Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It does not necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
Treatments like radiofrequency microneedling, lasers, and fillers can be effective to treat acne scars, but they can run you hundreds of dollars per treatment. And Hellman says you'll need six to eight treatments and a good amount of time before seeing results. "The process takes a good part of a year," she says. (Her office does offer some package options to help offset some of the cost.)
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.
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.
What you can do differently: When washing and conditioning your hair in the shower, tilt your head over to the side to keep the product's residue off your face, chest, and back as you rinse it away. And be sure to wash your face last when you're in the shower to make sure you haven't accidentally gotten any product on your skin that could break you out later.
A BHA product often cited includes salicylic acid, it must be between a pH between 3 and 4 to work. A BHA works to slough (to get rid of) off dead skin cells and encourage new skin growth. As a result, you may experience dry skin and scaliness around your acne, but this will dissipate over time as your skin begins to regenerate faster. Use this in a cleanser or spot treatment daily on the acne-affected areas of your skin.
3. You're eating spicy foods. Spicy foods often contain tomatoes and peppers, which contain acidic lycopene that can be an irritant to some people, throwing off their skin's pH levels and triggering breakouts. However, it isn't just spicy foods that can irritate your skin. Some people have an aversion to dairy, bread, or other types of foods — how your skin reacts to what you eat just depends on your own personal make-up. (Tip via Dr. Downie.)
The best way to fix them: You have a few options with these. The first would be to visit an aesthetician or a dermatologist for a deep-cleaning in a sterile environment. The second? Use an exfoliator. That could be a face scrub, retinol—which boosts skin cell turnover—or even facial cleansing brushes. If you go this route, just pick one. "You just don’t want to combine all them, since that’ll make skin sensitive," adds Dr. Hale.
Sometimes even though they wash properly and try lotions and oil-free makeup, people get acne anyway — and this is totally normal. In fact, some girls who normally have a handle on their acne may find that it comes out a few days before they get their period. This is called premenstrual acne, and about 7 out of 10 women get it from changes in hormones in the body.
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. 
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.