Your First Dermatologist Appointment for Acne: What You Need to Know

Anyone can experience an acne breakout, no matter their age. It’s one of the top reasons people see a dermatologist. But because acne is so common, many wait too long to get help, often until it spreads widely or starts affecting their confidence.

If this sounds like you or someone you care about, keep reading. In this article, we discuss how acne is treated and when to consult a specialist. We also talk about what to expect during your first dermatologist appointment for acne and how to prepare for it. Like most health issues, the sooner you treat acne, the better the results.

What Is Acne?

Acne vulgaris, commonly known as acne or pimples, is a skin condition affecting the hair follicles and oil (sebaceous) glands. Factors that contribute to its development include increased skin cell growth, excess oil (sebum) production, the presence of Cutibacterium acnes bacteria, and inflammation.

Androgens (male hormones) speed up skin cell growth and stimulate the oil glands. Dead skin cells that shed at a fast rate can clog hair follicles, trapping oil and bacteria inside. Cutibacterium acnes bacteria thrive in these blocked pores, leading to inflammation.

This buildup can cause two types of acne lesions. Comedones, the non-inflamed kind, occur when the clogged pore either remains open, forming a blackhead, or closes up, producing a whitehead. If the clog becomes infected or inflamed, it can turn into a red, swollen, and painful lesion.

Acne appears as bumps of different sizes. The condition primarily affects the face, though lesions can also pop up in other areas. Severe breakouts can cause emotional stress for some people.

This skin issue comes and goes, with flare-ups triggered by factors like hormonal changes, poor hygiene, stress, medications, toxic exposures, fatigue, and poor diet. Lesions may leave unsightly scars.

Up to 80% of people with acne report a family history of the condition. Individuals with family members who have acne often experience earlier outbreaks and more intense episodes.

What Lesions Commonly Occur with Acne?

As mentioned, acne lesions can be non-inflamed or inflamed. Non-inflamed types include blackheads and whiteheads, while inflamed ones are classified as papules, pustules, nodules, or, in severe cases, plaques.

Papules are small, red, round bumps on the skin. Pustules look like papules but contain pus. Nodules are larger, deeper lumps that are often painful. Plaques are raised, inflamed patches that can involve wide areas.

Most inflamed pimples begin as comedones. However, a considerable number of lesions develop on otherwise healthy skin. Breakouts may appear to have one main acne lesion type, but a closer look often reveals a mix of different forms.

In the past, large nodules were sometimes referred to as “cysts,” and the term “nodulocystic” was used to describe very inflamed pimples. However, true cysts are deep lesions filled with clear or yellowish fluid different from pus. These blemishes are almost never seen in acne. Some experts now suggest replacing “cystic acne” and “nodulocystic acne” with “severe nodular acne.”

How Do Dermatologists Determine Acne Severity?

At present, there isn’t a single, widely accepted scale for grading acne. However, the Food and Drug Administration (FDA), together with the American Academy of Dermatology (AAD), suggest using the Investigator Global Assessment (IGA) Scale to measure acne severity.

The IGA Scale for classifying acne by severity is as follows:

• Grade 0: Skin is completely clear with no pimples or clogged pores.
• Grade 1: Almost clear, with just a few tiny bumps or clogged pores.
• Grade 2: Mild acne with more blackheads, whiteheads, and a few pimples that may be red (papules) or pus-filled (pustules).
• Grade 3: Moderate breakouts with lots of bumps, possibly one small deep lump (nodule).
• Grade 4: Severe acne with many pimples and a few deep, painful lumps.

Determining acne severity enables dermatologists to select the right treatment and monitor its success.

What Skin Conditions Mimic Acne?

Skin disorders that are often mistaken for acne include heat rash (miliaria), rosacea, and acneiform eruptions. These conditions can cause lesions similar to those seen in acne. Some may even occur alongside acne. Recognizing the differences helps dermatologists choose the most effective treatment strategy.

Heat rash arises when sweat gets trapped under the skin due to blocked sweat openings. Unlike acne, this condition doesn’t involve clogged hair follicles or the presence of bacteria.

Rosacea is an inflammatory disorder like acne vulgaris, but it’s related to more significant immune system issues. It often starts with papules and pustules in the central facial area. However, severe rosacea can cause eye complications, as well as disfiguring pore enlargement and skin thickening on the nose. Key differences from acne include persistent redness and swelling and visible broken blood vessels across the face.

Acneiform eruptions are skin issues that resemble acne but aren’t always associated with comedone formation. An underlying cause is typically identified, which must be considered when planning treatment. Common triggers include the following:

• Steroids
• A vast array of nonsteroidal drugs, including seizure medications (e.g., phenytoin), antipsychotics (e.g., lithium), antituberculosis drugs (e.g., isoniazid), antifungals (e.g., nystatin), pain relievers (e.g., naproxen), and cancer treatments (e.g., cetuximab)
• Industrial chemicals, like chlorinated hydrocarbons in fungicides, insecticides, and wood preservatives
• Radiation exposure, often linked to certain jobs and cancer therapy
• Long-term use of antibiotics (e.g., doxycycline) for acne treatment, resulting in an acne-like condition known as gram-negative folliculitis
• Extreme heat, leading to tropical acne
• Sun or UV exposure, causing acne aestivalis
• Repeated irritation or blockage of pores and oil gland openings, such as from wearing tight clothes, producing acne mechanica
• Genetic factors, such as in nasal crease pseudoacne, Apert syndrome, and facial Afro-Caribbean eruption (FACE)

Unlike acne vulgaris, acneiform eruptions occur suddenly, and lesions have a more uniform look. Breakouts can also happen at any age but are more likely to affect the trunk than the face. Lesions don’t always appear in areas with more oil glands.

Dermatologists usually diagnose this skin problem based on the patient’s history and examination, but further tests may be done if necessary. Avoiding the suspected triggers, if possible, can help confirm the diagnosis and guide treatment decisions.

Is All Acne the Same, or Are There Different Kinds?

Acne variants are forms of acne vulgaris that arise due to unique underlying factors, explaining their prevalence in specific groups of people. These unusual cases often require thorough testing and collaboration between different specialists.

Childhood acne can show up in babies and young kids and is categorized by age group. In newborns, comedones are usually absent. This form is believed to be linked to increased sebum production and the presence of the oil-loving fungus, Malassezia. Lesions improve with antifungals like ketoconazole.

In older children, comedones may be seen alongside inflamed bumps due to high levels of androgens in the body. In infants aged 3-12 months, breakouts may result from androgen fluctuations, especially in boys. In children aged 1-7 years, acne is rare because androgen levels during this period are typically stable. Pimples in these kids could be a sign of a hormone issue and may require a referral to a pediatric endocrinologist.

Acne conglobata is a chronic, severe form of acne predominated by large, painful nodules. This skin condition usually shows up on the back, chest, and buttocks but can also affect the face, neck, upper arms, and thighs. Some spots may ooze foul-smelling pus. Although teenage boys are commonly affected, it can also impact teenage girls and adults of either sex.

Acne fulminans is the most serious type of acne vulgaris. It is marked by the sudden appearance of painful, bleeding plaques on the chest and back, often alongside other acne lesion types. Body-wide symptoms can also develop, including bone, joint, or muscle pain, liver swelling, and anemia. The face and neck are usually not involved. This type of acne can leave deep scars. Adolescent boys are most susceptible.

Adult acne affects mostly young women and is often linked to medical conditions that raise androgen levels, such as polycystic ovary syndrome and androgen-producing tumors. Pimples frequently surface on the jawline and chin. You can read more about this type of hormonal acne in our previous article discussing the condition.

Oral isotretinoin (brand name Accutane) is a strong acne treatment, but it may cause a brief acne flare known as “Accutane purge” during the first month. The exact cause isn’t fully understood, but it may be due to skin hypersensitivity to dead bacteria or the drug’s effect on skin turnover, pushing out abnormal cells to make way for new ones. To learn more, you may read about Accutane purge in our previous article on oral isotretinoin treatment.

Some rare acne types may be tied to mental health problems (acne excoriée), joint pains (SAPHO syndrome), or autoimmune disorders (PAPA, PASH, and PAPASH syndromes). These conditions require complex care and won’t be covered at length in this article.

At What Point Should You See a Dermatologist for Acne?

You don’t need to have severe acne to see a dermatologist. Getting help early can prevent complications, such as bad scarring. The AAD recommends consulting a board-certified dermatologist even for mild breakouts, especially if any of the following apply:

• You’ve tried several treatments without success.
• Acne keeps coming back.
• You have pimple-like bumps in unusual spots (e.g., armpits, thighs, upper arms, or groin).
• Acne started early (ages 8–11 or younger).
• You get painful, deep pimples.
• Acne has lasted for years without a clear reason.
• It affects your mood, confidence, or social life.
• You feel like hiding your face because of it.
• Breakouts began within 6 months of starting a new medication.
• You notice scars or dark marks after acne heals.
• Acne on your back or chest won’t go away, even if your face clears up.

If 6 or more of these statements sound familiar, it may be time to talk to your skin doctor about this issue. Doing so could also help you find out if you have a condition that only looks like acne but clears up with a different treatment.

How Do You Prepare for a Dermatology Appointment for Acne?

When preparing for your acne consultation at BHSkin Dermatology, a few key steps can help you ensure a smooth visit. Start by scheduling your appointment through our online booking platform, phone, or email and choose between an in-office or teledermatology consultation. We’ll send a text reminder three days before your visit and call you the day before to confirm details like directions and parking options.

If you’ve been referred by another doctor, bring your referral letter and medical records to help your BHSkin Dermatology specialist assess your concern more efficiently. Bring along a complete list of your current medications and skincare products, or the product packaging, to give a clear picture of your routine.

On the day of your visit, shower, avoid makeup, and remove nail polish to ensure your dermatologist can examine your skin properly. Wear loose clothing to change into a clinic gown easily. You may also perform a full-body skin exam before your appointment, marking problem areas with a washable marker if necessary. Have your insurance details ready to speed up the check-in process.

What Happens During an Acne Consultation?

On the day of your visit, arrive at least 15 minutes early to complete the required paperwork, which will help us gather your medical history and personal details. After filling out the forms, a staff member will guide you to a private space to change into a clinic gown and then escort you to the exam room, where you can comfortably wait for your doctor.

Your specialist will give you their full attention, starting with a review of your personal information and the main reason for your visit. They will then inquire more about your specific skin concern and perform a physical examination afterward.

A full-body skin check is essential for first-time consultations, as it allows your dermatologist to look for acne in less frequently affected sites, such as the chest, back, and groin. It also helps them identify more serious conditions, such as skin cancer, which can form acne-like nodules and plaques. If you prefer, you can decline the examination of your private areas. However, your specialist will explain why it’s vital for accurate diagnosis and treatment.

Your dermatologist will discuss their findings and recommend treatment options after a full evaluation. Further tests may be arranged when necessary. For instance, blood work may be required for women experiencing jawline breakouts along with excessive facial hair growth. A biopsy may be done on suspicious lesions to rule out skin cancer.

However, for acne experts like board-certified dermatologists, the history and physical exam are usually enough to diagnose and start treating acne vulgaris. If yours is a straightforward case, your specialist will create a personalized acne treatment plan right away. At the end of your visit, they will also document your other skin issues and incorporate them into your long-term skin health journey.

Before you leave the clinic, you’ll receive clear instructions for any prescribed treatments. Our staff will also provide you with educational materials to help you better understand your regimen at home.

What Acne Treatment Options Do Dermatologists Recommend?

Choosing the right acne treatment strategy begins by assessing the severity of your condition. As mentioned, the IGA Scale helps your dermatologist complete this part of their evaluation. However, as each patient is unique, the AAD advises that factors such as the expected degree of cosmetic improvement, presence of acne scars, long-term control, and quality of life are also considered.

If you have mild acne, topical treatment is generally effective in clearing the skin without causing serious side effects. Common AAD-recommended first-line options include topical retinoids like adapalene, benzoyl peroxide, salicylic acid, and antibiotics like clindamycin. These medications help reduce bacteria, unclog pores, and promote skin renewal.

These FDA-approved topical skin treatments are generally safe, but retinoids are typically avoided during pregnancy due to potential risks to the unborn child. For pregnant women with mild acne, the American Board of Family Medicine (ABFM) recommends azelaic acid as the first-line topical treatment.

For moderate acne, a more aggressive approach is usually needed, often combining oral and topical medications. Common agents include oral antibiotics like tetracycline, doxycycline, or minocycline, along with topical retinoids, benzoyl peroxide, or azelaic acid. These therapies work together to reduce inflammation, control sebum production and bacterial growth, and promote skin renewal.

For pregnant women with moderate acne, oral antibiotics are generally avoided. The ABFM recommends alternatives like azelaic acid and topical antibiotics as safer options.

For moderate-to-severe acne, a combination of topical and oral therapies is often necessary. Topical treatments like benzoyl peroxide, clindamycin, and the anti-androgen clascoterone may be paired with oral antibiotics or hormonal agents like oral contraceptives and spironolactone. These regimens target multiple factors involved in acne development, including hormonal influences, skin cell growth, sebum production, bacterial activity, and inflammation.

For severe acne that doesn’t respond to other treatments, oral isotretinoin may be given as a standalone therapy. This drug addresses all the key factors leading to acne formation but requires close monitoring due to potentially serious side effects.

In pregnancy, the ABFM recommends combining azelaic acid with oral antibiotics, such as erythromycin or cephalexin, as a safe alternative approach to severe acne. Benzoyl peroxide and steroid injections in the problem area are also potentially helpful.

Your skincare routine is just as important as your acne treatments, as it helps maximize their results. Critical components dermatologists recommend for patients with acne include cleansing, moisturizing, and sun protection.

Cleansing should be done twice daily, or up to three times if you live in a hot climate or are very active, to remove excess sebum and debris without irritating the skin. Moisturizing at least four to five times daily helps hydrate dry skin, which can result from acne treatments. Sun protection prevents UV damage, which can worsen acne and increase the skin’s light sensitivity, especially with certain acne medications.

You can buy these skincare products without a prescription, though it’s best to get recommendations from your dermatologist. You can learn more about the best over-the-counter acne products from our previous article explaining this topic.

The AAD advises that more research is needed to support the benefits of in-office treatments, including chemical peels, acne extraction, and light-based therapies, such as laser skin resurfacing and photodynamic therapy, in acne treatment. Still, trusted experts, including BHSkin Dermatology specialists, may offer these procedures as part of individualized care, especially for patients with stubborn acne, severe scarring, or a preference for non-drug options.

What Results Can You Expect After Visiting a Dermatologist for Acne?

Acne usually clears up in the early 20s, but some people continue to experience it into their 30s or 40s. The severity can change over time, with women often seeing flare-ups before menstruation, especially after age 30.

Family history, diet, and body mass index can influence the risk of developing moderate-to-severe disease. Women with high androgen levels and prepubescent girls who develop comedones may face more persistent or aggressive forms of acne.

People with complex acne types, such as school-age children and adults with underlying hormonal or autoimmune disorders, may require collaborative care. Consultations with specialists in fields like pediatric dermatology, endocrinology, or rheumatology may be needed to manage causative factors that do not respond to standard acne therapies. Cosmetic dermatology or plastic surgery experts may help address complications like scarring.

How Important Is It to Return for Follow-Up Acne Visits?

Follow-up appointments help your dermatologist assess how well your treatment is working, address any side effects, and decide if a referral to other specialists is necessary. They can also plan procedures, like laser treatment, for future visits.

Follow-ups are typically scheduled every 1-2 weeks, depending on factors such as the expected timeline of results and the complexity of your regimen. Feel free to contact our clinic if you need assistance with scheduling or have any concerns before your next appointment.

How Do You Stop Acne From Coming Back?

To keep acne at bay, your skincare specialist may advise you to follow your prescribed treatment, practice good skincare habits, and avoid possible breakout triggers. Keep up with your follow-up dermatology appointments to ensure your treatment plan stays effective.

Your Clear Skin Journey Starts Here

People often take acne lightly, but it can sometimes signify deeper health issues or extreme psychological stress. That’s why the AAD encourages seeing a dermatologist, no matter how mild or severe the case. Preparing for an acne consultation involves a few important steps: booking your appointment, gathering past health records and treatment details, checking your insurance information, and making sure your skin is clean and easy to examine.

During your appointment, expect your dermatologist to take a complete medical history, perform a thorough skin exam, and go over treatment options and any needed tests. Treatment depends on how significant your skin problem is. Sticking to your prescribed therapeutic plan and attending regular follow-ups help optimize results and reduce the risk of complications.

Finally, don’t forget that the right provider can make all the difference in your treatment journey. As you’ve learned from this article, acne vulgaris may be a common concern but often has many layers. By choosing a highly trained, board-certified dermatologist, you’re giving yourself the best chance of managing this skin problem effectively and scar-free.

Frequently Asked Questions

Is Acne Treatment Covered by Insurance?

Acne is recognized as a medical condition, so treatment is generally covered by insurance. However, benefits may differ between providers. For more details about dermatology consultations and treatments covered by insurance, check out our article comparing medical with cosmetic dermatology.

Which Acne Treatment Is Best for Skin of Color?

In patients with skin of color, dark spots that form after acne heals (post-inflammatory hyperpigmentation) can be more distressing than acne itself. Early and gentle treatment helps minimize this risk.

First-line options include topical retinoids and azelaic acid, which address both pimples and skin darkening. Combination therapies may improve outcomes, while lower starting doses can reduce irritation. Oral treatments and procedures like chemical peels may be considered if topical medications fail.

All therapies should be tailored individually. Additionally, choosing a dermatologist with expertise in skin of color ensures treatments are suited to this skin type.

Is Virtual Care for Acne as Effective as Face-to-Face Visits?

Research shows that teledermatology is as reliable as in-person visits when evaluating acne vulgaris. However, as mentioned, some skin tumors resemble acne lesions. If skin cancer cannot be ruled out during an online exam, your dermatologist may ask you to consult in person for further workup, which may include a biopsy.

BHSkin Dermatology offers telemedicine as a convenient solution for people who need easy access to dermatology services without leaving home or work. Read our previous article on preparing for a virtual dermatologist visit to learn more.

Want the Best Dermatologist for Acne? Your Search Ends Here

Breakouts are a normal part of life. But not every patient reacts the same to treatment, which is why some may get frustrated when results don’t match expectations.

At BHSkin Dermatology, our acne specialists are some of LA’s best. Visit us at our Glendale or Encino clinic or use our virtual platform for your first acne consultation.

Book your appointment today!

References:

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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.