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.
You may have heard the age old question, "does makeup cause acne?". While wearing makeup can exacerbate acne flare ups, it is not necessarily the case. Some support the fact that that cosmetics can fill up your pores, worsen pimples, and prevent your skin from “breathing”. The truth is, whether or not makeup worsens acne is highly individualized. While excessive use of foundations, concealers, and other cosmetics can work their way into and block up your pores, making sure to clean your face of such products before working out or going to bed lessens the likelihood of makeup blockages.
You can apply all the topicals you want, but unfortunately, most treatments you'll find at the drugstore won't help with acne scars, Hellman says. However, she notes that derma rollers (at-home microneedling devices) may help with acne scarring. If you're on a tight budget, that should be your first stop. You can get one on Amazon for less than $20. (Use yours once a week followed by a Vitamin C serum for best results—here's how to pick the best ones.)
Don't Squeeze, Pop, or Pick at Pimples: Pass up the temptation to pick or squeeze a pimple. Doing so can force debris deeper into the dermis, spreading an infection to other tissue and worsening inflammation. This is especially true for deep, serious blemishes like nodules and cysts. Remind yourself that popping pimples can extend the healing time and ups the chance of it leaving a permanent scar. Allow the blemish to heal on its own. If you've already picked at a blemish, take steps to help heal it and minimize skin damage.
While SPF is a must, some sunscreens can trigger breakouts. You want to look for oil-free and non-comedogenic formulas that won't clog pores,” says Karen Hammerman, MD, from Schweiger Dermatology. Options from brands like Elta MD and Peter Thomas Roth, which are recommended by the pros, are specifically tested on acneic skin so you can get your dose of SPF without having to worry about clogged pores.
If saving babysitting money for a year still won't make a dent in the funds you need to get a fancy laser treatment that will blast away acne scars, don't be discouraged. Thanks to the geniuses behind drugstore brands like La Roche-Posay, there's a new class of products that feature smart technology and better-than-ever ingredients to help treat dark marks and acne scars — at an affordable price. “La-Roche Posay’s Pigmentclar line is unique in the way it combines exfoliating lipohydroxy acid (LHA), phe-resorcinol, and ferulic acid, which are both strong brightening ingredients, all together to form a topical product that’s seriously effective," says dermatologist Dr. Mona Gohara.
Over-the-Counter Creams and Lotions. Retinoid creams or lotions can help clear your skin and also lessen wrinkles. Products made with sulfur can be good for the occasional spot treatment. Benzoyl peroxide is another acne fighter. Use benzoyl peroxide products only occasionally, because they can dry out your skin, Day says. You could also try a milder benzoyl peroxide product.
What you can do differently: Make sure all the skin care products you're using are labeled "noncomedogenic," which means your makeup or skin care has been specifically formulated not to clog your pores. That said, even if the product is "noncomedogenic," if you're using it continuously and your breakouts continue to get worse, make an appointment with your dermatologist, as you could be allergic to another ingredient in the product that is causing your issues.

Many people also report a direct relation towards dairy consumption and acne, with many reporting a complete clear up after cutting dairy out of their diet. While it is an effective way to deal with the problem, your body does still require the nutrients from dairy to remain healthy, so if you do cut it out, make sure you find other sources for the nutrients, including a supplement.


Laser resurfacing. This procedure can be done in the doctor's or dermatologist's office. The laser removes the damaged top layer of skin and tightens the middle layer, leaving skin smoother. It can take anywhere from a few minutes to an hour. The doctor will try to lessen any pain by first numbing the skin with local anesthesia. It usually takes between 3 and 10 days for the skin to heal completely.
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.
If you decrease overall inflammation in your body, you will decrease the inflammation in post pimple regions. Therefore, incorporate the anti-inflammatory lifestyle habits such as: drink plenty of water (10-12 cups a day), completely eliminate sugar and processed foods, stabilize your blood sugar with anti-inflammatory/low glycemic index diet, manage stress, meditate, do yoga, take supplements such as fish oil, zinc, vit C and B complex.

Good Genes All-In-One Lactic Acid Treatment is formulated with high potency, purified grade lactic acid that immediately exfoliates dull, pore-clogging dead skin cells, revealing smoother, fresher, younger-looking skin. Fine lines appear visually plumped while the skin looks more radiant. With continued use, the appearance of stubborn hyperpigmentation and the visible signs of aging are reduced for a healthier-looking complexion. Perfect for all skin types and all ages, this treatment is enhanced with licorice for brightening, Good Genes clarifies, smooths, and retexturizes for instant radiance.
Treatment of acne scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed acne scars and laser resurfacing to smooth out shallow acne scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and the procedures may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne scars.
All three dermatologists suggested that the best solution for boxcar or rolling scars are in-office procedures. Dr. Day, for instance, suggestedEndyMed Intensif, which uses microneedle radio frequency to remodel the skin by delivering heat into the skin to stimulate collagen and elastin production. For at-home treatments, however, Dr. Day turns to Olay's DIY microdermabrasion kit. It comes with both a foam head and crystal polisher, which claims to exfoliate 7 times better than a typical scrub and thoroughly cleanses the face to prevent future breakouts.
Medications prescribed for mental illnesses can have the unfortunate side effect of causing acne. Some antidepressants have been purported to trigger acne breakouts, including brands like Wellbutrin and Lexapro. Those diagnosed with bipolar disorder are often prescribed lithium to help handle their condition. Unfortunately, lithium can cause acne breakouts. Often the benefits of these types of drugs outweigh the negative onset of acne, but it’s important to look into various options to determine what might have the minimal amount of side effects.

When it comes to scarring, many doctors will tell you that prevention is key. Wearing sunscreen daily is critical, says Heidi Waldorf, a New York City-based dermatologist, and this one from Elta MD is her favorite. "It contains niacinamide, which reduces inflammation, and it's oil-free, which makes it excellent for daily use for acne-prone patients," she says.
13. You're still a sun-worshipper. You're probably already aware that lying out in the sun and going to tanning beds cause skin cancer, but if that still hasn't stopped you from hitting the beach without sunscreen or the proper protective gear (aka that chic sun hat), perhaps this will. Contrary to popular belief, the sun isn't healing your acne, it's actually making it worse. What happens is, as your face gets red from the sun, it makes any breakouts you might already have blend in, creating the appearance of clearer skin. But what's really going on is the sun causing your skin to dry out and triggering more oil production, which can lead to more zits.

Many people also report a direct relation towards dairy consumption and acne, with many reporting a complete clear up after cutting dairy out of their diet. While it is an effective way to deal with the problem, your body does still require the nutrients from dairy to remain healthy, so if you do cut it out, make sure you find other sources for the nutrients, including a supplement.


“After sweating, immediately use an exfoliating cleanser to help keep your pores clear and remove excess oil,” says Dr. Zein Obagi of ZO Skin Health. Try keeping Neutrogena Rapid Clear Treatment Pads in your gym bag or locker for those times you need an on-the-go cleanse. These will remove any leftover dirt while treating your skin with acne-fighting salicylic acid.
Steroid injections: If you feel a stress pimple rearing its ugly head, a steroid shot can be administered the same day you call your derm because the process is very fast. Not only does it immediately reduce the inflammation of an existing zit, but cortisone can also help thick scars (keloids) appear softer and flatter. "These are specifically for raised scars, however," says Dr. Shah. "It'll help flatten out the scar, but it won't do anything to any discrepancies in the texture."
For women who break out mainly around their menstrual cycle, some birth control pills can help. Research shows that these pills can clear acne by slowing down overactive oil glands in the skin. Sometimes, birth control pills are used along with a drug called spironolactone to treat acne in adult females. This medication lowers levels of the hormone androgen in the body. Androgen stimulates the skin's oil glands. Side effects of this drug include irregular menstruation, breast tenderness, headache and fatigue. Spironolactone is not appropriate therapy for all patients.
You've probably seen those tiny glass jars filled with liquid and some solid sediment at the bottom—sometimes it's pink, sometimes it's white, and (in the case of my favorite product) sometimes it's flesh-tone. The solid in the jar is usually a mix of drying ingredient like camphor, sulfur, and zinc oxide, but many brands throw in a few little extras. Cult-favorite Mario Badescu Drying Lotion adds calming calamine and exfoliating salacylic acid to their formula, while my favorite, End-Zit Acne Control Drying Lotion, keeps it simple, but comes in several shades so that it conceals your breakout while it treats it.
3. You're eating spicy foods. Spicy foods often contain tomatoes and peppers, which contain acidic lycopene that can be an irritant to some people, throwing off their skin's pH levels and triggering breakouts. However, it isn't just spicy foods that can irritate your skin. Some people have an aversion to dairy, bread, or other types of foods — how your skin reacts to what you eat just depends on your own personal make-up. (Tip via Dr. Downie.)
People trying to lose weight or build muscle are often encouraged to take photos along their journey—there's nothing more motivating than visible progress. I applied the same logic to my breakout. I took a photo of it at its worst to start, then continued. The second photo you see is one week after doing all of the above—you definitely see remnants of the breakout but they are not as active nor as inflamed (they're also flat and easy to cover up with my BFF, concealer). The last photo is four weeks later after me following these tips religiously—all clear.
Don't Squeeze, Pop, or Pick at Pimples: Pass up the temptation to pick or squeeze a pimple. Doing so can force debris deeper into the dermis, spreading an infection to other tissue and worsening inflammation. This is especially true for deep, serious blemishes like nodules and cysts. Remind yourself that popping pimples can extend the healing time and ups the chance of it leaving a permanent scar. Allow the blemish to heal on its own. If you've already picked at a blemish, take steps to help heal it and minimize skin damage.
To get rid of acne, wash your face with a pH balanced cleanser twice a day to eliminate acne-causing bacteria. You should also exfoliate your face at least once a week with a physical or chemical exfoliant which will remove dead skin cells that clog pores. Applying a benzoyl peroxide cream to your acne before you go to bed can also help get rid of breakouts.
17. Less is more. Too many products can irritate and too many steps may tempt you to skip. When it comes to your skin, more is definitely NOT more. In other words, trying a bunch of different remedies at once won't boost your chances of making the zit disappear — more likely, it'll just wreak havoc on your skin and turn a teeny-tiny pimple into a red, blotchy mess.
If you’re dealing with an acne breakout, avoid touching your face or popping any pimples to prevent the acne from spreading. Wash your face no more than twice a day and moisturize regularly in order to clear your skin up. Make sure you're eating plenty of fruits, vegetables, fish, and nuts, and stay away from sugary drinks and fast food. You can also try treating stubborn acne with benzoyl peroxide cream, salicylic acid, and tea tree oil. For tips on how to treat acne with vitamins, astringents, and natural antihistamines, read on!
Lowering stress levels can have an immediate beneficial effect on the appearance and frequency of acne breakouts. It’s important to maintain a regular exercise routine, get enough sleep every night, and practice stress control methods. Meditation has been shown to alleviate the effects of various skin conditions like eczema and psoriasis, and could have a positive effect on the symptoms of acne.
What you can do differently: For starters, stop going to tanning beds. Period. And if you are in the sun, make sure to slather on a titanium dioxide- or zinc-based sunscreen (these are natural sun protectants and their formulations usually contain fewer chemicals, so they won't break you out as easily), and wear a sun hat or ball cap to shield your facial skin from harsh rays.

Your body is capable of taking care of your scars and they will get lighter with time. However, if you expose them to the sun, their healing process will slow down and the scars will get darker. So, avoid the sun. If it’s essential to go out in sun, use sunscreen to guard your skin and also cover yourself with hat, umbrella, clothes- whatever you can lay hands on.


Because I'm constantly testing out new products, I don't often end up with "empties" (as in, products so good you've emptied out the bottle). However, I loved Sunday Riley's Good Genes so much I literally twisted the pump off and stuck my finger in it to try and get every last bit. The magic potion's main ingredient is lactic acid, which exfoliates away dead skin cells — key for clearing pores, fading scars, and revealing fresh skin on the surface.

However, if you have a scar, you’re dealing with permanent skin damage that needs treatment in order to disappear. An acne scar changes the texture of the skin. If acne has left indentations, or raised spots, the damage has occurred at a deeper level in the skin. This “cobblestoning” effect indicates scarring that needs more than a surface-level treatment.
When answering the question "why does stress cause acne?", it is important to note that stress is not the definitive catalyst for breakouts, but rather a factor that worsens a previously existing condition. When stress levels are consistently heightened, adrenal glands signal the production of the male hormone androgen, which signals sebaceous oil glands to secrete more sebum. As this excess oil builds up, acne is more likely to develop. As women produce a larger percentage of androgens in the adrenal gland than men, stress more commonly has an affectation on acne frequency in women.
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