But, sometimes a particularly aggressive blemish is truly on a mission to leave its permanent mark. "Acne scars occur when normal tissue in the skin is destroyed and replaced with fibrous tissue. You can think of an acne lesion as a wound. When the damage caused by acne is severe, the body can respond by creating too much tissue or too little tissue. The production of too much tissue forms a keloid or a hypertrophic scar, and too little tissue leads to that depression in the skin, or atrophic scar. The deeper and more inflamed the acne lesion, or the more that it is picked or squeezed, the more likely it is to scar," says Dr. Bowe.

Photodynamic therapy (PDT) is a procedure that treats precancerous cells, in addition to other types of cancer cells. The medical treatment does this with the help of a photosensitizing drug and a light source that activates the applied drug, destroying cancer cells. PDT is approved to treat non-small cell lung cancer, esophageal cancer, and Barrett's esophagus. It's used to treat actinic keratosis, as well as acne, rosacea, skin cancer, sun damage, oily skin, wrinkles, warts, psoriasis, and enlarged sebaceous glands.
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.
Many over-the-counter lotions and creams containing salicylic acid or benzoyl peroxide are available to help prevent acne and clear it up at the same time. You can experiment with these to see which helps. Be sure to follow the instructions exactly — don't use more than you're supposed to at one time (your skin may get too dried out and feel and look worse) and follow any label directions about allergy testing.
All right!...Worked for me...I have scarring from acne (fun!...Right before bed, I washed my face and grabbed one pad and started swiping my face with it and loved the feeling, the pad smells like sugar water, that was the first thing I noticed right off the bat, I found that to be very calming, also, while I was swiping I was getting this exfoliating type of sensation which I loved because I found it wasn't overwhelming on my face.
Birth controls can affect hormone levels, and some women may be finding that their birth control is causing acne due to increases in sebum production. This rise in sebum can affect the skin, clogging up pores and leading to acne. According to The Huffington Post, birth control pills that contain androgen-based progestin have been indicated as the most likely offender.

Steroids have long been known to cause acne. These drugs are generally taken without a prescription in order to gain muscle, but there are instances in which women are prescribed steroids for rare conditions. Steroids cause hormonal changes, and as the androgen hormones increase, so too does oil production. The more sebum, the greater chance of clogged pores. Steroids might also accelerate the growth of P. acnes, which can make pimples and inflammation worse.


The best way to fix them: Since they're more closely related to bacteria than your hormones or a lack of exfoliation, papular pustules require a different plan of attack entirely. "Inflammatory acne types really respond to antibiotics, either topical or systemic," says Dr. Hale. These, of course, require a trip to your dermatologist. To tide you over, you could also try applying hydrocortisone cream, which temporarily takes down redness and swelling. But in the long run, it won't do much to make these disappear completely or keep them from popping up again.
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.
The best way to fix them: This is where the classic zit treatments come into play. "Topical medications are the best way to treat a lesion like this," says Jennifer Chwalek, M.D., a dermatologist at Union Square Laser Dermatology in NYC. "Benzoyl peroxide-, salicylic acid-, or sulfur-based products can help to dry it up." She prefers salicylic acid over benzoyl peroxide for these, since the latter can cause irritation, dryness, and even post-inflammatory hyperpigmentation (a.k.a. dark spots) in those with darker skin tones. Retinol works well for these, too.
Oral contraceptives: Oral contraceptives (birth control pills), which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been shown to have modest effectiveness in treating acne. Those that have been U.S. FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary care physicians or gynecologists when recommending these medications.
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