Acne occurs when the small pores on the surface of the skin become blocked with oil, dead skin cells, and bacteria. Each individual pore on the skin opens up to a follicle beneath the epidermis. Within these follicles lie a singular hair and a sebaceous gland. The sebaceous gland produces sebum, an oil designed to keep your skin lubricated and soft. However, when hormonal changes and other factors cause the gland to produce an excess of sebum, the oil will be pumped through the follicle, and may pick up dead skin cells and P. acnes bacteria on its way out. Should these substances clump together, a plug will form. As this plug starts to press up against the surface of the skin, the body responds with an accumulation of red and white blood cells to combat any infection, and this results in inflammation and redness. Acne can occur on the face, back, neck, chest, arms, and buttocks, and any other skin area with a saturation of sebaceous pores.

"Overwashing your face can make acne worse," Dr. Kazin explains. Cleansing more than twice a day is too much and can just dry out skin, "which can cause [it] to produce more oil to overcompensate." Your Clarisonic addiction may not be helping either. "It helps remove all makeup and helps your cleanser work better, but I worry about the coarse ones. It's almost like giving yourself microdermabrasion twice a day, which can cause a breakout," says Dr. Kazin. Dr. Schultz seconds that: "Anything that rubs skin will, to a small extent, promote acne." That includes a grainy or gritty cleanser, too. Try these two gentle face washes instead: Phace Bioactive Detoxifying Gel Cleanser or Frank Body Creamy Face Cleanser.

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What to know about hormonal imbalances While it is natural to experience hormonal imbalances at certain times in life, such as puberty, menopause, and pregnancy, some hormonal changes are related to underlying medical conditions. This article looks at the causes and symptoms of hormonal imbalances in men and women, as well as treatment and home remedies. Read now
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!)
Keloid bumps are generally discolored and raised. These scars form when the body tries to recover from the inflammation caused by cystic acne. According to Dr. Sobel, you can get a keloid if too many fibroblasts or dermal cells are produced during the healing process. The first step in treatment is to flatten the bump with a shot of cortisone. Then, you can follow up with other treatments like laser or retinol to even out the skin tone.
Even if battling zits is a distant memory, filed away with high-school gym class and algebra tests, acne marks and scars can annoyingly linger long after pimples are gone. “If someone gets a very large pimple or cyst, the natural healing process of the skin will create a scar,” says David Avram, M.D., of Heights Dermatology and Laser. “The more intense the inflammation, the more likely it will leave a scar.”
Do not—we repeat, do not—even think about attempting to get this out yourself. "With deep zits, there’s no exit strategy, so if you’re pushing on it to try to get rid of it, it could actually leak sebum into the dermis and cause more lesions," explains Dr. Hale. Instead, this is the time to visit your dermatologist for a cortisone injection, which should take care of it in 24 hours. If you're sitting here wondering why doctors don't just shoot all of your zits up with cortisone, that's because that it can actually lead to scarring or even a depression in your skin, especially with smaller zits, says Dr. Chwalek. That's why cortisone shops reserved for the oversize monsters like these.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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