If you have scarring, your dermatologist may suggest surgery to help heal acne lesions and remove scarring. A laser can reshape scar tissue and reduce redness. Dermabrasion is a type of surgery that can remove surface scars and reduce the depth of deep scars. Another option is to transfer fat from one part of the body to the face. In some cases, a single treatment can help scarring. But for lasting results, several are often needed. There are also topical treatments for acne scarring.
We've all heard the foods that allegedly cause acne—chocolate, fried foods, pizza, caffeine, nuts. But Dr. Schultz reminds us that in large, statistically significant studies, these have not been proven to cause zits, but there are always exceptions. "If you break out when you eat chocolate, don't eat chocolate." Same with dairy, which again, has been shown in some cases to have an effect but no concrete cause-and-effect relationship exists.
No one factor causes acne. Acne happens when oil (sebaceous) glands are activated at puberty, stimulated by male hormones from the adrenal glands in both boys and girls. Oil is a natural substance which lubricates and protects the skin. Under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria, which live in everyone's skin and generally cause no problems, to multiply and cause surrounding tissues to become inflamed.
Scrubbing your face daily with grainy cleansers and exfoliating products can do more harm than good. When done too often, it can cause redness, inflammation, and irritation. “Exfoliating a pimple can pull away healthy skin cells and create an open wound and higher risk for scarring,” says Jessica Weiser, MD, from New York Dermatology Group. “Exfoliation should be done with caution, and not more than 2-3 times a week maximum.”
Cysts, which are also called blind pimples, are the very worst kind of acne. Basically, cysts are made up of sebaceous content (again, a gross combination of oil, dirt, and bacteria) that's trapped beneath the skin and has no way out—so they just live and grow under the skin, causing both a bump and, in some cases, pain. "These take longer to resolve on their own, are less responsive to topical treatments, and over time may lead to scarring," says Dr. Chwalek. Um, no thanks.
Acne appears when a pore in our skin clogs. This clog begins with dead skin cells. Normally, dead skin cells rise to surface of the pore, and the body sheds the cells. When the body starts to make lots of sebum (see-bum), oil that keeps our skin from drying out, the dead skin cells can stick together inside the pore. Instead of rising to the surface, the cells become trapped inside the pore.
There are a number of mild chemical peels available over the counter, but acne scar removal requires a stronger peel typically administered by a doctor or dermatologist. Trichloroacetic acid (TCA) peels are slightly stronger than alpha hydroxy acid (AHA) peels and may be used for acne scar treatment. The strongest type, phenol peels, may cause significant swelling and require up to two weeks of recovery time at home. Neither are recommended for people with active severe acne.
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.
Mix and match: "Since acne scars vary, so do treatments. Depending on the individual, I often use a multimodal approach to treating acne scars. First, I might use Fraxel treatments to smooth out the skin texture. Then, I often use a combination of the fillers Restylane and Belotero to lift the depressed scars. Finally, I perform a few punch excisions to surgically remove any deep scars that may remain," says Dr. Bowe. There are also topical treatment options for active breakouts that help prevent scarring, which can be used to get out ahead of things.
Unfortunately, sometimes our workout routines can have a negative effect on our skin and be a cause of acne. One of the top perpetrators of gym-related skin conditions is dirty workout equipment. Whether it’s a yoga mat, weights, or handle bars on a cardio machine, shared gym equipment is filled with bacteria and dirt. When this comes into the contact with the skin and sits on the surface, it can cause skin irritation. If you don’t shower immediately after working out, the mixture of sweat, body oils, and bacteria can remain heavy on the surface of your skin, settling back into your pores and causing the onset of pimples.
One study that gained a lot of traction in the acne vs. food debate appeared in the Archives of Dermatology in 2002. This research was based on the study of 115 people in Eastern Paraguay and 1,200 individuals in Papua New Guinea. The individuals in this study lived on a diet of self-raised lean meats and fresh plant foods, and scientists were astonished to record not a singular case of acne in either population. Based on this evidence, researchers concluded that the standard Western diet composed largely of starches and refined sugars might be a culprit between the high rates of acne in the Western world.
"I have seen many patients develop a tolerance to prescription acne treatments, and when they stop working, it’s devastating. Treating acne demands a more holistic approach that includes lifestyle, nutrition, and advances in topical skincare. I developed Outsmart Acne™ Clarifying Treatment to be used as part of a whole-person regimen to help skin stay consistently clear."Howard Murad, M.D., FAAD
Acne (acne vulgaris, common acne) is a disease of the hair follicles of the face, chest, and back that affects almost all teenagers during puberty -- the only exception being members of a few primitive Neolithic tribes living in isolation. It is not caused by bacteria, although bacteria play a role in its development. It is not unusual for some women to develop acne in their mid- to late-20s.