• Excess oil production (androgens in both men and women stimulate oil glands).
• Hormonal changes – menstrual cycles, pregnancy, and menopause for women; consistently higher androgen levels in men that often cause more severe, persistent acne.
• Genetics – a family history increases risk.
• Lifestyle and environment – diet, stress, poor sleep, skincare, and shaving irritation in men.
• Bacteria (C. acnes) – thrives in clogged pores and worsens inflammation.

For Females

1. Topical-only therapy (mild acne):

• Morning: benzoyl peroxide + clindamycin.
• Evening: retinoid (e.g., tretinoin, adapalene) +/- Winlevi/Aklief.
• Works for minimal acne, but requires ongoing maintenance.

2. Topicals + Spironolactone (hormonal acne):

• Spironolactone reduces androgen effects, lowering oil production.
• Effective for jawline, chin, and cycle-related acne.
• Requires monitoring for potassium levels; recurrence if stopped.

3. Bridge Therapy or Micro-Dosed Accutane (Isotretinoin):

• The only treatment that can permanently “cure” most acne.
• Uses a phased approach: prepping with topicals, managing side effects during treatment, then maintaining results post-therapy.
• Requires monthly pregnancy tests due to teratogenic risks.

For Males

1. Topical therapy (mild acne):

• Morning: benzoyl peroxide + clindamycin.
• Evening: retinoid +/- Winlevi.

2. Micro-Dosed Accutane (Isotretinoin):

• Recommended for severe or recurrent acne.
• Taken daily in small doses (10–40 mg, often 20 mg).
• Achieve 120–150 mg/kg cumulative dose with goal of 2 months clear.
• Provides ~80% long-term remission, compared to 20–40% with older high-dose regimens.
• Lower side effects than traditional dosing; safe for athletes and active men.

3. Antibiotics:

• Used only short-term (≤3 months).

• Topicals: Improvement in 6–8 weeks, maintenance required.
• Spironolactone: 4–6 weeks for noticeable results, recurrence if discontinued.
• Accutane: Gradual but often permanent remission, with recurrence rate only ~20%.

1. Can acne be cured? – Only Accutane offers a long-term cure in most patients.
2. Why is acne worse in men? – Higher androgen levels drive more severe and persistent breakouts.
3. Is Accutane safe for athletes? – Yes, micro-dosing reduces side effects and doesn’t impact testosterone or muscle growth.