Oral contraceptives: Oral contraceptives (birth control pills), which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been shown to have modest effectiveness in treating acne. Those that have been U.S. FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary care physicians or gynecologists when recommending these medications.
Photodynamic therapy (PDT) is a procedure that treats precancerous cells, in addition to other types of cancer cells. The medical treatment does this with the help of a photosensitizing drug and a light source that activates the applied drug, destroying cancer cells. PDT is approved to treat non-small cell lung cancer, esophageal cancer, and Barrett's esophagus. It's used to treat actinic keratosis, as well as acne, rosacea, skin cancer, sun damage, oily skin, wrinkles, warts, psoriasis, and enlarged sebaceous glands.
Chemical peels: "A chemical peel is a treatment that uses the application of mild solutions for skin refinement and regeneration. Products containing glycolic acid promote cell turnover, which is the process where new skin cells form and help even out your skin tone," says Dr. Bowe. You can try an at-home peel like Peter Thomas Roth 40% Triple Acid Peel, which uses both glycolic and salicylic acids to help fade spots by exfoliating dead skin cells and smoothing out skin texture. "Or, your dermatologist can prescribe you a stronger peel based on your skin type and treatment goals," says Dr. Bowe.
The spots that linger after a pimple has healed are caused by inflammation that has disrupted the skin's natural healing process. "When your skin is opened up (like when you pop a pimple) and then closes back together, you can get abnormal pigmentation, texture, and tone that looks different from the rest of your skin. Sometimes the broken blood vessels that remain after an acne lesion fades can result in a mark," says Dr. Bowe. For a number of people who are able to refrain from picking, inflamed pimples or blemishes can still leave a dark brown or red mark — but these naturally fade over the course of a few months, notes dermatologist Heather C. Woolery-Lloyd, MD.
Another source of hormonal changes: stress. Whether you work full time, are a full-time mom, or juggle both, chances are, your stress levels are high. "When you're stressed, you have an organ called the adrenal gland that makes the stress hormone cortisol, and puts it out into the body to help the body deal with stress," Dr. Schultz explains. Unfortunately, a tiny bit of testosterone leaks out with it. For a woman, this male hormone can drive the oil glands to produce more oil—the root cause of breakouts. (Thanks a lot, hormones!)
Punch excisions: "This procedure is best for those with icepick scars, which aren't as wide as rolling or boxcar scars," says Dr. Shah. "If you use a punch excision on a scar that's wide at the surface, you're making a bigger punch and trading in one scar for another," she says. "Your dermatologist will numb up the area and use a tiny cookie-cutter like device to cut out the scar, and then sew it closed with a tiny stitch. The stitch is removed in less than a week," says Dr. Bowe. However, Dr. Idriss cautions against this method for those with darker skin or undertones who are prone to hyperpigmentation.
Topical (external) applications: Antibacterial cleansers come in the form of gels, creams, and lotions that are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol. Some brands promoted on the Internet and cable TV (such as ProActiv) are much more costly than identical and sometimes more potent products one can buy in the drugstore.