How big of a scar you'll be left with after a blemish (if any at all) depends on the depth of the breakout, Schlessinger says. "As our pores become engorged with oil and form a blemish, the pore may swell and collapse the follicle wall," he says. "The depth of the resulting lesion determines the severity of the scar. Shallow lesions usually heal quickly and leave little-to-no scarring, while deeper lesions spread to nearby tissue, causing a more pronounced scar."
Unfortunately, subtype 2 rosacea was historically referred to as “acne rosacea,” reflecting the belief that the two conditions were related. Although it is now known that there is no connection between acne and rosacea, the term can still be found in older literature about the disease, as well as in occasional reports today. This has often led to confusion by the public, and rosacea sufferers with bumps and pimples may mistakenly self-diagnose themselves as having acne. The two disorders require different treatment, however, and acne medications may cause rosacea symptoms to get worse.
Rena Levi is known for her sensitivity towards clients with severe acne and problem skin. In 1968 she moved from Israel to the U.S. and studied with Christine Valmy at the European Esthetic Skincare Institute. In 1975, she opened the Rena Levi Skin Care Salon in New York City. In 1980, she moved to Albuquerque, NM, where she managed the skin care center for Eleganza Salon and further developed and refined her practice. It was there that she became well known for her ability to treat what many considered impossible skin, while also teaching budding estheticians and skin practitioners at the same time, including the then-president of the New Mexico Board of Cosmetology. Here, Levi shares with us one of her most popular facial protocol treatments for treating clients with moderate to severe acne.
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.
"Retinoids work over time by continuously increasing cell turnover which in turn helps fade hyperpigmentation," says Dr. Idriss. Dr. Shah agrees, noting that Retin-A helps with acne marks by causing your skin cells to "divide more rapidly and pushing out cells with discolored pigments." Since retinoids make your skin super-sensitive to the sun, it's best to not only wear SPF, but to also apply a treatment like RoC Retinol Correxion Sensitive Night Cream before you go to bed.
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!)
You’re a typical hormonal-acne patient if, well past puberty, you’re breaking out around your period, usually in the jawline area, says Anolik. A consistent routine is key—as is enduring a waiting period of two to three months for said routine to work, he continues: “Even powerful prescription treatments can take a few months to really clear things up, and that’s our biggest challenge. People who get frustrated and don’t stick to their treatments get stuck in a cycle of trying and quitting too early, and feeling like nothing works.”
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Contrary to popular belief, acne isn't caused by a harmful diet, poor hygiene, or an uncontrolled sex drive. The simple truth is that heredity and hormones are behind most forms of acne. Swearing off chocolate or scrubbing your face 10 times a day won't change your predisposition to this unsightly, sometimes painful, and often embarrassing skin problem.
Our second primary treatment, the Icon Laser, offers patients the best results for smoother skin. Laser therapy breaks up the scar with laser light. It punches holes in the collagen without ever piercing the skin. Because it doesn’t break the skin, recovery tends to be quicker after this treatment. Also, lasers penetrate deep into the skin causing long-lasting results.
A U.K. survey found that on average single men only change their sheets four times a year. And while we certainly hope you are swapping out your linens much more frequently, dirty pillowcases can lead to clogged pores. Nasty as is sounds, bacteria can build up on your bed and your face rubs around on it for a good eight hours a night. Well, that just can’t be good. If your skin is oily, change those sheets (or at least your pillowcases) twice a week. It might be a pain, but isn’t a clear complexion worth it?
Doxycycline is another of the tetracyclines that is equally effective in treating acne. It comes in generic versions and also as the branded Doryx and Acticlate which are easier on the stomach. Originally FDA approved for the treatment of rosacea, Oracea is a non antibiotic dose of doxycycline that is often used as an acne treatment, as well. Taken orally, it can be used as solo therapy or in combination with a topical acne treatment regimen. More severe cases of acne might need higher doses of doxycycline, but since Oracea is not an antibiotic, many patients can be “down-graded" to Oracea after improvement and it is suitable for longterm use as it does not cause antibiotic resistance.
Blackheads are a mild form of acne that appear as unsightly, open pores that appear darker than the skin surrounding them. They get their dark appearance from a skin pigment called melanin, which oxidizes and turns black when it's exposed to the air. Blackheads aren't caused by dirt, but by sebum (oil) and dead skin cells blocking the pore. If the pore remains open, it becomes a blackhead; if it's completely blocked and closed, it turns into a whitehead.
12. Step away from your hands. You know how you rest your face on your hand while you're studying? That might be the reason for those blemishes on your cheek or jaw. You're constantly touching things that have germs—anything from your phone to your locker—so putting your hands on your face for a long period of time can cause dirt and bacteria from anything you touch to get into your pores.
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.
Best used for treating hyperpigmentation, these products — packed with glycolic acid — promote cellular turnover to remove the top layers of the skin revealing a brighter, fresh complexion, says New York City-based dermatologist Dendy Engelman. "Glycolic acid is the smallest acid in size," she says. (This means it can get deep into the skin.) "It is very effective in breaking down skin cells and removing dead particles," says Engleman. "It boosts collagen production and elastin production with the removal of waste and dead skin cells." Bottom line: By removing these dead cells, healthy, glow-y skin is revealed.
Toning. After you wash and exfoliate you should apply a toner to the face that will help tighten the pores so oil and dirt cannot become trapped and create a home for harmful bacteria. Toners designed for acne sufferers are readily available at drugstores, but you can also apply products like apple cider vinegar or witch hazel. Apply toners with cotton balls and allow them to sit on the skin rather than rinsing them away.
Doctors infrequently prescribe isotretinoin for severe and resistant rosacea. Often physicians prescribe it after multiple other therapies have been tried for some time and have failed. Patients take a daily capsule of istotretinoin for four to six months. Typically, isotretinoin is most commonly used in the treatment of severe, common acne called acne vulgaris. Close physician monitoring and blood testing are necessary while on isotretinoin. Generally, at least two forms of birth control are required for females using this medication, as pregnancy is absolutely contraindicated while on isotretinoin.
There are several low-level light devices designed as at-home acne remedies on the market — but do they really work? Some, like the Zeno electronic "zit-zapper" are FDA-approved as acne remedies, but reviews with these products are typically mixed. Even the best acne treatment won't work for everyone, as the severity of the acne, types of acne and quality of the device are all factors. Ask your dermatologist for a recommendation if you're considering purchasing an at-home light device to treat your acne.
Breakouts can come and go, but the scars they leave behind can linger for years (or more). You've probably been told, "Don't pop your pimples, or you'll end up with a mark." But recently, I learned that the most common acne scars have nothing to do with your tendency to squeeze zits. "Popping pimples doesn't cause scarring," Mark Karolak, D.O., a board-certified facial plastic surgeon at Reflections Center for Skin and Body, tells SELF. "If it's just a whitehead and blackhead on the surface, it can be popped without creating any scarring."
What you can do differently: Wipe your face, chest, and back down before you work out with facial wipes, like Neutrogena Makeup Remover Cleansing Towelettes, to remove your makeup. Then, if you don't have time to shower immediately after the gym, use another fresh facial wipe to clear away any sweat and bacteria on your skin to minimize the chance of new pimples popping up.
Have good hygiene. There is a balance between under-washing and over-washing skin. Under-washing leaves excess skin cells, oil, bacteria, and other debris on the skin, potentially clogging pores and creating blemishes. Over-washing irritates and dries the skin, contributing to excess oil production and more breakouts. Refrain from washing problem areas more than twice a day. When washing, use gentle cleansers with smooth grains and light scrubbing to exfoliate. Avoid products containing large grains, such as almond or apricot shell fragments, that will potentially damage or irritate the skin.
While over-the-counter products don’t treat the hormonal component of acne, salicylic acid—a.k.a. willow bark, a.k.a. what aspirin is made of—addresses all other aspects involved in a breakout. “It works,” says Anolik, who recommends using salicylic acid-based products in conjunction with benzoyl peroxide preparations that target acne bacteria with greater strength. Benzoyl peroxide can definitely cause dryness and irritation; if you decide not to use it, know that you’ve got to be even more vigilant about the bacteria on your skin, so cleanse and treat more often. Tea-tree oil preparations like Tammy Fender’s Clarifying Dermagel ($72, goop.com) help. Burt’s Bees Natural Solutions Acne Spot Treatment ($10, burtsbees.com) combines tea tree and salicylic acid for powerful (yet easy on skin) results.
Many over-the-counter lotions and creams containing salicylic acid or benzoyl peroxide are available to help prevent acne and clear it up at the same time. You can experiment with these to see which helps. Be sure to follow the instructions exactly — don't use more than you're supposed to at one time (your skin may get too dried out and feel and look worse) and follow any label directions about allergy testing.
Some people swear by the disinfecting power of tea tree oil for acne treatment. It can be applied either full strength or slightly diluted with water directly onto pimples. Use a small amount on a clean cotton swab or cotton pad and dab on the affected areas immediately after cleansing. Because tea tree oil can be drying, you might choose to use both tea tree oil and coconut oil for acne as part of your clear skin regimen.
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Avoid getting sunburned. Many medicines used to treat acne can make you more prone to sunburn. Many people think that the sun helps acne, because the redness from sunburn may make acne lesions less visible. But, too much sun can also increase your risk of skin cancer and early aging of the skin. When you're going to be outside, use sunscreen of at least SPF 15. Also, try to stay in the shade as much as you can.
Lasers. Your dermatologist can use a laser to remove the outer layer of your skin, contour areas of acne scars, or lighten redness around healed acne lesions. Various types of lasers are used, depending on whether the acne scar is raised or flat. More than one laser treatment may be required and, depending on the laser used, you may need to several days to heal.
Cleansing . Create a cleansing routine, washing your face each morning and before bed. This alone can significantly reduce acne breakouts. Wash your face for at least a minute to ensure that all bacteria are killed. Make sure to wash away any makeup before going to bed as these products can increase acne outbreaks while damaging the skin. Use oil free products that will not clog the pores during this step. Also wash any other areas where acne appears during this ritual such as your chest, back or shoulders.
Take an extra five minutes before hopping on the treadmill to completely wash your face and remove your makeup to minimize the risk of breakouts. "Sweat is released through visible pores in the skin," says dermatologist Dr. Janelle Vega. "When makeup covers those pores, that barrier doesn't allow the sweat to make it to the surface of the skin, which can lead to clogged pores. The trapped debris and bacteria are a perfect breeding ground for acne bumps and zits."
If you look in the mirror and see a pimple, don't touch it, squeeze it, or pick at it. This might be hard to do — it can be pretty tempting to try to get rid of a pimple. But when you play around with pimples, you can cause even more inflammation by popping them or opening them up. Plus, the oil from your hands can't help! More important, though, picking at pimples can leave tiny, permanent scars on your face.
Some of us are more at risk for acne scars than others, although there is no way to say for sure who will develop scars after acne and who will not. These scars tend to occur more commonly after inflammatory acne, especially when it’s not treated early and aggressively. Other risks include picking squeezing or popping zits. (But whatever you do, never, ever pop a zit in the “danger triangle.”) Genetics can also play a role. “The earlier that acne gets treated, the better,” says Dr. Levine. “If somebody has active acne at 13 or 14, we want to jump on it.” Some scar resurfacing treatments also help keep acne at bay, she says. Dr. Imber adds that Youth Corridor RetinUltimate Transforming Gel applied twice daily can help treat active acne and prevent recurrence. Next, find out how to get rid of acne once and for all.
Those who consume a bevy of seafood, seaweed, and iodized salt experience high iodine levels. These iodine levels have also been purported to trigger acne flare ups. Word spread about iodine’s potential for causing skin issues in the 1960s, and it’s had a bad rap ever since. However, recent studies have fought against this pervasive thought, as some studies have seen no difference between acne in those who were given iodine and those who weren’t. It’s important to take these studies with a grain of salt, and understand that depleting your diet of iodine can have negative effects on holistic health. Iodine is essential for proper thyroid function, and is responsible for the manufacture of T3 and T4 thyroid hormones and it’s important to maintain proper levels of iodine in your diet.