What causes acne? 

A few things go into making a pimple. First, oil and bits of dead skin clog your pores. When these clogged pores become inflamed, a pimple forms. Skin bacteria can worsen acne by adding to inflammation.  Oil + dead skin + bacteria are all natural and common. BUT - testosterone causes your body to make more oil. This makes acne worse!


How is acne treated?

For many people, acne treatment includes “topical” meds (like creams, ointments, or face/body wash) that you use on your skin. Sometimes, acne can also be treated with oral medication.

The primary goal of acne treatment is to reduce oil and inflammation.  Sometimes, we also have to fight bacteria as well.  However, the bacteria that are involved in acne become easily resistant to antibiotics, so antibiotics are not a long term solution for acne. Frequently we use two or more medications at a time to attack those pimples! Common medications used for mild to moderate acne include: 

Topical Retinoids

Tretinoin (“Tret-i-no-in”) is a form of vitamin A.  It is applied to the skin and is part of most acne treatment regimens. It helps to unclog pores and calms down inflammation. 

  • Common side effects: 

    • Tretinoin can cause redness and irritation of the skin. It often helps to start by using it every other day. As your skin gets used to it, you can slowly increase to using daily.   It also helps to wait at least 20 min after washing your face before applying it.

    • Tretinoin can make your skin more sensitive to the sun. It’s best to apply at night, and to wear a daily sunscreen. 

Benzoyl Peroxide

Benzoyl (“Benz-oil”) Peroxide can be a gel, cream or body wash. Some forms can be found over-the-counter (no prescription needed). It can be used alone, or with other meds, and helps to unclog pores and fight inflammation.. 

  • Common side effects: 

    • Benzoyl Peroxide can cause redness and irritation of the skin. It can also bleach towels and clothing. We recommend starting off slow, and not getting it near your favorite clothes or towels! 

Azelaic Acid 

Azelaic acid is applied to the skin. It can be used alone or with other meds. We think it likely works by attacking the bacteria that causes acne. 

  • Common side effects:

    • Azelaic acid can cause redness and irritation of the skin.   

Salicylic Acid

Salicylic Acid is found over the counter (without a prescription). It is used in body/face washes and creams, and works by unclogging pores. It can be used alone for mild acne, or with other meds. 

  • Common side effects: 

    • Salicylic acid can cause redness and irritation of the skin. 

Topical Antibiotics

Topical antibiotics are prescription antibiotics applied directly to the skin in the form of a gel or solution. They work by attacking the bacteria that causes acne. These should not be used alone, but used in combination with other acne meds. Formulations are available that contain both topical antibiotics and other topical acne medications.

  • Common side effects:

    • Topical antibiotics can cause redness and irritation of the skin.

Oral Antibiotics

Oral antibiotics are prescription tablets or capsules that you take by mouth, usually once or twice a day. They work by attacking the bacteria that causes acne.  These are designed for short term use only, to get bacteria under control.

  • Common side effects:

    • Oral antibiotics can cause GI upset, nausea, vomiting and diarrhea.

    • Certain antibiotics can make you sunburn more easily (doxycycline/minocycline)

Oral Contraceptives (OCPs)

Oral contraceptives are estrogen and progestin containing prescription pills that you take by mouth once a day. They work by helping to reduce the amount of circulating “male” sex hormones, which can cause acne. OCPs do not interfere with T and can be taken safely with T therapy, but some patients on T do not want to add estradiol to their bodies. This is a personal choice!

  • Common side effects:

    • OCPs can cause nausea, breast/chest tenderness, irregular bleeding, and headaches.

Who is eligible for acne medication/treatment with Plume?

Currently, acne treatment is available through Plume for members with mild to moderate acne. Treatment can improve acne on your face and/or body. We can’t promise that every pimple will go away, but our hope is that you feel better about your skin! Sometimes, acne can get really bad and lead to scarring of the skin. For really bad (or what we call “severe”) acne, we recommend seeing a dermatologist (a skin specialist). Plume does NOT prescribe isotretinoin (Accutane). For this, we recommend seeing a dermatologist if you are interested in this treatment.

How does Plume offer the medication/treatment?

To begin, you’ll be scheduled for a video visit with a Plume medical provider. During this visit, your provider will ask questions about your acne and any previous treatments you’ve tried. We’ll help you decide on a skin care plan that makes sense for you. This might mean we prescribe one or more medications for you. If necessary, we may suggest seeing a skin specialist if your provider determines that would meet your needs the best. 

If the patient needs to choose a medication, what information do they need to know to decide?

Your Plume provider can help you decide which medication(s) are right for you. This will be based on your skin type, where your acne is, and how severe (or not so severe) your acne is. 

Will acne medications interfere with my hormones?

No, your acne medication will not interfere with your hormones. 

How long does it take for my acne to improve? 

A visible improvement in acne can take 2-3 months. You may start to notice fewer pimples during this time. Initial treatment will likely improve acne, but may not clear it completely. Patients often need to use some acne treatment long-term; it is not usually a total cure. If acne has caused dark spots on your skin, these can take much longer to go away. 

Personal skincare tips

Here are a few skin tips to keep in mind to help improve acne. Note: we have no clear data that changes in diet are helpful.

  • Don’t touch, squeeze, or pick at a pimple! 

  • Wash face with gentle cleansers. Look for cleansers containing salicylic acid and benzoyl peroxide. 

  • Select “non comedogenic” skin products and moisturizers.  

  • Avoid scrubbing skin and skin picking

  • Use a daily sunscreen of SPF 30 or higher (many acne medications can cause increased sun sensitivity)