Stress: Being under stress can boost the production of male hormones called androgens. These hormones, which naturally occur in both men and women, stimulate oil production and can worsen acne. Experts believe that an excessive amount of androgens, a condition called hyperandrogenism, may be a significant cause of late-onset acne in women who didn't have acne as adolescents.
Acne occurs when the small pores on the surface of the skin become blocked with oil, dead skin cells, and bacteria. Each individual pore on the skin opens up to a follicle beneath the epidermis. Within these follicles lie a singular hair and a sebaceous gland. The sebaceous gland produces sebum, an oil designed to keep your skin lubricated and soft. However, when hormonal changes and other factors cause the gland to produce an excess of sebum, the oil will be pumped through the follicle, and may pick up dead skin cells and P. acnes bacteria on its way out. Should these substances clump together, a plug will form. As this plug starts to press up against the surface of the skin, the body responds with an accumulation of red and white blood cells to combat any infection, and this results in inflammation and redness. Acne can occur on the face, back, neck, chest, arms, and buttocks, and any other skin area with a saturation of sebaceous pores.
When it comes to scarring, many doctors will tell you that prevention is key. Wearing sunscreen daily is critical, says Heidi Waldorf, a New York City-based dermatologist, and this one from Elta MD is her favorite. "It contains niacinamide, which reduces inflammation, and it's oil-free, which makes it excellent for daily use for acne-prone patients," she says.
Clear, perfect, glowy skin is pretty much a magical unicorn we’ve been chasing since we hit puberty. We love to believe it exists, but for most of us it’s a myth that only exists in fairy tales. And, honestly, the internet doesn’t help much. There are so many supposedly “natural” DIYs floating around the World Wide Web, it’s hard to tell what treatments and tips are real—and what’s a bunch of BS.
Back acne (sometimes called “bacne") is a potentially embarrassing and sometimes painful condition where clogged hair follicles on the back cause pimples and blackheads. Back acne can be caused by the same factors as other types of acne: diet, hormones, certain medications, genetics, or any combination thereof. But when you're considering how to get rid of back acne, also remember that most people have their back covered the majority of the day. The clothing we wear matters, and the way in which we wash the skin on our back are key for clear skin, the whole body over. Learn more about common back acne causes, the best acne products for your body, and how to prevent acne on the back from returning in this section.
The spots that linger after a pimple has healed are caused by inflammation that has disrupted the skin's natural healing process. "When your skin is opened up (like when you pop a pimple) and then closes back together, you can get abnormal pigmentation, texture, and tone that looks different from the rest of your skin. Sometimes the broken blood vessels that remain after an acne lesion fades can result in a mark," says Dr. Bowe. For a number of people who are able to refrain from picking, inflamed pimples or blemishes can still leave a dark brown or red mark — but these naturally fade over the course of a few months, notes dermatologist Heather C. Woolery-Lloyd, MD.
If you have scarring, your dermatologist may suggest surgery to help heal acne lesions and remove scarring. A laser can reshape scar tissue and reduce redness. Dermabrasion is a type of surgery that can remove surface scars and reduce the depth of deep scars. Another option is to transfer fat from one part of the body to the face. In some cases, a single treatment can help scarring. But for lasting results, several are often needed. There are also topical treatments for acne scarring.
Doctors can treat telangiectasias with a small electric needle, a laser, intense pulsed light, or minor surgery to close off the dilated blood vessels. Usually, multiple treatments are required for best results, and only a portion of the blood vessels improve with each treatment. Not everyone responds the same to these types of treatments, and a physician can help someone decide which treatment is best for his or her skin type, condition, and size of blood vessels.
Eat healthily. Foods that are highly processed and contain a lot of oils greatly increase the amount of acne on your body. Getting the proper amount of nutrients from whole grains, fruits, vegetables, and protein help your skin to regenerate faster and limit unnecessary oil production. When at all possible, avoid foods that are processed or contain a lot of sugar (think junk foods).
Photodynamic therapy (PDT) is one of the newly available treatments. PDT uses a topical photosensitizer liquid that one applies to the skin and a light to activate the sensitizer. Levulan (aminolevulinic acid) and blue light, commonly used to treat pre-cancers (actinic keratosis) and acne vulgaris, can treat some rosacea patients. The use of PDT in rosacea is off-label, since it is primarily designed for regular acne. PDT works at reducing the inflammation; PDT is performed in a physician's office. The treatment takes anywhere from one to one and a half hours to complete. Strict sun avoidance for approximately one to three days is required after the treatment. Mild discomfort during the treatment and a mild to moderate sunburn appearance after the treatment is common. Some patients have experienced remissions (disease-free periods) of several months to years from these types of treatments. Other patients may not notice significant improvement.
There is also a role for Bellafill and other injectable fillers, including fat, for some depressed scars. Bellafill is currently the only filler that’s approved by the U.S. Food and Drug Administration to help raise depressed scars. It packs a one-two punch by adding volume, and also encouraging collagen formation beneath the surface by creating a supportive scaffold. “Bellafill and other injectables can fill in scars but these tend to be better for one scar,” adds New York City facial plastic surgeon Jennifer Levine, MD. Filler results can last up to 18 months. “If you have a cheek full of depressed scars, it’s better to resurface the face with laser, radiofrequency, or another energy-based treatment,” she adds.
Glycolic-acid peels may additionally help improve and control rosacea in some people. Professionals can apply chemical peels to patients for approximately two to five minutes every two to four weeks. Mild stinging, itching, or burning may occur and some patients experience peeling for several days after the peel. Any peel can irritate very sensitive skin and cause flares for some people. Peels should be used with caution in rosacea as not everyone is able to tolerate these treatments.
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.
Acne scar treatment: Injections of steroids can flatten keloid scars, according to Dr. Elbuluk. When they are discolored or red, there is some active inflammation in the skin. “The goal is to make the inflammation go away,” she says, “and certain lasers, such as pulsed dye laser, can improve any discoloration by targeting blood vessels.” Cryosurgery freezes the scar tissue, causing it to slough off, but this can cause pigmentation problems of its own among people with darker skin, who are already at higher risk for keloids. Prevention has an important role to play for anyone who is prone to keloids, she says. Using a scar-minimizing treatment like Mederma and/or silicone gel scar sheets before scars form can help stave off a keloid. Vitamin C serums such as Kiehl’s ‘Clearly Corrective’ Dark Spot Solution, Perricone MD Vitamin C Ester Serum, Skinceuticals C E FERULIC® vitamin C serum, or Kiss My Face C The Change (Ester C Serum) can also reduce pigmentation around a keloid scar.
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.