If you’ve made a concerted effort with over-the-counter regimens and/or diet and still aren’t seeing results, a dermatologist is absolutely worth it. There are many levels of care: Prescription retinoids (Retin A, Tazorac, Differin et al) and/or topical antibiotics are the mildest, along with blue-light treatments like Isolaze, which kill bacteria and clear pores, with virtually no downtime. Light lasers like Clear and Brilliant can clear pores and treat the red and brown tones left by old acne lesions. “Some patients think they’ve got a severe problem, when they really only have a few pimples, surrounded by red and brown marks from old breakouts,” notes Anolik. Oral antibiotics represent a more aggressive (and unsustainable long-term) solution; birth control pills and hormone-mitigating medications like Spironalactone and Deldactone can get many more-severe patients’ acne under control. Most aggressive is Accutane; while it can be severely drying and can cause birth defects if taken during pregnancy, it represents a cure for truly-severe acne cases, says Anolik. “Used correctly, it is something of a miracle for people who’ve tried everything and failed,” he says.
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.
While you’re waiting on all those active ingredients to kick in, Tzu says it’s best to use “makeup or foundation with a green tint to neutralize the redness.” She likes the Clinique Redness Solutions line, designed to color-correct red marks or spots. While this foundation includes SPF, it’s still best to layer over a dedicated sunscreen for maximum protection.
The bad news: There's no secret ingredient or miracle gadget that makes scars totally disappear. Don't get discouraged, though. A lot of what you think is acne scarring is really just hyperpigmentation or erythema (brown or red spots) rather than an actual change in the texture of the skin. Plus, there's a bevy of gels, creams, and treatments that can bring that discoloration down. We asked top dermatologists to recommend the most effective of the bunch.
Exfoliating. Exfoliating products are used to gently remove dead skin cells that can build up and create a place for acne-causing bacteria to grow. You can purchase an exfoliant or make one using household ingredients. Those with dry skin can add coffee grounds to their regular cleansing product. A standard treatment can be made by creating a paste made from water and baking soda and applying it with a circular motion on the face. Those with sensitive skin can use a gentler treatment by mixing oatmeal with honey and rubbing it on the face for 2-3 minutes before rinsing it away.
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.
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.
Treat Acne As Soon As It Develops: The best thing you can do is get acne under control as soon as possible. Begin treating it right away, and see your doctor immediately if your acne isn't getting any better with over-the-counter acne treatments. Quick treatment helps to keep breakouts to a minimum and prevents acne from developing into a more severe form. Prevent pimples and you'll prevent scarring.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.