A keen observation of Acne treatment information will show that acne cure takes two broad approaches - external and internal. The former relates to topical application of creams, lotions, face-masks, etc., while the latter is about treating the root internal cause of acne. Well, either approach is right, yet neither is complete. Considering external or topical treatment methods, they are thought to deliver active ingredients directly to the afflicted spot, setting to work immediately. Topical treatments are essential to maintain a skin care routine. Proper cleansers, exfoliators and moisturizers play a vital role in keeping your pores unclogged. In fact, conditions like hyperkeratinization need to be managed externally by delivering ingredients like S
alicylic acid to break the unnecessary cell bonds and keep your pores open. Another important advantage of topical remedies pertains to treating acne inflammation. Inflammation-a result of overreaction to the P. Acnes bacteria, needs some extent of external management through the application of anti-inflammatory preparations.
Coming to the internal approach, you are probably aware that it is considered to be a holistic approach. In other words, you address the systemic factors that contribute to hormonal imbalance, excessive sebum secretion and inflammation that are among the root causes of acne. Sometimes, acne happens to be one of the symptoms of underlying health problems. In such instances, you need to treat the internal issues by decreasing inflammation, controlling sebum production, balancing hormones or treating medical problems, if any.
That seems enough information to help you deduce the answer. Yes, a complete acne treatment regimen incorporates both external and internal methods. By far, your topical treatment products should be free from harsh chemical or synthetic ingredients that can potentially harm your skin. There is no dearth for home-made or herbal formulas to make your own facemasks, moisturizers, astringents, cleansers, or any skin-nourishing formulations for that matter.
Your internal treatment methods should aim to boost your bodily functions and immunity to combat hormonal imbalances and inflammations. For example, the right acne diet will deliver minerals, vitamins and other nutrients in the right proportion to keep skin problems at bay. Proteins and vitamins, especially antioxidant vitamins, help build immunity. On the other hand, excessive fat causes inflammation. Similarly, excessive carbohydrates disturb your blood sugar levels, which in turn affect the immune system and aggravate acne
True, all nutrients are essential, but your objective is to take them in the right quantities. Avoid saturated fats that can aggravate breakouts, but make sure that you include good fats and oils, like olive oil, avocado, nuts and fish. You can include specific natural ingredients in your diet to address acne problem; for example, green tea is said to prevent excessive production of androgen, which can disturb the hormonal balance. To address deficiencies, you can take acne supplements that contain oil-balancing vitamins, essential fatty acids or detox properties.
The bottom line is that topical acne remedies address your skin's reactions to hormonal imbalance, while internal remedies work to balance the hormones. My advice- Go for a complete acne treatment regimen incorporates both external and internal methods.

The goal when treating Acne is to heal existing lesion, stop new lesion from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this condition. How your acne is treated may depend on how severe and persistent it is.
TREATING MILD ACNE
The majority of people who get Acne will develop mild Acne. This can usually be treated with OTC (over-the-counter) medications. OTC medications can be bought at a pharmacy without a doctor's prescription. They are usually applied to the skin. Most Acne OTC (Over-The-Counter) products may contain the following active ingredients:

·         Resorcinol - Helps break down blackheads and whiteheads. It is a crystalline phenol and comes from   various resins. Resorcinol is also used for treating dandruff eczema and psoriasis.

·         Benzoyl Peroxide - Kills bacteria and slows down your glands' production of oil. Benzoyl peroxide is a white crystalline peroxide used in bleaching (flour or oils or fats) and as a catalyst for free radical reactions. It works as a peeling agent, accelerating skin turnover and clearing pores, which in turn reduces the bacterial count in the affected area.

·         Salicylic Acid - Helps break down Blackheads and Whiteheads also reduces shedding of cells which line the follicles of the oil glands, effective in treating inflammation and swelling. Salicylic acid is a white crystalline substance which is also used as a fungicide, or in making aspirin or dyes or perfumes. It causes the epidermis to shed skin more easily, prevents pores from becoming blocked while at the same time allowing room for new cells to grow. It is commonly added to shampoos used for treating dandruff.

•   Sulfur - Helps break down blackheads and whiteheads. Sulfur, in its natural form, is a yellow crystalline  solid. Sulfur has been used for centuries for treating acne, psoriasis and eczema. Scientists are not sure how sulfur works to help skin diseases. We do know that elemental sulfur does oxidize slowly to sulfurous acid which is a mild reducing and antibacterial agent.
•   Retin-A - Helps unplug blocked pores. Retin-A contains Tretinoin, an acid form of vitamin A, also known as all-trans retinoic acid (ATRA). Tretinoin is also used for the treatment of acute promyelocytic leukemia. Retin-A has been used widely to combat aging of the skin, it also acts as a chemical peel.
• Azelaic Acid - Strengthens cells that line the follicles, stops oil eruptions reduces bacteria growth. It is a saturated dicarboxylic acid found naturally in wheat, rye, and barley. Azelaic acid also mops up free radicals, which reduces inflammation. It is useful for patients with darker skin who have dark patches on their face (melasma), or whose acne spots leave persistent brown marks.

You can buy Acne medications in the forms of gels, soaps, pads, creams and lotions. If your skin is sensitive you may prefer a cream or lotion. Gels, which are usually alcohol based and tend to dry the skin, are better for people with oily skin. OTC medications will have these ingredients in different concentrations. It is advisable to start with the lowest strengths. You may experience skin irritation, redness, and/or burning when you first try them. These side effects usually go away after continued use. If they don't you should see your doctor.

TREATING MORE SEVERE CASES OF ACNE
If your acne is more severe you should consider seeing a dermatologist - a skin specialist. The specialist may prescribe a treatment that contains some of the active ingredients mentioned above, such as Benzoyl Peroxide, Azelaic acid, as well as Adabalene. Prescription medications for acne are presented in many forms, such as creams, lotions, etc. Your dermatologist will decide what is best for you. You may be prescribed an oral or topical antibiotic. Antibiotics can combat the growth of bacteria and reduce inflammation. Most commonly Erythromycin and Tetracycline are prescribed as antibiotics for the treatment of acne.

• Treating a Cyst With Interlesional Corticosteroid Injection
  If an acne cyst becomes severely inflamed there is a high risk of rupturing. A rupturing acne cyst can often result in scarring. The specialist may inject a diluted corticosteroid to treat the inflamed cyst and to prevent scarring. The injection will lower the inflammation and speed up healing. The cyst will "melt" within a few days.
• Isotretinoin
  This is a strong oral retinoid, used for the treatment of severe cystic acne, as well as severe acne that has not responded to other medications and treatments.
• Oral Antibiotics
  Oral antibiotics are frequently prescribed for patients with severe acne and some patients with moderate acne too. The aim of such oral antibiotics is to lower the population of Propionibacterium Acnes (P. acnes), a bacterium commonly found on the skin, which will multiply rapidly in blocked follicles. The dosage will be initially high, and then as the acne reduces so will the dosage. Antibiotics are not taken for more than six months. As time passes the P. acnes can become resistant to the antibiotic and another antibiotic is needed. Some American studies have indicated that it is better to use oral broad-spectrum antibiotics.
• Oral Contraceptives
  The majority of women with acne find that taking certain oral contraceptives clears it up. Oral contraceptives suppress the overactive gland and are commonly used as long-term treatments for acne in women. If the woman has a blood-clotting disorder, smokes, has a history of migraines or is over 35, she should not take this medication without checking with a gynecologist first.
• Topical Antimicrobials                                                                                              As with oral antibiotics, the aim of topical antimicrobials for the treatment of acne is to reduce P. acnes populations. Topical antimicrobials are used for patients with moderate to severe acne. Examples may be clindamycin Erythromycin, and Sodium Sulfacetamide.

The Dermatologist may prescribe a topical retinoid. Topical Retinoids are a derivative of Vitamin A and are very popular for the treatment of Acne. They unclog the pores and prevent whiteheads and blackheads from developing. Examples of topical Retinoids prescribed in the USA are Adapalene, Tazarotene, and Tretinoin.

Acne, medically known as Acne Vulgaris, is a skin disease that involves the oil glands at the base of hair follicles. It commonly occurs during puberty when the sebaceous (oil) glands come to life - the glands are stimulated by male hormones produced by the adrenal glands of both males and females. The word acne comes from the Greek word akme meaning "the highest point". Acne at its most basic is a disorder of the pilosebaceous unit, or what is commonly called the hair follicle or pore. According to the American Academy of Dermatology, it is the most common skin disorder in the United States.

Acne commonly starts during puberty between the ages of ten (10) and thirteen (13) and tends to be worse in people with oily skin. It is estimated that 80% of eleven (11) to thirty (30) years are affected by Acne. It most commonly develops in the face attacking over 90% of its victims in that particular region, the back affecting 60% and the chest 15%.Teenage Acne usually last for five to ten years, normally clearing out in the early 20s, it occurs in both sexes and all race although teenage boys tend to have more severe cases (probably because Testosterone, which is present in higher quantities in young men can make it worse). Women however are more likely than men to have mild or moderate Acne into their 30s and beyond (over 80% of adult Acne victims are women). This is also most likely due to link between Acne and hormones. Dermatologists describe Acne as a disease of the pilosebaceous units (PSUs).  Found over most of the body. PSUs, consists   of a canal called a follicle, that contains a fine hair. These units are most numerous on the face, upper back and chest. The sebaceous gland makes an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle (commonly called a pore). The hair sebum and KERATINOCYTES (these are cells that line the follicle) that fill the follicle may produce a plug which is an early sign of Acne. The plug prevents sebum from reaching the surface of the skin through the pore. The mixture of oil and cells allows the bacteria PROPIONIBACTERIUM ACNES (p. acnes) that normally live in the skin to grow in the plugged follicle. The bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. When the wall of the plugged follicle breaks down, it spills everything into the nearby skin sebum, shed skin cells, and bacteria-Leading to Lesions. People with Acne frequently have a variety of lesions. The basic lesion called the COMEDO (KOM-e-do) is simply an enlarged and plugged hair follicle.

TYPES OF LESIONS                                                                         WHITEHEADS:  Whitehead results if the plugged follicle (Comedo) stays beneath the skin.                                                                                                                        

BLACKHEADS: Results when a Comedo reaches the surface of the skin and opens up (it is called a blackhead because it looks black on the skin’s surface).               

PAPULES:  This is an inflamed lesion that usually appears as a small bump on the skin and can be tender to touch-It is a circumscribed, solid elevation of the skin with no visible fluid, and comes in varying sizes. They can be purple, pink or red in color. The papules may be open when scratched and becomes infected and crusty.

PUSTULES (PIMPLES):  Another type of Acne lesion is pustule, it is a small inflamed swelling of the skin that is filled with pus (It is similar to blisters). They may or may not be tender to touch, pustules most commonly occur on the face, chest and areas of increased sweating.

NODULES:  Skin nodules are slightly elevated lesion on or in the skin. They are larger than Papules. The depth of the lesion is more significant than the width. Some are free within the Dermis some are fixed to the skin above or below the Subcutaneous Tissue. Nodules are painful to touch.           

CYSTS:  Cyst is a closed sac, having a distinct membrane and division compared to the nearby tissue. It may contain air, fluids or semi-solid materials. Cysts occur within tissues and can affect any part of the body. They vary in size from microscopic to the size of some team-sport balls.

CAUSES OF ACNE

 Experts believe the primary cause 0f acne is a rise in androgen levels.  Androgen levels rise when a human becomes an adolescent. Rising androgen levels make the oil glands under your skin grow; the enlarged gland produces more oil. Excessive sebum can break down cellular walls in your pores, causing bacteria to grow. Acne skin also produces more dead skin cells than is normal, and those skin cells are not being shed properly (a condition called retention hyperkeratosis). These dead cells stick to the surface of the skin and inside the follicles, mixing with excess oil and creating a Comedo. When the pore becomes blocked by cellular debris and oil, a bacterium that is normally present within the pore grows unchecked. Propionibacteria acnes (P. acnes) are found in great numbers on acneic skin, causing inflamed breakouts. Certain factors have been proven to trigger Acne at different stages in life, they include:   

GENETICS

 Researchers believe that the tendency to develop Acne can be inherited from parents. This is particularly something to consider if you are experiencing adult Acne. Research conducted at the General Infirmary at Leads, department of Dermatology in the UK suggests that family factors are important in determining individual susceptibility to adult facial Acne. Genetic factors may determine the failure of Acne-prone follicles to evolve into Acne-resistant follicles in early adult life. Acne gene is called Retention hyperkeratosis. What this means is that you have inherited the ability to over produce dead skin cells, then improperly shed them when you shouldn’t. This results in abnormally shaped lining of the pore that is prone to clogging, which will eventually result in Acne lesions if nothing is done about it.

 HORMONES

Common Acne in teenagers starts with an increase in hormone production. During puberty, both boys and girls produce high levels of androgen which signals the body to make more sebum. According to the America Academy of Dermatology, testosterone works to stimulate oil gland activity, making an oiler skin more prone to Acne break-outs. Androgens are hormones released from the adrenal glands, ovaries and tests. Testosterone is an androgen hormone, while it is typically thought of as a male hormone it is present both in male and female.

Menstrual Acne (a flare up of blemish every month that coincides with menstruation) is fairly common. According to a study published in the archives of Dermatology, 63% of Acne-prone women experience these premenstrual flares. They usually strike about seven(7) to ten (10) days before a woman’s period starts and then subsides as soon as bleeding begins. The average menstrual cycle is 28days. Each of these days is different hormonally. In the first half of a woman’s menstrual cycle, the predominant hormone is Estrogen, whereas Progesterone is predominant in the second half “– OB-GYN- Elizabeth Gutrecht Lyster, MD. The levels of both hormones fall to their lowest level of the month as bleeding approaches. Meanwhile, the male hormone Testosterone (available in small amount in women) stays at a constant level all month. This means that before and during menstruation, Testosterone is relatively higher than the female hormones. These hormonal shifts do all sorts of things to a woman’s skin. Again the mid-cycle Progesterone rise stimulates the production of sebum. And as the levels of progesterone increases, skin cells and pores are compressed shut, as a result pores appear minimized.  This also causes sebum to build up beneath the skin’s surface. Still higher Testosterone levels around menstruation further activate the sebaceous gland to make even more sebum (Sebum yields different effect in different women. For some, it produces a healthy glow, for others, it creates a chronic oil slick, says Kunin Audrey MD of dermadoctor.com). The oil provides food for the bacteria P. acnes. This bacterium causes increased breakouts and inflammation around the time of women’s period.                                                                  

 BACRETIA

 A bacteria known as Propionbacterium Acnes (P. acnes) is a normal inhabitant of the skin. It uses sebum as a nutrient for growth. People with Acne have more propionbacterium acnes in their follicles than people without acne. The presence of propionbacterium attracts white blood cells to the follicle.  These white blood cells produce enzymes that damage the wall of the follicle, allowing contents of the follicle to enter the dermis. This process causes an inflammatory response seen as papules (red bumps), pustules and nodules. The bacteria also cause the format ion of free fatty acids which are irritants, increasing the inflammatory process in the follicle.

DIET

 It is a commonly debunked myth that certain foods cause breakouts, but this is not say that your diet doesn’t matter when it comes to Acne. Diets high in sugar, refined carbohydrates and trans-fats, and low in anti-oxide, create systemic inflammation, which manifests itself in the form of Acne, Rosacea or Premature aging. Diets that is high in pro-inflammatory omega 6-fatty acids, while low in inflammatory- soothing omega 3 can also trigger Acne.

OTHER FACTORS THAT CAN MAKE ACNE WORSE

Anxiety and Stress - Mental stress can affect your levels of some hormones, such as cortisol and adrenaline, which in turn can make Acne worse. Again, stress can make some people binge-eat. Experts believe the culprits are most likely the hormone levels, rather than the binge-eating.                    

Hot and Humid Climates - When it is hot and humid we sweat more. This can make the acne worse.

Oil based Make-ups - Moisturizing creams, lubricating lotions, and all makeup that contains oil can speed up the blocking of your pores. Try as much as you can to avoid such products, water based product are much better.

Greasy hair - Some hair products are very greasy and might have the same effect as oil based makeup. Hair products such as cocoa butter or coconut butter contain much oil. 

Squeezing the pimples - if you try to squeeze pimples your acne is more likely to get worse, plus you risk scarring.                                                                                                 

MYTHS ABOUT CAUSES OF ACNE.

There are several wrongly assumed causes of Acne. These myths are most likely spread by teenagers or even parent that try to manipulate their young children to stop them from either eating or indulging in certain activities. Some of these myths include:                           
You can catch Acne from someone else- This is completely false as acne is not contagious.

 Masturbation causes Acne- This one is a very popular myth especially with teenagers. But that is definitely not true, there is so far no medical evidence backing such claim. Masturbation doesn't cause acne and neither does sex.  

 Chocolate, pizza, and French fries cause Acne – Though it is true that certain food can increase your risk of acne breakout there is however no prove that pizza or French fries or even chocolate at that causes Acne.