"Fluctuation in hormones, such as before one's menstrual cycle, is the main cause," explains dermatologist Julia Tzu, M.D., of Wall Street Dermatology. Specifically, androgens (male hormones) like testosterone. This usually rears its ugly head in the form of deep (painful) cystic acne around the chin, neck, and back, says dermatologist Rebecca Kazin, M.D., F.A.A.D., of the Washington Institute of Dermatologic Laser Surgery and the Johns Hopkins Department of Dermatology.
Bacteria. Excess sebum clogs the openings to hair follicles -- especially those on the face, neck, chest, and back. Bacteria grow in these clogged follicles. This makes blackheads or whiteheads, also known as ''comedones,'' form on the skin's surface. Sometimes, this clogging causes the follicle wall to break under the pressure of this buildup. When this happens, sebum leaks into nearby tissues and forms a pustule or a papule -- this is called inflammatory acne. Larger, tender pustules are called nodules.
But, sometimes a particularly aggressive blemish is truly on a mission to leave its permanent mark. "Acne scars occur when normal tissue in the skin is destroyed and replaced with fibrous tissue. You can think of an acne lesion as a wound. When the damage caused by acne is severe, the body can respond by creating too much tissue or too little tissue. The production of too much tissue forms a keloid or a hypertrophic scar, and too little tissue leads to that depression in the skin, or atrophic scar. The deeper and more inflamed the acne lesion, or the more that it is picked or squeezed, the more likely it is to scar," says Dr. Bowe.
Rolling scars can look like little saucers, giving the skin a wavy texture. Lasers that resurface the skin are Dr. Karolak's top treatment pick for this type of scar, and Dr. Sobel agrees. "Many scars can be improved with lasers such as the matrix CO2, which remove the outer layers of skin, burning away the scar tissue and stimulate new collagen production," he says. "Non-ablative lasers such as the Fraxel can help activate the production of collagen without damaging the surface of the skin." Keep in mind, that these laser treatments can take a bit of recovery time and require multiple treatments to see results. For a quicker solution, your dermatologist can plump the bowl-like scar with fillers like Juvederm, Restylane, or Bellafill.
Although acne remains largely a curse of adolescence, about 20% of all cases occur in adults. Acne commonly starts during puberty between the ages of 10 and 13 and tends to be worse in people with oily skin. Teenage acne usually lasts for five to 10 years, normally going away during the early 20s. It occurs in both sexes, although teenage boys tend to have the most severe cases. Women are more likely than men to have mild to moderate forms into their 30s and beyond.
Glycolic acid: A true magic maker, glycolic acid is the smallest acid in size, meaning it’s able to penetrate deeply into the skin’s pores to do its work. It breaks apart the cellular glue holding dead skin cells together to reveal a fresher, brighter complexion. It also promotes cellular turnover by boosting collagen and elastin, helping your skin regenerate and repair itself.
Acne scar treatment: Injections of steroids can flatten keloid scars, according to Dr. Elbuluk. When they are discolored or red, there is some active inflammation in the skin. “The goal is to make the inflammation go away,” she says, “and certain lasers, such as pulsed dye laser, can improve any discoloration by targeting blood vessels.” Cryosurgery freezes the scar tissue, causing it to slough off, but this can cause pigmentation problems of its own among people with darker skin, who are already at higher risk for keloids. Prevention has an important role to play for anyone who is prone to keloids, she says. Using a scar-minimizing treatment like Mederma and/or silicone gel scar sheets before scars form can help stave off a keloid. Vitamin C serums such as Kiehl’s ‘Clearly Corrective’ Dark Spot Solution, Perricone MD Vitamin C Ester Serum, Skinceuticals C E FERULIC® vitamin C serum, or Kiss My Face C The Change (Ester C Serum) can also reduce pigmentation around a keloid scar.
No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty or due to other hormonal changes. Sebum (oil) is a natural substance that lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to plug the follicular pore. The plug can appear as a whitehead if it is covered by a thin layer of skin, or if exposed to the air, the darker exposed portion of the plug is called a "blackhead." The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst.