Why Do Some Acne Creams Work and Others Destroy Your Skin?

Jeff Hautala
By Jeff Hautala, Co-Founder of Exposed Skincare

Acne treatments come in all shapes and sizes, but acne creams are some of the most popular because they are applied directly to the skin, meaning they often have the most impact with the fewest side effects. There are creams developed specifically for acne like tretinoin acne cream and retinol, but there are also general skin creams that some people also use for acne. Regardless of whether or not a cream was meant for acne, some creams are better than others. The best way to determine the difference and find the best acne cream for your skin is to understand how acne forms and what kind of ingredients can actually help.

Cream in a container
From retinol to antibiotics, there are countless acne creams out there.

Why a Face Cream for Acne Is Important

If you’re new to acne treatment and trying to set up a good skin care routine, a face cream for acne is one of the most vital steps. Face washes are important as well, but the beauty of a face cream is that it stays on all day and the acne-fighting ingredients it contains continue working on your skin until you wash your face again.

However, this very strength can often be an acne cream’s downfall. Because a face cream for acne stays on all day, if there are any comedogenic (likely to clog pores) or irritating ingredients, they will continue to clog pores and irritate the skin until they’re washed away. Because of this, it’s best to find a face cream for acne that is gentle but effective, containing ingredients that are non-comedogenic, non-inflammatory, but still fight acne. Sound like a tall order? It is; that’s why many face creams for acne aren’t actually all that effective.

How Does Acne Form?

First and foremost, acne is an inflammatory condition, but there are two other important factors: bacteria and excess oil production. Blackheads, whiteheads, and pimples form due to different combinations of these factors, but regardless of which kind of acne you typically have, it all starts with inflammation.

The skin can become inflamed lots of different ways, from physical irritation to emotional stress. When the skin is inflamed, the pores constrict slightly, and this is where our acne troubles begin. When the pores constrict, any oil, dead skin cells, and bacteria that were in the pore are now trapped there. If a pore doesn’t have much bacteria in it, then a blackhead or whitehead forms. Though they look very different, blackheads and whiteheads are nearly the same thing. The only difference is that a whitehead is in a closed pore and a blackhead is in an open pore. This is how blackheads get their dark color. They aren’t dirty, they’re just exposed to the open air, which causes our natural skin oils to oxidize and take on a darker hue.

If acne-causing bacteria does get trapped in a pore, that’s when a pimple forms. Pimples are caused by a specific type of bacteria called p. acnes that consume the oil our skin produces and always live on the surface of our skin to some extent. Typically, they’re pretty harmless, but whenever the skin produces too much oil, giving them extra food, or when they get trapped in a pore due to inflammation, their numbers grow and quickly turn into a minor infection. The immune system is alerted to this infection and sends immune system cells to kill the bacteria. In the process, many immune system cells die as well, and this mixture of dead cell matter becomes pus, which gives pimples their white or yellow head.

How to Find the Best Acne Cream

Ideally, you’d want an acne cream that addresses all three of these acne issues, but a cream that is particularly good at dealing with one or two works as well. However, just because a cream can help acne in one way, that doesn’t automatically mean it’s a good acne cream. For instance, many creams fight p. acnes bacteria, but they’re often so harsh that they cause inflammation, and since inflammation is the root of all acne, these types of creams are counterproductive for acne treatment.

Finding the right face cream for you can be tricky, but there are several good options out there—just make sure you know to look out for the bad ones too.

What Are Retinoids for Acne, and How Do They Work?

Retinoids for acne have become the industry’s gold standard for acne treatment, for good reason. Products containing mild versions or small amounts of retinoids can treat moderate acne, but stronger versions and larger amounts of retinoids can treat very stubborn and painful acne, like cysts. But what are retinoids?

Retinoids are a derivative of vitamin A in very concentrated form. Don’t be fooled though. Just because retinoids are essentially a vitamin and all-natural, that doesn’t mean they’re gentle or automatically safe for all skin types. Retinoids are very powerful, and are not right for everyone. They’re used on the skin for a variety of reasons, from anti-aging efforts to acne, but they function the same way regardless. Retinoids regulate skin cell production and skin cell death. This is great for acne because if skin cells are produced quickly, but don’t die quickly, they cling to the sides of the pore, causing clogs. But if skin cells are produced slowly and die quickly, the dead skin cells clog the pore too. Retinoids function as a pace car for skin cells, making sure they’re produced and dying at a good, healthy rate that won’t clog pores.

There’s a wide variety of retinoid products, from over-the-counter options to prescriptions you can get from a dermatologist. Some products contain retinoic acid, which is an active form of vitamin A that immediately starts regulating skin cells the moment it touches your skin, while others contain retinol, which is an inactive form of vitamin A that needs to be broken down by your skin before it can work. There are advantages and disadvantages of both kind of retinoids.

Retinol for Acne: The Safer, But Less Effective, Choice

The spectrum of retinoids includes all kinds of concentrated derivatives of vitamin A, even inactive ones. Retinol is not able to interact with our skin cells right away because it needs to be broken down into retinoic acid to do so.

This process takes time, and much of the retinol decays before it can be transformed into retinoic acid. This has two results, one good and one bad. The good part is that this is a relatively gentle way to regulate the skin cells. Retinoids containing retinoic acid are often incredibly harsh and unsafe for sensitive skin, but retinol for acne works slowly and in small amounts, making it much gentler. However, the downside to this is obvious: it’s gentler, sure, but the reason it’s gentler is because it doesn’t work as well. Retinol for acne delivers less retinoic acid to the skin than other retinoids, meaning it regulates fewer skin cells and makes less of an impact on acne. If you have sensitive skin and mild to moderate acne, retinol-based retinoids are a great acne cream worth consideration, but if you have moderate to severe acne, retinol is unlikely to be of much help.

Retinoic Acid: Stronger, Harsher Products like Retin-A for Acne and Tretinoin Acne Cream

Retinoic acid, unlike retinol, is an active form of vitamin A, so when various acne creams containing retinoic acid, like Retin-A and tretinoin are applied to the skin, they start working right away. This makes them much stronger and more effective, but also more irritating to the skin.

First, what are Retin-A for acne and tretinoin acne creams? Well, they’re actually the same thing. Retin-A is just one of the most popular brand names for tretinoin acne cream. Tretinoin is very powerful, and many people with severe acne like it because it can treat cystic acne, one of the most stubborn and painful forms of acne. Cysts are like pimples in that they are caused primarily by an infection of p. acnes bacteria, but a cystic infection is much more severe than a pimple.

Cysts form when the immune system starts attacking your own skin cells rather than the p. acnes bacteria, and the p. acnes are free to spread deeper into the skin instead of forming a head, like with a pimple. This allows a healthy layer of skin to grow over the infection, making it more difficult for acne treatment creams to make their way to the bacteria beneath.

Tretinoin acne cream and Retin-A for acne work by encouraging a quick rate of skin cell turnover, so the ones being attacked by your own immune system are quickly discarded and replaced with new ones that your immune system are more likely to recognize as friend rather than foe. This is a powerful way to help prevent the creation of cysts.

Ortho Neutrogena Retin-A Cream
Retin-A is just one popular brand of tretinoin acne cream, which is most effective against moderate to severe inflammatory acne, like cysts.

Exploring the World of Off-Label Acne Creams

Retin-A for acne and retinol for acne are some of the most popular creams designed specifically for treating acne, but there are also plenty of “off-label” creams that people often use to treat acne, even though they aren’t officially approved for use on acne specifically. These creams include everything from Neosporin for acne to corticosteroids. One of the reasons many people explore off-label options for all kinds of ailments and conditions is because getting a product approved by the FDA for a particular condition can take a long time and a lot of evidence. This is a good thing, of course, it just means that it might be worth your while to branch out beyond officially approved acne treatments. At the same time, some off-label treatments are simply a bad idea. Before trying anything off-label, it’s important to make sure it’s safe for your skin.

Niacinamide for Acne: Reliable and Effective

Niacinamide for acne is one of the off-label acne creams that just hasn’t gotten its official stamp of approval yet. According to a substantial amount of research, it’s effective in treating mild to moderate acne, and acne improves at least slightly while using niacinamide for acne, and most of the time it improves significantly (around 70% clearer). In fact, while niacinamide cream for acne hasn’t been approved yet, a supplement containing niacinamide, folic acid, zinc, and copper has been.

Okay, so niacinamide is probably a good acne cream. But what is it exactly? Niacinamide is a particular type of vitamin B3 found in all kinds of things, from sunscreen to leafy green vegetables. When applied directly to our skin, it effectively treats two of the main causes of acne: inflammation and oil production. Studies show that a 4% niacinamide cream can reduce the amount of oil our skin produces, and it has mild antihistamine properties that allow it to reduce the kind of minor inflammation that typically leads to acne. This could be particularly effective in preventing blackheads and whiteheads, but the research shows that it can also diminish inflammatory acne like pimples and pre-pimples, called papules. Overall, niacinamide for acne is one of the most effective off-label acne creams out there.

Why Neosporin for Acne Sounds Like a Great Idea, But Really Isn’t

Neosporin is a great treatment for minor cuts and wounds, but Neosporin for acne is less than ideal. At best, Neosporin will make your acne slightly better, but it’s far more likely that it won’t do anything at all, and it could make things worse.

Neosporin Ointment
Neosporin helps fight bacteria, but unfortunately, it doesn’t fight the right kind of bacteria.

Neosporin’s three main ingredients are antibiotics: bacitracin, neomycin, and polymyxin. Because bacteria play a major role in acne, especially pimples and cysts, it makes sense that Neosporin for acne might be a good idea. Unfortunately, none of those three antibiotics are designed to fight p. acnes bacteria specifically. The mechanisms these antibiotics use to fight bacteria wouldn’t be able to stop p. acnes from growing, so that aspect of the Neosporin formula is more or less useless for acne.

The one element of Neosporin that might be able to help acne is the petroleum jelly. Because it’s so thick, it might make sense to believe that it clogs pores, but petroleum jelly actually has a comedogenicity rating of 0. Comedogenicity is rated on a scale from 0 to 5, with 0 being the least likely to clog pores and 5 being the most likely. Petroleum jelly forms a protective coating on the skin to prevent extra bacteria and irritants from getting to it, but it doesn’t get into the pores and clog them.

If those were its only ingredients, Neosporin for acne might not be such a bad idea. However, because Neosporin contains cocoa butter and olive oil, it’s a bad choice for treating acne. Olive oil has a comedogenicity rating of 2, and cocoa butter is a 4, meaning Neosporin is very likely to clog your pores. If it had some acne-fighting properties, it might be worth the risk, but overall, Neosporin for acne is not the best treatment out there.

The Jury is Still Out on Mupirocin for Acne

There have been a few studies on using mupirocin for acne, but many have been inconclusive, and the ones that do come to a conclusion, one way or the other, tend to disagree with each other.

Mupirocin ointment for acne could theoretically help because it’s an antibiotic that functions totally differently from most antibiotics. There are lots of different kinds of antibiotics that kill or disable bacteria in a wide variety of ways, from destroying bacterial cell walls to splicing bacterial RNA. Mupirocin interferes with the formation of bacterial proteins in a way that’s completely different from typical antibiotics, like amoxicillin or clindamycin, meaning it’s very effective in treating some of the more stubborn kinds of bacteria, like MRSA and boils.

Because of this, it’s tempting to trust that mupirocin for acne is the perfect treatment. There are two issues with this. First, there’s not a lot of research confirming that mupirocin kills p. acnes bacteria specifically. And second, it’s important to avoid using any antibiotic unless 100% necessary, and this is especially true of novel antibiotics like mupirocin. This is because of something called antibiotic resistance, a phenomenon where some bacteria have a random mutation that allows them to survive an antibiotic. These bacteria then reproduce and create more and more bacteria that are resistant to the antibiotic, until the infection is very difficult to beat.

Because mupirocin is so effective on conditions like MRSA, a type of infection that is resistant to most forms of antibiotic, we want to avoid overusing it for other conditions. The more it’s used, the more likely it is that bacteria will develop resistance and it will no longer be effective for those difficult conditions like MRSA. So even though mupirocin for acne seems like a great solution, we don’t necessarily recommend it.

You Definitely Want to Avoid Triamcinolone Acetonide Ointment for Acne

Triamcinolone acetonide ointment for acne might come in handy once in a great while, but it should definitely not be used regularly or incorporated into your skin care routine. Triamcinolone acetonide ointment is something called a corticosteroid, and when used consistently, it can cause all kinds of skin issues.

Corticosteroids are not to be confused with anabolic steroids, the kind used by bodybuilders to gain muscle. Corticosteroids don’t affect the muscles; rather, they target the immune system and decrease inflammation. Generally, it’s good to have your immune system show up and fight an infection, but in some cases, it can be a little overzealous, causing more harm than good with all the inflammation. Corticosteroids suppress the immune system slightly so the inflammation can go down, which is why some people believe triamcinolone acetonide ointment for acne is a good idea, since acne is primarily an inflammatory condition. Unfortunately, corticosteroids aren’t meant for long-term use.

When used for more than three or four weeks, triamcinolone acetonide ointment can cause stinging and extra hair growth in the area it’s been applied, but it can also cause irritation, and that’s why it’s a very bad idea for acne treatment. Irritation causes more inflammation, making triamcinolone acetonide ointment for acne counterproductive. At first it might reduce acne, but over time, it could make things worse than ever.

Triamcinolone acetonide ointment for acne is best used for especially large, painful cysts, just for a few days, to bring the swelling down enough for antibacterial acne creams to do their job better and fight the infection.

The Best Acne Cream is Part of a Skin Care System

The best acne cream is one used in conjunction with a full skin care system, like the acne creams we make at Exposed Skin Care. Our Acne Treatment Cream and Clear Pore Serum are both great options for acne treatment, but they work even better when combined with our Facial Cleanser and Clearing Tonic, available together in the Basic Kit. All of our products incorporate both natural and scientific ingredients, like benzoyl peroxide and sage extract, or salicylic acid and green tea extract. Together, this blend of ingredients gently treats acne, preventing any irritation and inflammation that might lead to more acne.


Exposed Skin Care Basic Kit
Acne creams are most effective when used with a full skin care system, like the Exposed Skin Care Basic Kit.