin texture

Chemical peels are generally used alongside a good acne regimen, rather than as a replacement for one.

Sulfur Washes

Best for: Mild inflammatory acne, oily skin, and patients who need another gentle acne option

Sulfur has been used in dermatology for decades.

It has antimicrobial and anti-inflammatory properties and can help reduce excess oil, making sulfur washes useful for some patients with oily or acne-prone skin.

Sulfur can also be a nice option when patients cannot tolerate some of the more irritating acne ingredients.

The downside? Depending on the formulation, sulfur products can have a very distinctive smell!

Which Acne Treatment Is Best for You?

Why Your Acne Routine May Have Several Medications

Patients sometimes ask me:

“Why do I need three different acne medications?”

Because they aren’t necessarily doing the same job.

For example, I might use:

Retinoid → prevents clogged pores and treats the foundation of acne

Benzoyl peroxide → targets inflammatory acne and acne-associated bacteria

Spironolactone → addresses the hormonal component

Instead of repeatedly treating individual pimples as they appear, the goal is to prevent new acne from forming in the first place.

What About Accutane?

For patients with severe, scarring, treatment-resistant, or certain persistent forms of acne, isotretinoin (commonly known as Accutane) can be one of our most effective treatments.

But isotretinoin is very different from the medications above and deserves a discussion of its own.

Coming next in our acne series: Everything You Need to Know About Accutane.

Acne Treatment at Rangel Dermatology in Miami

There is no single “best” acne medication for everyone.

The right treatment depends on whether your acne is primarily comedonal, inflammatory, hormonal, or a combination, as well as your skin type, medical history, previous treatments, pregnancy plans, and whether acne is causing pigmentation or scarring.

At Rangel Dermatology in Miami, I create individualized acne treatment plans based on the type of acne each patient actually has, with the goal of not only clearing existing breakouts but also preventing new acne and reducing the risk of permanent scarring.