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've probably seen the Proactiv clear skin system advertised on television at some point over the last several years, but does it work? Proactiv is one of the better acne remedies out there for mild cases of inflammatory and noninflammatory acne, hormonal acne, and adult acne. The basic kit comes with a gentle glycolic acid and benzoyl peroxide exfoliator, a benzoyl peroxide pore cleanser, and an oil-free moisturizer that contains both glycolic acid and salicylic acid. Prices and shipping rates vary by location but Proactiv typically starts at $30.

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. 
The two laser treatment options above are great for acne scar removal, but aren't generally recommended as acne treatment. If you're still experiencing active acne breakouts and wondering how to get rid of acne with laser treatments, check out photodynamic therapy. It combats active moderate to severe acne while also diminishing older acne scars by using light energy to activate a powerful acne-fighting solution. Patients may require 2 or 3 treatments over several weeks and should expect some redness, peeling, and sun sensitivity. This treatment will cost between $2000 to $3500 per series.
Old marks still sticking around take patience and consistency to treat. One way to even out skin tone over time is with regular exfoliating. "[Exfoliating] is important in treating acne scars at home as it lifts dead skin and allows new skin to grow and proliferate," Dr. Moy explains. This exfoliator contains papaya enzymes to break down dead skin cells and microderm crystals to buff away acne scars. Aloe vera, coconut, and vitamins E and B nourish the skin simultaneously.
This is Dr. Schultz's number-one piece of advice. "Exfoliation is the most important thing you can do on a regular basis to be fighting acne both in terms of preventing it and treating it." His go-to ingredient? Glycolic acid. While a glycolic cleanser will help, a treatment that really soaks into your skin is what will give you the results you want. Try BeautyRx Advanced 10% Exfoliating Pads or Drunk Elephant T.L.C. Framboos Glycolic Night Serum.
"Fluctuation in hormones, such as before one's menstrual cycle, is the main cause," explains dermatologist Julia Tzu, M.D., of Wall Street Dermatology. Specifically, androgens (male hormones) like testosterone. This usually rears its ugly head in the form of deep (painful) cystic acne around the chin, neck, and back, says dermatologist Rebecca Kazin, M.D., F.A.A.D., of the Washington Institute of Dermatologic Laser Surgery and the Johns Hopkins Department of Dermatology.
Treating acne requires patience and perseverance. Any of the treatments listed above may take two or three months to start working (even isotretinoin). Unless there are side effects such as excessive dryness or allergy, it is important to give each regimen or drug enough time to work before giving up on it and moving on to other methods. Using modern methods, doctors can help clear up the skin of just about everyone.
Not for those with moderate to severe acne: Facials are effective in removing comedones (whiteheads and blackheads), but aren’t for those with many pimples, or inflammatory acne. Exfoliants help reduce comedones, but they frequently irritate pimples — causing them to become more inflamed and noticeable. Also, extracting inflammatory acne, like nodules and cysts, can be very challenging and when done improperly, can lead to scarring or further inflammation.
Some patients elect combination therapies and notice an improvement by alternating metronidazole and azelaic acid: using one in the morning and one at night. Sodium sulfacetamide (Klaron lotion) helps reduce inflammation. Other topical antibiotic creams include erythromycin and clindamycin (Cleocin). Topical ivermectin cream (Soolantra Cream, 1%) is also available.
Acne scar treatment: Energy-based skin resurfacing with a laser, radiofrequency, or an ultrasound device can help treat boxcar scars, according to Nada Elbuluk, MD, an assistant professor at the Ronald O. Perelman Department of Dermatology at New York University Langone Medical Center in New York City. “They all work by creating new collagen beneath the surface of the skin.” A series of treatments is likely needed based on the extent of scarring, she says. Chemical peels can also help but to a lesser extent. With either procedure, using a retinoid to increase cell turnover and further boost collagen can help improve results, Dr. Elbuluk adds.
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.
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.”
You can find it in many drugstore products—just take a peek at the label. Dermatologist Dendy Engelman, M.D. likes the Benzac line. "It's active ingredients are salicylic acid and East Indian Sandalwood oil—salicylic acid is a beta hydroxy acid that serves as a keratolytic agent (meaning it dissolves keratin). It unclogs pores by penetrating into the pore to dissolve dead skin cell accumulation and aids in shedding of the top layer of skin. East Indian sandalwood oil is a naturally occurring anti-inflammatory agent, which is new to the skin care scene. It soothes the skin and fights off inflammation that often accompanies breakouts."

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.
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.
See Your Doctor If You Get Large, Deep Breakouts or Acne Cysts: While smaller blemishes can still scar the skin, it's the big guys that usually do the damage. Because they extend deeper into the skin, deep nodular breakouts or cystic breakouts are more likely to destroy skin tissue and leave scars. Over-the-counter acne products just won't help these types of breakouts. Get an appointment with a dermatologist. Quick, effective treatment can help lessen the chance of developing deep scars.

If you really must do something about your pimple beyond washing your face and spot treating, ice or a cold compress can help reduce swelling. Wrap an ice cube or the compress in a soft tissue or cloth and apply it to your zit for 20-30 seconds at a time, a few times a day. In case of an emergency (like, prom), you can also see a dermatologist for a cortisone injection, which can help shrink the cyst down quickly in a day or two.
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"You want to calm the inflammation right away," Chiu says of treating newly popped pimples prone to scarring. She suggested asking your dermatologist to prescribe an anti-inflammatory acne medication like Aczone Gel. For a prescription-free solution, dermatologist Ronald Moy suggests treating newer scars with a product containing innovative growth factors that "stimulate collagen production immediately" and "should prevent any new scars from becoming old scars." This serum from Moy's product line, DNA EGF, uses growth factors clinically proven to speed up the growth of healthy skin cells. Both hyperpigmentation (not true scarring, but the spotty aftermath of a breakout) and atrophic scars (those crater marks more deep and sunken) benefit from a stimulating collagen boost because thickening the skin leads to less visibility of existing scars, Moy says.

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.
Mild rosacea may not necessarily require treatment if the individual is not bothered by the condition. Situations that are more resistant may require a combination approach, using several of the treatments at the same time. A combination approach may include prescription sulfa facial wash twice a day, applying an antibacterial cream morning and night, and taking an oral antibiotic for flares. A series of in-office laser, intense pulsed light, or photodynamic therapies may also be used in combination with the home regimen. It is advisable to seek a physician's care for the proper evaluation and treatment of rosacea.
Ablative lasers deliver an intense wavelength of light to the skin, removing thin outer layers of the skin (epidermis). In addition, collagen production is stimulated in the underlying layer (the dermis). Patients are typically numbed with local anesthetic and the ablation is done as an outpatient procedure. CO2 and erbium are the ablative lasers most often used for acne scar treatment.
15. Try the 3-step solution. If you have acne, dermatologists recommend fighting it with a three-step regimen: a salicylic acid cleanser, a benzoyl peroxide spot treatment, and a daily moisturizer. Benzoyl peroxide works by fighting the bacteria that causes acne. It causes an exfoliating effect that might cause some slight peeling and can dry out your skin. It's great for mild cases of acne, and you can get it without a prescription — many drugstore acne washes, creams and gels contain benzoyl peroxide. Prescriptions creams that contain higher doses of benzoyl peroxides such can also be prescribed by a doctor for more severe cases. Salicylic acid dries out the skin and helps exfoliate it to make dead skin cells fall away faster. It's good for mild cases of acne, and is available without a prescription. Many drugstore acne creams, washes, and gels contain salicylic acid, but stronger versions are also available in prescription form. It can dry up your skin and cause redness and peeling.

Retinoids: Retin-A (tretinoin) has been in use for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. Adapalene 0.1% is now available without a prescription. With proper sun protection, however, they can be used even during sunny periods. The combination medication known as Epiduo gel -- which contains the retinoid, adapalene, along with the antibacterial, benzoyl peroxide -- is applied once a day.
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