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The facialist, Tanya Eubanks, first exfoliates and steams my face. Then she uses her gloved fingers and a medical needle to perform extractions. And it is as painful as it sounds. The worst part is when I hear the noise of the needle pricking each cyst. It sounds like a tiny burst of air, which might not seem bad, but all I can think about is all the gunk coming out each time, and it makes me cringe. By the time she applies a mask to reduce redness, I've lost all feeling in my face.
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.

Clean your skin gently with a mild soap or cleanser twice a day — once in the morning and once at night. You should also gently clean the skin after heavy exercise. Avoid strong soaps and rough scrub pads. Harsh scrubbing of the skin may make acne worse. Wash your entire face from under the jaw to the hairline and rinse thoroughly. Remove make-up gently with a mild soap and water. Ask your doctor before using an astringent.
A good way to lessen constant acne is to improve your lifestyle choices. Try to maintain a fresh and healthy diet, incorporating a lot of fresh fruits and nuts. Try your best to avoid dairy products and any packaged foods. The more fresh the food is, the better it is for your skin. Exercise is also a vital component in the maintenance of healthy skin. Try to complete some form of cardio for at least 30 minutes a day, 3-4 times a week. If none of this is successful, consider consulting a dermatologist.

Caused by a bacteria that lives on our skin, acne comes to life at any age when our hormones cue our body to produce excess oil, essentially throwing fuel on the fire. “Our skins’ oils are a wonderful environment for acne bacteria to thrive in, unfortunately,” says Dr. Robert Anolik, clinical assistant professor of dermatology at the NYU School of Medicine. Add dead skin cells, dirt, stress, irritation from everything from diet to skin products, and a breakout is going to result unless you (constantly) work to prevent it.
A recent study has found a difference between strains of acne bacteria, which could have a significant impact on acne treatment down the road. This study, published in the Journal of Investigative Dermatology, found that these strains play a role in the severity and frequency of developing pimples. One particular strain of P. acnes was found among study participants that exhibited few symptoms of acne. Researchers came to the conclusion that this “good” strain of bacteria features a natural defense mechanism that fights back bacteria which might infect the cell. Researchers are hopeful that this discovery will help dermatologists better and more accurately prescribe effective acne treatment in the future, and reduce the severity of acne by ridding the skin of bad acne bacteria while preserving the good. 
For UVA protection, a sunscreen with a high UVA protection of PA+++ or higher of PA++++ as recommended, especially to treat PIE. PPD is the UVA equivalent of SPF; use a sunscreen with a minimum of PPD20. The PA+ system has a + that corresponds to a tier of PPD protection. Of note, different countries use different PA systems. Japan and Taiwan changed their PA system to a 4+ tier system while Korea uses a 3+ tier system.

Acne scars, on the other hand, are formed when there is damage to the skin which leads to abnormal collagen production, and usually appear raised or bumpy. "There are two types of acne scars: depressed and raised. Depressed scars may look like pits or craters, and raised scars may be firm and tender," explains Dr. Zeichner, who notes that unfortunately, these are permanent.
If a pore gets clogged up and closes but bulges out from the skin, you're left with a whitehead. If a pore gets clogged up but stays open, the top surface can darken and you're left with a blackhead. Sometimes the wall of the pore opens, allowing sebum, bacteria, and dead skin cells to make their way under the skin — and you're left with a small, red bump called a pimple (sometimes pimples have a pus-filled top from the body's reaction to the bacterial infection).

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation that develop deep inside hair follicles produce cystlike lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren't usually involved in acne.

This treatment is performed by dermatologists and combines two different technologies — microneedling and radio frequency — for big results in eliminating acne scars. First, a topical numbing gel is applied. Then the doctor uses the microneedling device to penetrate the skin and, simultaneously, radiofrequency is delivered right to the dermis. Downtime is usually around 24 hours and then you can resume wearing makeup to cover any lasting redness.
Isotretinoin: Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem. Isotretinoin is an excellent treatment for severe, scarring, persistent acne and has been used on millions of patients since it was introduced in Europe in 1971 and in the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, that has been unresponsive to conventional therapies like those listed above. If taken in sufficient dosage, it should eliminate the need to continue the use of prescription drugs in most patients. The drug has many potential serious side effects and requires a number of unique controls before it is prescribed. This means that isotretinoin is not a good choice for people whose acne is not that severe but who are frustrated and want "something that will knock acne out once and for all." In order to use the drug, the prescribing physician, the patient, and the supplying pharmacy must be enrolled in the online "iPLEDGE PROGRAM." Used properly, isotretinoin is safe and produces few side effects beyond dry lips and occasional muscle aches. This drug is prescribed for five to six months at a dosage that has a high likelihood of preventing the return of acne. Fasting blood tests are monitored monthly to check liver function and the level of triglycerides, substances related to cholesterol, which often rise a bit during treatment but rarely to the point at which treatment has to be modified or stopped.
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