This article was medically reviewed by Hilary Baldwin, MD. Baldwin, medical director of the Acne Treatment Research Center, is a board-certified dermatologist with nearly 25 years of experience. Her area of expertise and interest are acne, rosacea and keloid scars. Baldwin received her BA and MA in biology from Boston University. She became a research assistant at Harvard University before attending Boston University School of Medicine. She then completed a medical internship at Yale New Haven Hospital before becoming a resident and chief resident in dermatology at New York University Medical Center.
21. You might try a prescription. Topical antibiotics are available only with a prescription and work by killing the bacteria on your skin that cause acne, and by reducing inflammation. Some examples of topical antibiotics are erythromycin and clindamycin. Your doctor may prescribe you them in conjunction with another topical treatment such as one containing benzoyl peroxide or a retinoid such as Retin-A.
The process involves first removing makeup with an emollient formula—I use her Soothing Aloe Cleansing Milk, which looks and feels like lotion—on dry skin for 30 seconds, then rinsing and follow with another cleanser. Rouleau's AHA/BHA Blemish Control Cleanser has been my lifesaver, it's a blend of salicylic, lactic, and glycolic acids, plus jojoba beads for physical exfoliation. It sloughs away residue and oil and targets pimples, blackheads, and leftover scarring. I always followed this with Rouleau's Balancing Skin Tonic before applying any other layers.
Acne appears when a pore in our skin clogs. This clog begins with dead skin cells. Normally, dead skin cells rise to surface of the pore, and the body sheds the cells. When the body starts to make lots of sebum (see-bum), oil that keeps our skin from drying out, the dead skin cells can stick together inside the pore. Instead of rising to the surface, the cells become trapped inside the pore.
Some teens who have acne can get help from a doctor or dermatologist (a doctor who specializes in skin problems). A doctor may treat the acne with prescription medicines. Depending on the person's acne, this might mean using prescription creams that prevent pimples from forming, taking antibiotics to kill the bacteria that help create pimples, or if the acne is severe, taking stronger medicines such as isotretinoin, or even having minor surgery. Some girls find that birth control pills help to clear up their acne.
While acne is a much more visible condition than most, it is important to remember that it is like most diseases, in which early detection can help to mitigate its impact. Bearing that in mind, we have taken the time to put together 10 of the most common causes for acne, so that you can be better informed and potentially avoid some (and only some) of its root causes.
Sometimes, your gynecologist can share insight into your acne, especially when it comes to deciding if birth control could help your breakouts. The FDA approves of Estrostep, Ortho Tri-Cyclen and Yaz to combat acne, but the trick is to be patient, as it can take up to four months to start seeing results. "This plan of attack works best when paired with whatever topical treatments you’re already using to treat your acne, like Proactiv, benzoyl peroxide, salicylic acid, etc," advises dermatologist Dr. Elizabeth Tanzi.
Sometimes it seems like pimples sprout up overnight, but the process of pimple formation is a bit more complex. So what are the most common causes of pimples? A variety of factors can result in an acne blemish. Pimples can develop on anyone at any age, but tend to be most common amongst teens. Why do teenagers get the brunt of breakouts? Hormone fluctuations. When hormone levels increase, the sebaceous glands found within the skin’s hair follicles produce an excess of sebum. Sebum is a waxy substance that the body produce to keep the skin soft and moisturized. However, when hormonal changes cause an increase in sebum production, the pores can become clogged. This sticky substance can collect dead skin cells, debris, and bacteria, forming a plug in the follicle. Blackheads, whiteheads, pimples, and pustules all begin the same way. Preventing pimples means discovering the reasons you’re breaking out and doing all you can to combat these factors. There is no single answer to the age old question of how to get rid of pimples.
Acne scar treatment: The best acne scar treatment for hyperpigmentation is with 4 percent hydroquinone and sunblock, according to Dr. Imber. Hydroquinone is a topical bleaching agent that you apply directly to a dark spot. Sunblock is essential, since sun exposure can worsen hyperpigmentation. Other potential treatments include glycolic acid products, which remove the upper-most layer of the skin and the dark marks, and retinoids to increase skin cell turnover, Dr. Elbuluk says. These can be used with the bleaching agent hydroquinone as well. “We can also try glycolic acid chemical peels in the office at higher doses than you could do at home,” she says. “If peels don’t do the trick, lasers are usually the next thing we would try to improve hyperpigmentation.” Check out these amazing skin transformations that will make you run to your dermatologist.
True acne scars — as in indentations in the skin like ice-pick scars — can only be erased with professional procedures like microneedling or lasers. Fortunately, what most of us refer to as “scars,” according to Julia Tzu, M.D., founder and medical director of Wall Street Dermatology, are actually marks caused by post-inflammatory hyperpigmentation (brown spots) or post-inflammatory erythema (red spots), that will fade over several months or years. Fortunately, there are products that can speed up the process.
Avoid creams with vitamin E. Creams with vitamin E may actually do more harm than good. Because it's a vitamin, we're tempted to think that it will be either beneficial or harmless. In fact, one University of Miami study reported that vitamin E treatment had no effect or worsened the appearance of scars in 90% of subjects, with improvement in only 10% of cases.
Acne scars are most often the product of an inflamed lesion, such as a papule, pustule, or cyst. Inflamed blemishes occur when the follicle, or pore, becomes engorged with excess oil, dead skin cells, and bacteria. The pore swells, causing a break in the follicle wall. If the rupture occurs near the skin's surface, the lesion is usually minor and heals quickly. More serious lesions arise when there is a deep break in the follicle wall. The infected material spills out into the dermis and destroys healthy skin tissue.
Kate's bestselling EradiKate™ Acne Treatment is specifically formulated with the highest level of sulfur allowed to effectively fight blemishes, reduce acne, and help keep skin free of new breakouts. AHAs are designed to reduce the appearance of enlarged pores while zinc oxide, a natural mineral, provides oil control by absorbing excess sebum. The result is clearer skin that lasts.
The hair follicles, or pores, in your skin contain sebaceous glands (also called oil glands). These glands make sebum, which is an oil that lubricates your hair and skin. Most of the time, the sebaceous glands make the right amount of sebum. As the body begins to mature and develop, though, hormones stimulate the sebaceous glands to make more sebum.
Common knowledge would dictate that most people are aware that certain foods, and in turn, the nutrients they contain, can be beneficial for specific body parts. For example, healthy bones require calcium and vitamin D; our hearts function better when we eat certain seafood that is rich in omega-3 fatty acids. However, this does beg the question as to what food promotes healthy skin?
"If you occupy the area [under the skin] with a cyst, it destroys fat around it. Once the cyst goes away, the loss causes indentation," Dr. Karolak explains. A boxcar scar is a depression that has hidden scar tissue, which acts like an accordion pulling the scar downward. Subsicion is one solution for these deeper scars. Subsicion uses a sharp needle to go under the surface and break up that scar tissue. Then, you can fill it in with fillers made specifically for acne scars like Bellafill. Or you can do a fat transfer. "One of my favorite treatments for volume loss is fat transfer, which allows me to take inject a patient's own body fat instead of synthetic filler," says Dr. Karolak. Another treatment for boxcar scars is punch excision where the indented area of the scar is removed and the edges are pulled together with a suture. These treatments are often followed up with a collagen-boosting laser treatment.
5. You're scrubbing your skin too hard. A lot of people with acne think that the more you scrub your skin with a washcloth, rough exfoliants (like crushed apricot seeds), or cleansing brushes, the smoother your skin will be, but in reality, the problem will only inevitably get worse. What happens when you do that is you scrub the active acne and the blemish bacteria gets spread across the skin, worsening the condition.
Experiment with aloe vera. The sap of the aloe vera plant is a soothing natural substance which can be used to relieve many ailments, from burns to wounds to acne scars. Aloe vera helps to rejuvenate and moisturize the skin, encouraging acne scars to fade. It is possible to buy aloe vera products in the drugstore, but the best thing to do is buy an aloe vera plant and use the sap from a broken leaf. This gel-like sap can be applied directly on the scarring, and there is no need to wash off.
Rosacea is a common skin problem often called "adult acne." Faired skinned and menopausal women are more likely to have rosacea. Rosacea also seems to run in families. It causes redness in the center parts of the face and pimples. Blood vessels under the skin of the face may enlarge and show through the skin as small red lines. The skin may be swollen and feel warm.
When it comes to skincare, we often put so much attention on the outside that we forget about our insides. Once upon a time, a common acne myth was that French fries and chocolate were to be avoided at all costs if you wanted clear skin. Now we know those foods don’t necessarily cause acne, but some foods do have properties that can trigger breakouts.
You may have been told that what you eat affects your skin and that it can be the cause of pimples and outbreaks, but the debate about diet playing a role in acne frequency still rages on. Many dermatologists will vehemently dismiss the claims that food and acne are linked, as so much of the research surrounding this aspect of skin care has been inconclusive. Studies either yielded weak results, or were flawed with too few subjects or lack of control groups.
"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.
"Hyperpigmentation is an increase of melanin, which is the substance that colors the skin," says Dr. Sobel. Hyperpigmentation often clears up on its own. However if you want to speed up the process, you can use topical treatments with ingredients like retinol, vitamin C, and kojic acid, which can help brighten skin overall. We like Sunday Riley Sleeping Night Oil ($105, sephora.com) and InstaNatural Vitamin C Serum ($17, amazon.com). The most important thing is to stay out of the sun to keep the dark spots from getting even deeper in color.
13. You're still a sun-worshipper. You're probably already aware that lying out in the sun and going to tanning beds cause skin cancer, but if that still hasn't stopped you from hitting the beach without sunscreen or the proper protective gear (aka that chic sun hat), perhaps this will. Contrary to popular belief, the sun isn't healing your acne, it's actually making it worse. What happens is, as your face gets red from the sun, it makes any breakouts you might already have blend in, creating the appearance of clearer skin. But what's really going on is the sun causing your skin to dry out and triggering more oil production, which can lead to more zits.
Rouleau also enlightened me about another culprit making my skin care routine less effective: using oil-based products at the beginning of my skin care routine. As Rouleau explained, oils have a large molecule size and, therefore, should go at the end of a skin care routine because it almost acts like a sealant. When you use a cleansing oil or balm first (as I used to do along with makeup wipes), you're basically creating a barrier that makes it more difficult for other skin care products to penetrate and do their job.
Rolling scars can look like little saucers, giving the skin a wavy texture. Lasers that resurface the skin are Dr. Karolak's top treatment pick for this type of scar, and Dr. Sobel agrees. "Many scars can be improved with lasers such as the matrix CO2, which remove the outer layers of skin, burning away the scar tissue and stimulate new collagen production," he says. "Non-ablative lasers such as the Fraxel can help activate the production of collagen without damaging the surface of the skin." Keep in mind, that these laser treatments can take a bit of recovery time and require multiple treatments to see results. For a quicker solution, your dermatologist can plump the bowl-like scar with fillers like Juvederm, Restylane, or Bellafill.
Sunscreen: "Sun exposure during an active breakout can lead to darkening of inflammatory lesions, prolonging their appearance on your skin and making them harder to fade over time," says Dr. Shereene Idriss from Union Square Dermatology, which means it's important to lather on the sunscreen daily — even when it's cloudy. And don't worry about breaking out from a pore-clogging sunscreen; the latest formulas are more innovative and acne-friendly than ever. Elta MD UV Clear Broad-Spectrum SPF 46 is a top derm-approved favorite. It contains niacinamide, which is an anti-inflammatory that helps reduce redness.
Over-the-Counter Creams and Lotions. Retinoid creams or lotions can help clear your skin and also lessen wrinkles. Products made with sulfur can be good for the occasional spot treatment. Benzoyl peroxide is another acne fighter. Use benzoyl peroxide products only occasionally, because they can dry out your skin, Day says. You could also try a milder benzoyl peroxide product.
This formula gently and effectively treats visible acne overnight using a skin-recovery complex that blends salicylic acid, vitamin B3, azelaic acid, caffeine, and other complexion clearers. The formula helps fight redness and unclog pores while calming and soothing post-breakout skin. The result is a clarified, glowing complexion free of redness, dark spots, and hyperpigmentation.
This powerful, medicated cleanser delivers a luxuriously whipped texture and three percent sulfur to address acne and blemishes, draw out impurities, and target congested pores. Honey and rice bran extracts calm redness, while natural oat extract addresses excess sebum. With continued use, this gentle, yet effective daily cleanser leaves skin clearer with visibly minimized pores.
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.
Topical treatments on their own may not be enough to give you clear skin, especially in those with complicated, inflammatory cystic acne. There are several acne medication options approved for use by the FDA, but which one is best for you is a question for your dermatologist and/or general practitioner. Baldwin says if you have insurance and you have acne, a prescription may be the best step because "it makes no sense to try to handle the condition yourself or to use over the counter products that are always less effective than prescriptions meds." Here are a few of the acne medications you'll want to ask about:
Those who consume a bevy of seafood, seaweed, and iodized salt experience high iodine levels. These iodine levels have also been purported to trigger acne flare ups. Word spread about iodine’s potential for causing skin issues in the 1960s, and it’s had a bad rap ever since. However, recent studies have fought against this pervasive thought, as some studies have seen no difference between acne in those who were given iodine and those who weren’t. It’s important to take these studies with a grain of salt, and understand that depleting your diet of iodine can have negative effects on holistic health. Iodine is essential for proper thyroid function, and is responsible for the manufacture of T3 and T4 thyroid hormones and it’s important to maintain proper levels of iodine in your diet.