Acne treatment by video for teens and adults

Acne happens when pores clog with oil (sebum) and dead skin cells, and bacteria grow inside. It shows up mostly on the face, but also on the back, chest and shoulders.

It is most common in teens and young adults. In the teen years it is more frequent in males; when it continues into adulthood, it is more common in women. Hormones (at puberty and in pregnancy), family history and some medicines, such as corticosteroids, lithium and hormone-containing medicines, all play a part.

These do not cause acne but can make it worse: stress, pressure from helmets, tight clothes or backpacks, pollution, high humidity, squeezing or picking at pimples, and scrubbing your skin too hard.

Here is how the video visit works:

A skin and acne visit is a doctor visit, the same price for all ages, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the clinic can’t see you. A doctor's note after your visit is included at no extra charge. See all prices.

If you already use an acne medicine and only need a refill, choose the video follow-up visit. If the doctor finds you need a full visit, she explains why and, with your consent, you pay the difference.

Acne takes different forms, sometimes several at once:

• Whiteheads: clogged pores that stay under the skin.
• Blackheads: clogged pores open at the surface. They look dark from contact with air, not dirt.
• Papules: small pink bumps that are inflamed and tender.
• Pustules: pimples with white or yellow pus.
• Nodules: large, hard, painful lumps deep in the skin.
• Severe nodular (cystic) acne: deep, painful, pus-filled lesions. A single red, painful, pus-filled lump around a hair, especially in the armpit, buttocks or thighs, may be a boil rather than acne.

Skin treatments include benzoyl peroxide, retinoids, salicylic acid and sulfur, and topical antibiotics combined with one of these. They can cause irritation, burning or redness at first.

For moderate or severe acne, the doctor may consider medicines by mouth, such as antibiotics, or hormone therapy, used mostly in women. Oral doxycycline is among the oral antibiotics the American Academy of Dermatology (AAD) 2024 guideline recommends for acne. It can harm the baby in pregnancy, so the doctor asks whether you are pregnant or planning to be, and it can make your skin burn more easily in the sun, so use sunscreen and protective clothing. Acne improves gradually: the doctor tells you when to judge the results and adjusts the plan with you.

Severe acne and isotretinoin. For severe nodular acne that does not improve with other treatments, there is isotretinoin, a medicine by mouth. Because of its risks in pregnancy, only a prescriber registered in the iPLEDGE program can prescribe it, and the patient registers too. If your acne is severe or scarring, the doctor goes over the options with you, treats you in the meantime and, if isotretinoin may be right for you, refers you to a skin specialist.

If the doctor suspects a hormonal condition, such as PCOS, is playing a part, she gives you a lab order for a lab near you. And if your face flushes red and the bumps are on your nose and cheeks, it may be rosacea, which is treated differently.

Many acne medicines make your skin burn more easily in the sun. With year-round sun in Puerto Rico, use sunscreen and avoid burning and tanning; sunscreen also helps the dark spots acne can leave fade, especially on darker skin.

Starting early helps. In a 2026 study of 464 patients at 12 dermatology clinics in Puerto Rico (data from summer 2023), the average wait for an appointment was 2.5 months, 55% waited more than 3 months and 38.7% said their symptoms got worse while they waited. A video visit lets you start your acne treatment without that wait.

These NIAMS tips help care for your skin while treatment takes effect:

• Wash with a gentle cleanser in the morning, at night and after exercise. Avoid harsh soaps, astringents and rough scrubbers.
• Rinse with warm water, and shampoo regularly if your hair is oily.
• Do not touch, squeeze or pick at pimples: it can leave scars or dark spots.
• Shave carefully, with a sharp razor and only when needed.
• Choose cosmetics carefully.

We see teens with acne. As with every patient under 21, a parent with patria potestad (parental authority) or a legal guardian signs the consent, stays on camera for the whole visit and shows photo ID. Visits are not recorded. To get ready, see the parents' guide.

For your safety, go to the emergency room or call 911 if you have any of these signs. If you feel deep sadness or have thoughts of harming yourself, call 988 or Línea PAS.

• Swelling of the face, lips or tongue, or trouble breathing after starting a medicine
• A widespread rash with blisters, peeling skin or mouth sores after starting a medicine
• A very painful, hot, spreading bump with fever