Real talk time: Treating acne can be complicated. There’s the mindset and motivation of the acne sufferer, who will undoubtedly go to great lengths to banish their breakouts with medications and a variety of treatments. Then there’s the everyday skincare routine, which needs to work harmoniously with whatever the physician is doing in-office. And last but not least, there’s the dermatologist, the expert trained to coordinate this symphony of solutions.

When under a doctor’s care, prescription medication and in-office treatments are inevitably a major part of the master plan. As far as what’s recommended, it’s decided on a case-by-case basis—everyone is different. “When I’m selecting medications for patients, it’s going to depend on things like what type of acne lesions they’re getting,” says James Del Rosso, D.O., adjunct clinical professor of dermatology at Touro University Nevada in Henderson, NV and an Acne Store advisory board member. “And I always magnify it beyond what I’m seeing at the time, so I’m treating the highest level of acne that they’re dealing with.”

In many instances multiple therapies are required. “Specific medications do different things and when used together it’s like fighting a war—you have to attack the acne from all angles,” says Del Rosso. As the patient, it’s good to do some research on what’s being advised. Here, Dr. Del Rosso does some of the legwork for you, explaining the top dermatologist recommended acne treatments.

"Specific medications do different things and when used together it’s like fighting a war—you have to attack the acne from all angles."

1. Benzoyl peroxide

Benzoyl peroxide is probably one of the most widely known acne fighters. This topical agent an antibacterial, reducing the bacteria on the skin that contribute to causing acne lesion and battling whitehead and blackhead formation. “If you’re also taking or applying an antibiotic, it’s going to reduce any of the resistant bacteria—a very important property of benzoyl peroxide,” says Del Rosso. Benzoyl peroxide can be irritating so it’s important that it’s in a formulation—be it a gel, foam, cream—that doesn’t cause skin irritation.

2. Dermatologist Extraction

“I do this when patients come in with a lot of blackheads or whiteheads that aren’t inflamed which they’ve been trying to squeeze out but are too deep or firmly attached within the skin,” says Del Rosso. He or one of his professional staff carefully use an extractor tool to remove the comedones that aren’t responding well to topical medication.

3. Retinoids

With anti-inflammatory and other properties, retinoids help speed up cell turnover to ensure pores stay unclogged. Popular prescriptions retinoids for acne include tretinoin, also known by the brand name Retin-A or Altreno, adapalene, also known by its brand name Differin, and tazarotene, or Tazorac or Arazlo. “Because retinoids accelerate cell turnover, you might see a bit of scaling or redness but that means it’s working, as long as it’s not too severe or causing symptoms like stinging or burning” explains Del Rosso. Your doctor may recommend using it every other day so there’s less irritation. He says that retinoids pair extremely well with bacteria-fighting benzoyl peroxide, especially when formulations are used that reduce the risk of skin irritation. “They are the Romeo and Juliet or Daryl Hall and John Oates of acne.”

4. Cortisone shots

“When someone has what’s called an acne nodule or an acne cyst that’s large and tender, I can inject it directly with an intralesional triamcinolone, which is a cortisone,” says Del Rosso. The in-office procedure will typically take out a large tender and inflamed pimple fast and is a popular option before a big event. “If it’s a Thursday and there is a woman getting married on Saturday, in many cases I may be able to inject the acne nodule and it almost always goes down very, very quickly.”

5. Topical antibiotics

Topical antibiotics can stop bacteria growth and reduce inflammation. The most common examples include clindamycin and eurythromycin. Although dapsone (the brand name is Aczone) has some antibiotic effects, it is used topically for acne mostly because it can lessen inflammation. “I’ve used topical dapsone primarily for its anti-inflammatory affects and it’s been shown to be helpful on the face or the body,” Del Rosso explains.

6. Phototherapy

Blue light has an antimicrobial effect and can help kill breakout-causing bacteria found on the skin. While light therapy can be done at home, professional treatments may be more powerful and more effective.  Know that you’ll typically need a few treatments to see optimal results.

7. Azelaic acid

This dermatologist recommended acne treatment is typically found in gel or foam formulas and can be effective in treating acne by several modes of action. It’s beneficial to those with rosacea as well and “is also helpful in reducing hyperpigmentation which is a big concern for acne patients with darker skin,” says Del Rosso.