When it comes to skincare, we often put so much attention on the outside that we forget about our insides. Once upon a time, a common acne myth was that French fries and chocolate were to be avoided at all costs if you wanted clear skin. Now we know those foods don’t necessarily cause acne, but some foods do have properties that can trigger breakouts.
Understanding why you break out requires consideration of a variety of aspects. There are many underlying reasons for acne breakouts, but most pimples are caused by fluctuations in hormone levels. During puberty, the increase in androgens (male hormones) causes the adrenal glands to go into overdrive. This triggers the production of sebum within the sebaceous glands. The more sebum produced, the easier it is for hair follicles to become clogged. When the follicle becomes blocked, oil can’t leave the pore, collecting dead skin cells that would have otherwise sloughed off and hanging onto bacteria called p. acnes. These hormonal fluctuations can arise at other times in life, including menstruation, pregnancy, and menopause.

According to dermatologist Dr. Whitney Bowe, some scars are thick, raised hypertrophic scars that stick out above the skin; others are keloid, which are scars that have over-healed, and manifest as dense, rubbery skin tissue. Then, there are atrophic scars that appear as depressions in the skin — they're the most challenging to treat. The three main categories of atrophic scars are:
Even if you have amazing willpower—like the willpower of a Girl Scout with a full inventory of Thin Mints under her bed—and never, ever mess with your acne, you can still scar. "Acne scars result from damage to the skin following repeated inflammation from acne cysts," says Judith Hellman, M.D., a board-certified dermatologist in New York City. "Pimple popping can make the process worse, but acne can cause scarring even without pimple popping."

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If you’ve made a concerted effort with over-the-counter regimens and/or diet and still aren’t seeing results, a dermatologist is absolutely worth it. There are many levels of care: Prescription retinoids (Retin A, Tazorac, Differin et al) and/or topical antibiotics are the mildest, along with blue-light treatments like Isolaze, which kill bacteria and clear pores, with virtually no downtime. Light lasers like Clear and Brilliant can clear pores and treat the red and brown tones left by old acne lesions. “Some patients think they’ve got a severe problem, when they really only have a few pimples, surrounded by red and brown marks from old breakouts,” notes Anolik. Oral antibiotics represent a more aggressive (and unsustainable long-term) solution; birth control pills and hormone-mitigating medications like Spironalactone and Deldactone can get many more-severe patients’ acne under control. Most aggressive is Accutane; while it can be severely drying and can cause birth defects if taken during pregnancy, it represents a cure for truly-severe acne cases, says Anolik. “Used correctly, it is something of a miracle for people who’ve tried everything and failed,” he says.
Moderation and regularity are good things, but not everyone can sleep eight hours, eat three healthy meals per day, and drink plenty of water a day. Probably the most useful lifestyle changes one can make is to never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean one is, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately, it usually isn't permanent. It's just a mark that takes months to fade if left entirely alone.
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