Understanding Acne Treatment
Caused by a combination of excess oil (sebum) production, skin cell accumulation and bacterial growth, many factors contribute to your risk of experiencing acne. Genetics, hormones and stress levels are some of the most common.
If over-the-counter acne treatments containing benzoyl peroxide, salicylic acid or retinoids haven’t helped, a primary care physician or dermatologist may prescribe other acne medications.
Typically, prescription acne treatments contain stronger ingredient strengths, antibiotics, specialist drugs or a combination of these things.
The pitfalls of standard acne treatments
Standard acne treatments are effective for many people, but can fail to address the underlying causes of acne (like hormonal changes, diet, stress, or gut health). Some can also damage the skin barrier, especially if too much is applied or they’re used too often.
Antibiotic-based treatments may also disrupt the body’s sensitive balance of good and bad microorganisms. This may also make bacteria less sensitive to future treatment, sometimes creating problems with antibiotic resistance.
Finally, treatments are often given as part of a standard treatment plan in a one-size-fits-all approach. This may not account for differences in skin or acne type – a more personalised plan can help with this.
The Regenerative Medicine Approach
Regenerative medicine takes more of a holistic approach to treating acne. It focuses on repairing and replacing damaged cells and restoring normal function within the body.
Although acne is often thought of as a superficial skin problem, it’s actually driven by hormonal dysregulation, chronic low-grade inflammation and microbiome imbalances on the skin but also in the gut (Sivamani et al., 2023).
Taking an approach that addresses these root causes helps to see the body as a whole. It focuses on making lasting lifestyle changes and using new regenerative therapies that boost skin cells’ natural abilities to repair and replace themselves.
Regenerative and functional medicine isn’t a replacement for conventional acne treatments, but can be used alongside them as a way to tackle some of the root causes of acne.
Treatments That May Help
Acne is typically treated using prescription medications, but making lifestyle changes and trying regenerative therapies can make these treatments more effective.
Lifestyle changes and functional strategies
Although the symptoms of acne appear superficially, more widespread changes are happening in the body. Lifestyle changes and functional strategies focus on treating acne from the inside out rather than just focusing on the outer symptoms.
They work by addressing the different causes of acne, including:
Systemic inflammation – often linked to gut inflammation and worsened by certain foods, leading to skin inflammation
Hormonal imbalances – high androgen, insulin and insulin-like growth factors levels stimulate sebum overproduction
Microbiome disruption – imbalance of microorganisms in the gut and/or on the skin can lead to overgrowth of acne-causing bacteria and even disrupt hormone levels linked to acne
Nutrient deficiencies – lack of zinc, vitamin D, selenium and other nutrients can disrupt skin health and worsen acne (Kazeminejad et al., 2024)
Lifestyle changes that address these issues often focus on diet and gut health.
Diet and gut health
A moderate amount of evidence suggests a low-glycemic index (GI) diet is effective for avoiding and managing acne, but there is some conflicting evidence. The American Academy of Dermatology advises that a low-GI diet can reduce breakouts in people with acne (Reynolds et al., 2024). This may be because a low-GI diet minimises gut permeability (a phenomenon linked to increased inflammation).
There’s some evidence that a low dairy diet, a diet high in omega-3 and gut-supporting probiotics can all help with acne, but research in this area is still ongoing and more information is needed (Religa et al., 2025; Reynolds et al., 2024).
Although some studies have found that probiotics can help with acne, human studies are limited. One randomized control trial found that probiotics and botanical extract supplements reduced inflammatory acne lesions by 57% over 8 weeks, but more studies are needed (Rinaldi et al., 2022).
Prescription acne treatments
The American Academy of Dermatology recommends the following prescription acne treatments strongly based on evidence from several large studies: (Reynolds et al., 2024)
Topical benzoyl peroxide (applied to the skin to target acne-causing bacteria and unblock pores)
Retinoids (applied to the skin to reduce inflammation and unblock pores)
Topical antibiotics (applied to the skin to target acne-causing bacteria)
Oral doxycycline (to target acne-causing bacteria)
Oral isotretinoin for acne that’s severe, causing scarring/psychological issues or unresponsive to other treatments (to reduce sebum secretion, inflammation and skin shedding)
These treatments must be prescribed by a healthcare professional and some topical medications may be combined with oral or other topical treatments.
There’s a smaller amount of evidence that other treatments like salicylic acid, azelaic acid, combined oral contraceptives, and spironolactone may be helpful for acne in some cases (Reynolds et al., 2024).
Evidence from one study suggests salicylic acid may help to unblock pores and reduce inflammatory breakouts.
Azelaic acid helps unblock pores, reduce inflammation and target acne-causing bacteria as shown in three studies. It may be particularly useful for sensitive or dark skin and skin prone to post-inflammatory pigmentation.
Combined oral contraceptives contain the hormones estrogen and progestin. Evidence from 10 studies shows they can help reduce androgen levels (a sex hormone that stimulates sebum production), but they’re unsuitable for many people including men.
By lowering androgen levels, spironolactone helps reduce sebum and improve breakouts. However, the evidence from the existing studies is low-quality, and spironolactone isn’t suitable for everyone – it can disrupt women’s periods and isn’t safe during pregnancy.
Regenerative therapies
Regenerative therapies support the body’s natural ability to heal acne, with different therapies supporting different aspects of healing and skin health.
Red and blue light therapy
Red light therapy works by lowering skin inflammation, reducing sebum production and supporting healing by activating cells’ energy producing mitochondria. Blue light also reduces inflammation and targets the bacteria responsible for acne: Cutibacterium acnes.
Together, red and blue light therapy improved the number of inflammatory and non-inflammatory breakouts in several studies (Pei et al., 2015). One randomized controlled trial found that both therapies are effective for mild-to-moderate acne, especially for inflammatory lesions, but that red light tends to lead to fewer side effects (Li et al., 2022)
There is moderate evidence that combining both types of light seems to have the biggest impact on acne symptoms (Pei et al., 2015; Yuan et al., 2024). However, many of the studies in this area are not high quality.
Laser therapy
Laser therapy for acne uses light energy to kill bacteria, shrink oil-producing glands and minimize inflammation.
Evidence from small to moderate trials suggest that laser therapies are an effective acne therapy, both alone and in combination with other treatments (Jean-Pierre et al., 2024).
Novel 1,726nm, erbium: glass and pulse dye laser therapies are particularly effective at treating inflammatory acne breakouts, while neodymium: yttrium-aluminum-garnet lasers can be used to treat active acne and scarring (Jean-Pierre et al., 2024).
Larger studies on the long-term effects of laser therapy are still needed.
Platelet-rich plasma (PRP)
Platelet rich plasma (PRP) treatment involves taking a sample of your own blood and putting it in a centrifuge machine to concentrate the part containing platelets. This is then injected back into the area of your body that’s affected by acne.
PRP is usually used to treat and/or minimize acne scarring rather than active acne breakouts. It works by supplying high concentrations of the body’s own chemical messengers that encourage cell growth and tissue healing.
There’s some low-quality evidence that PRP is effective for acne scarring but studies are mainly small with a high risk of bias.
A recent review article of seven studies found varying improvements in acne scarring across study participants after PRP treatment (Hsieh et al., 2019). In all these studies, PRP was used as an adjunctive therapy alongside other acne treatments.
Finding the Right Provider
Evidence around regenerative therapies for acne continues to grow, and these therapies are becoming more popular as add-ons to other acne treatments.
Regenerative therapies for acne like PRP or laser therapy are typically offered by either dermatologists or estheticians. Before choosing a treatment provider, it’s essential to check their credentials and reviews to make sure they’re legitimate.
Watch out for providers:
with few or no reviews
offering bargain prices
mentioning “miracle” results that seem unrealistic
lacking transparency around their professional credentials or the equipment they use
who provide treatment without an initial, personalized consultation
It’s generally better to opt for a qualified board-certified dermatologist, as you know they’re appropriately trained and insured.
Combining Treatments
You don’t have to choose between traditional acne treatments and functional therapies. Taking a whole-body approach doesn’t mean you can’t use prescription treatments too.
Start with the foundations of your skin health. This means cutting out things you know trigger your acne, avoiding vitamin deficiencies, opting for a low-GI diet and looking after your gut health. If you’re taking antibiotics, you might also include probiotics to offset the impact they can have on your gut.
Next, add in prescription treatments from your primary care doctor or dermatologist. They may suggest one medication or for you to take a combination of a few. Some prescribed topical products already contain several combined ingredients (like benzoyl peroxide and a retinoid/antibiotic).
Finally, you can add regenerative therapies like laser or PRP on top. Some therapies can be effectively combined, like microneedling and PRP, but make sure any therapies are safe to receive with the medications you’re taking. Strong medications like isotretinoin can’t be combined with all regenerative therapies due to skin sensitivity and risk of scarring.
Takeaway
Standard acne treatments like retinoids, benzoyl peroxide, antibiotics and isotretinoin have the most evidence behind them. However, antibiotics should only be used for limited periods of time to avoid disrupting your microbiome. All prescription treatments should be used under medical guidance as they’re not suitable for everyone and can have side effects.
For a more holistic approach, prescription treatments can be used in combination with lifestyle changes, like a low-GI diet, and regenerative therapies.
There’s low to moderate evidence that red/blue light therapy and laser therapy can help with inflammatory acne and low-quality evidence that PRP can help with acne scarring. Side effects for these therapies tend to be minimal so you may decide to try them as add-on acne treatments.
When choosing a provider for regenerative therapies, make sure they’re offering realistic prices and clearly displaying their credentials.
