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Isotretinoin (previously known as Accutane) is the most effective form of acne therapy and the only one that can actually result in a cure for your acne. After finishing a course 80% of people never see acne again. It works so well because it unclogs pores, kills bacteria, reduces oil production and reduces inflammation. It is taken as a daily pill. Isotretinoin has numerous rare and potential side effects that has made it a controversial choice, but for patients with severe acne there is often no other option. Patients taking isotretinoin must also be on highly effective birth control as the drug can cause birth defects. Isotretinoin can only be taken under close medical supervision.
Acne scar treatment: “You have to take all of these factors into account, and I always advise people that multiple treatments will be needed, and even after a year or two, a 50 percent improvement may be all they get,” Dr. Levine says. Still, it’s important to remember that less visible or deep scars can still make a difference to a person’s self-esteem. “It takes patience, but every scar can be improved, and even if the results are not perfect,” says Dr. Hellman.
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.
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.

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.
"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.
When you get acne, there is intense inflammation of your facial skin and there is a loss of collagen. Collagen is the protein fiber, one of the components of skin which gives skin its elasticity. When you pick or squeeze your pimples, it leads to further inflammation and injury to your skin. It also leads the bacteria and pus in your pimple go deep down into your skin resulting in more loss of collagen which means even deeper scars on your face.
The inflammation caused by your breakout can cause more than just the pimple you see on the surface, it can also cause damage below the skin. "The inflammatory response produces a loss in collagen and the overlying skin will collapse and leave a depression," Howard Sobel, M.D., a NYC dermatologist and founder of DDF Skincare, tells SELF. To get rid of these tiny pockmarks, Dr. Karolak relies on a TCA Cross chemical peel. TCA stands for trichloroacetic acid. "We use a little applicator and go into the hole with chemicals to cause a burn. That causes the wall of that ice pick to heal itself and close in on itself," explains Dr. Karolak.
Acne scars take many different forms. You might see tiny pockmarks, a swollen keloid, or a discolored area on the skin. And just like the types of scars vary, there isn't a one-size-fits-all fix. Your dermatologist can use a combination of treatments including lasers, chemical peels, or fillers to minimize the spots. "Once there is scarring you can't get the skin back to the way it was before," says Dr. Karolak. "But we can get it to look significantly better, so that [clients] feel more comfortable in social environments."
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.

Avoid touching or rubbing your face, since that can make acne worse. Try to keep your cell phone from touching your face, too. Use earbuds instead of having the phone against your skin. Also, don't lean your face on your hands, which may carry oils and germs that can irritate blemishes. Sweat can also make acne worse. Sweaty after exercise? Wash up.


In dermatology, PDT with the photosensitizer Levulan Kerastick (20% delta-aminolevulinic acid HCl) is used for the treatment of very early, thin skin cancers called actinic keratoses (AK). The initial approval was specifically for the treatment of actinic keratosis of the face and scalp with a combination of an application of the photosensitizer followed by a timed exposure to a special blue light source. PDT is also used for acne, rosacea, skin cancer, sun damage, cosmetic skin improvement, oily skin, enlarged sebaceous glands, wrinkles, rejuvenation (anti-aging), warts, hidradenitis suppurativa, psoriasis, and many other skin conditions.
Use retinoid skin products. Retinoids are vitamin A derivatives which are used in a wide array of skin care products treating fine lines and wrinkles, skin discoloration, and acne. Retinoids boost collagen production and speed up cell turnover, making them a great choice for targeting acne scars. These creams can be a little on the pricey side, but they are highly recommended by dermatologists for their fast, effective results.
Consider exfoliating with baking soda. Baking soda can be used to exfoliate the skin and minimize the appearance of acne scars. All you need to do is mix one teaspoon of baking soda with two teaspoons of water to form a liquid paste. Apply this paste all over your face and use gentle circular motions to rub the baking soda into the skin, concentrating on the scarred areas, for about two minutes. Rinse off with warm water and pat the skin dry. [10]
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.
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