Acne

Key messages

• Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually. (1)

• There are different types of acne (blackheads, whiteheads, pimples, acne cysts or nodules), so a one-size-fits-all approach is not the best way to achieve clearer skin. (1) A board-certified dermatologist can diagnose the type of acne you have and determine the right treatment based on your skin type and type of acne.

  • To find a board-certified dermatologist, visit aad.org/findaderm.

• There are many effective acne treatments available from oral to topical over-the-counter or prescription medications or products. (1)

Supporting messages

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• Acne usually begins in puberty and affects many adolescents and young adults; however, it can occur at any stage of life and may continue into one’s 30s and 40s. (2-4) Adult acne continues to increase and affects up to 15% of women. (2-5)

  • Approximately 85% of people between the ages of 12 and 24 experience at least minor acne. (6)

• Acne is caused by many factors. (1)

• The following can bring on acne or make it worse:

  • heredity/genetics

  • smoking

  • hormones

  • menstruation

  • emotional stress

  • medications

• There is insufficient evidence to support using the following complementary/alternative therapies for acne treatment: Topical tea tree oil, topical green tea, topical witch hazel, oral pantothenic acid, oral or topical zinc, oral or topical niacinamide. (1)

Isotretinoin

• Isotretinoin has been used as a course of treatment for acne for more than 25 years. (1)

• Oral isotretinoin is the only medication approved for severe cystic acne, the most serious form of acne. (1)

  • Isotretinoin can also be used for patients who have failed standard oral or topical therapy treatment. (1) Patients with psychological burden or scarring can be considered as having severe acne and are candidates for isotretinoin. (1)

• Mood disorders, depression, suicidal ideation, and suicides have been anecdotally reported in patients taking oral isotretinoin, but a causal relationship has not been established. (1,7-11)

• Many studies have indicated that acne treatment with isotretinoin was accompanied by improvement of both depression and anxiety, as well as improved quality of life. (1,12-15)

Academy Position Statement on Isotretinoin

• The American Academy of Dermatology Association is committed to the safe and responsible use of isotretinoin. (16)

• Isotretinoin is FDA-approved and generally considered by dermatologists to be the most effective treatment for severe recalcitrant nodular acne. (1)

• The AADA promotes compliance with the manufacturer-sponsored and FDA-approved risk management program for prescribing isotretinoin (iPLEDGE). (1)

• A correlation between isotretinoin use and depression/anxiety symptoms has been suggested but an evidence-based causal relationship has not been established. (1)

• Read the AADA’s Position Statement on Isotretinoin. (16)

Related Academy resources for the public

References

1. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. May 2024;90(5):1006 e1-1006 e30. doi:10.1016/j.jaad.2023.12.017

2. Holzmann R, Shakery K. Postadolescent acne in females. Skin Pharmacol Physiol. 2014;27 Suppl 1(Suppl. 1):3-8. doi:10.1159/000354887

3. Khunger N, Kumar C. A clinico-epidemiological study of adult acne: is it different from adolescent acne? Indian journal of dermatology, venereology and leprology. 2012;78:335.

4. Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD. Understanding the burden of adult female acne. J Clin Aesthet Dermatol. Feb 2014;7(2):22-30.

5. Collier CN, Harper JC, Cantrell WC, Wang W, Foster KW, Elewski BE. The prevalence of acne in adults 20 years and older. Journal of the American Academy of Dermatology. 2008;58(1):56-59.

6. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. Mar 2013;168(3):474-85. doi:10.1111/bjd.12149

7. Gallitano S, Berson D. How acne bumps cause the blues: the influence of acne vulgaris on self-esteem. International journal of women's dermatology. 2018;4(1):12-17.

8. Kaymak Y, Taner E, Taner Y. Comparison of depression, anxiety and life quality in acne vulgaris patients who were treated with either isotretinoin or topical agents. International journal of dermatology. 2009;48(1):41-46.

9. Hahm BJ, Min SU, Yoon MY, et al. Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients. The Journal of dermatology. 2009;36(5):255-261.

10. Magin P, Pond D, Smith W. Isotretinoin, depression and suicide: a review of the evidence. Br J Gen Pract. Feb 2005;55(511):134-8.

11. Oliveira JM, Sobreira G, Velosa J, Telles Correia D, Filipe P. Association of Isotretinoin With Depression and Suicide: A Review of Current Literature. J Cutan Med Surg. Jan/Feb 2018;22(1):58-64. doi:10.1177/1203475417719052.

12. Wolverton SE, Harper JC. Important controversies associated with isotretinoin therapy for acne. Am J Clin Dermatol. Apr 2013;14(2):71-6. doi:10.1007/s40257-013-0014-z

13. Marron SE, Tomas-Aragones L, Boira S. Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin. Acta Derm Venereol. Nov 2013;93(6):701-6. doi:10.2340/00015555-1638

14. Li C, Chen J, Wang W, Ai M, Zhang Q, Kuang L. Use of isotretinoin and risk of depression in patients with acne: a systematic review and meta-analysis. BMJ Open. Jan 21 2019;9(1):e021549. doi:10.1136/bmjopen-2018-021549

15. Huang YC, Cheng YC. Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis. J Am Acad Dermatol. Jun 2017;76(6):1068-1076 e9. doi:10.1016/j.jaad.2016.12.028

16. Position Statement on Isotretinoin American Academy of Dermatology. Updated 02/19/2018. Accessed 10/01/2024, chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://server.aad.org/forms/policies/Uploads/PS/PS-Isotretinoin.pdf

Last updated: 12/04/24