"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
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.
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.
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.
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."
Rosacea is a common skin problem often called "adult acne." Faired skinned and menopausal women are more likely to have rosacea. Rosacea also seems to run in families. It causes redness in the center parts of the face and pimples. Blood vessels under the skin of the face may enlarge and show through the skin as small red lines. The skin may be swollen and feel warm.
"Leafy green vegetables and other brightly-colored fruit and vegetables which are rich in antioxidants and nutrients dampen inflammation and improve skin quality (studies have shown acne patients have higher oil production and lower antioxidant levels)," says Dr. Weiser. "Limit intake of dairy products, which can contain hormones and antibiotics that can worsen acne breakouts." Other skin-boosting superfoods include eggs, nuts, legumes, and quinoa.
Can’t use the good stuff: The best medications for clearing acne include topical retinoids like Differin and Retin-A. The strong chemicals that are used in exfoliants can cause severe inflammation and sun irritation when combined with these medications. This means that you will have to choose between facials or proper medications. The choice is yours.
Dilute white vinegar facial soaks or cleansing daily or weekly using approximately 1 part regular table vinegar to 6 parts water may be helpful. Vinegar helps as a natural disinfectant and can help decrease the number of yeasts and bacteria on the skin. Since vinegar may flare rosacea in some people, try a small test area before applying to the entire face.
Glycolic Acid is an alpha-hydroxy acid and an exfoliating ingredient that targets both acne and wrinkles at the same time. "The same way it helps acne, it helps wrinkles—by removing dead cells on surface. If you have effective exfoliation, you're stimulating collagen and hyaluronic acid," Dr. Schultz explains. This will help improve skin's texture and reduce fine lines and wrinkles while also clearing up breakouts.
Hormone changes as an adult. The menstrual cycle is one of the most common acne triggers. Acne lesions tend to form a few days before the cycle begins and go away after the cycle is completed. Other hormone changes, such as pregnancy and menopause, improve acne in some women. But some women have worse acne during these times. Stopping use of birth control pills can play a role as well.
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.
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.
In unusual cases, a skin biopsy may be required to help confirm the diagnosis of rosacea. Occasionally, a dermatologist may perform a noninvasive test called a skin scraping in the office to help exclude a skin mite infestation by Demodex, which can look just like rosacea (and may be a triggering factor). A skin culture can help exclude other causes of facial skin bumps like staph infections or herpes infections. Blood tests are not generally required but may help exclude less common causes of facial blushing and flushing, including systemic lupus, other autoimmune conditions, carcinoid, and dermatomyositis.
This article was medically reviewed by Hilary Baldwin, MD. Baldwin, medical director of the Acne Treatment Research Center, is a board-certified dermatologist with nearly 25 years of experience. Her area of expertise and interest are acne, rosacea and keloid scars. Baldwin received her BA and MA in biology from Boston University. She became a research assistant at Harvard University before attending Boston University School of Medicine. She then completed a medical internship at Yale New Haven Hospital before becoming a resident and chief resident in dermatology at New York University Medical Center.
True acne scars — as in indentations in the skin like ice-pick scars — can only be erased with professional procedures like microneedling or lasers. Fortunately, what most of us refer to as “scars,” according to Julia Tzu, M.D., founder and medical director of Wall Street Dermatology, are actually marks caused by post-inflammatory hyperpigmentation (brown spots) or post-inflammatory erythema (red spots), that will fade over several months or years. Fortunately, there are products that can speed up the process.
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.