The inflammation caused by your breakout can cause more than just the pimple you see on the surface, it can also cause damage below the skin. "The inflammatory response produces a loss in collagen and the overlying skin will collapse and leave a depression," Howard Sobel, M.D., a NYC dermatologist and founder of DDF Skincare, tells SELF. To get rid of these tiny pockmarks, Dr. Karolak relies on a TCA Cross chemical peel. TCA stands for trichloroacetic acid. "We use a little applicator and go into the hole with chemicals to cause a burn. That causes the wall of that ice pick to heal itself and close in on itself," explains Dr. Karolak.
"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.
If you use hair sprays or gels, try to keep them away from your face, as they also can clog pores. If you have long hair that touches your face, be sure to wash it often enough to keep oil away. And if you have an after-school job that puts you in contact with oil — like in a fast-food restaurant or gas station, for example — be sure to wash your face well when you get home. It also can help to wash your face after you've been exercising.
Exfoliate dead skin cells that can clog pores and lead to breakouts with the power of salicyclic acid. Mario Badescu's Acne Facial Cleanser was specially formulated to effectly target acne-prone or acne-erupted skin. A soothing blend of botanical extracts including aloe, chamomile, and thyme help to improve the look and feel of troubled skin, while leaving skin thoroughly refreshed.
Take an extra five minutes before hopping on the treadmill to completely wash your face and remove your makeup to minimize the risk of breakouts. "Sweat is released through visible pores in the skin," says dermatologist Dr. Janelle Vega. "When makeup covers those pores, that barrier doesn't allow the sweat to make it to the surface of the skin, which can lead to clogged pores. The trapped debris and bacteria are a perfect breeding ground for acne bumps and zits."
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.
“After sweating, immediately use an exfoliating cleanser to help keep your pores clear and remove excess oil,” says Dr. Zein Obagi of ZO Skin Health. Try keeping Neutrogena Rapid Clear Treatment Pads in your gym bag or locker for those times you need an on-the-go cleanse. These will remove any leftover dirt while treating your skin with acne-fighting salicylic acid.
Even if battling zits is a distant memory, filed away with high-school gym class and algebra tests, acne marks and scars can annoyingly linger long after pimples are gone. “If someone gets a very large pimple or cyst, the natural healing process of the skin will create a scar,” says David Avram, M.D., of Heights Dermatology and Laser. “The more intense the inflammation, the more likely it will leave a scar.”
"I often recommend PCA Skin Pigment Gel to patients looking to treat scars left behind from acne," explains Rebecca Kazin, a dermatologist at Washington Institute of Dermatologic Laser Surgery and Johns Hopkins department of dermatology. "This gel contains 2 percent hydroquinone blended with other skin brighteners, like kojic acid, resorcinol, and azeleic acid, which work to lighten the pigmentation without irritating the skin," she says. The addition of lactic acid helps maintain moisture to prevent overdrying, which can worsen pigmentation.
There are simple things you can do on your own to help prevent adult acne and keep it from getting worse. First, wash your skin once or twice a day with a non-drying, non-comedogenic cleanser that won't clog your pores. Look for cosmetic products labeled oil-free, non-comedogenic and non-acnegenic (unlikely to cause acne breakouts). In addition, avoid heavy skin creams or hair products which may aggravate your skin condition.
Another potential skin saboteur is sugar, because it raises your insulin level. More and more evidence shows that insulin may boost those oil-triggering male hormones, Dr. Schultz explains. Stick to low-glycemic foods—ones that have complex carbs like whole grains, which break down slower in the body and cause less of an insulin spike. Your health will be better for it, too.
Those big, painful zits will leave a scar if you pick and prod at them—"the only way to reduce it quickly is to drain it, and that's not a DIY deal," Dr. Schultz warns. The reason they're painful is because quick expansion stretches the nerves. "Drinking good red wine is often helpful [to numb the pain]," he jokes. Take Advil, apply a warm or cold compress (whichever feels better to you), and go see your derm. "Cortisone shots are the true 'spot treatments' for painful cystic acne lesions," Dr. Tzu says.

Doctors infrequently prescribe isotretinoin for severe and resistant rosacea. Often physicians prescribe it after multiple other therapies have been tried for some time and have failed. Patients take a daily capsule of istotretinoin for four to six months. Typically, isotretinoin is most commonly used in the treatment of severe, common acne called acne vulgaris. Close physician monitoring and blood testing are necessary while on isotretinoin. Generally, at least two forms of birth control are required for females using this medication, as pregnancy is absolutely contraindicated while on isotretinoin.
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.
The one food Dr. Schultz does recommend to avoid is iodine. "Iodine causes acne in everyone if you eat enough," he says. You can find it in shellfish, like lobster, shrimp, crab, and some greens like kelp and spinach. The different between iodine and those other "acne-causing foods" is that iodine builds up over weeks and months before it starts to affect skin.
Since there is some overlap between acne and rosacea, some of the medications may be similar. Acne and rosacea have in common several possible treatments, including (but not limited to) oral antibiotics, topical antibiotics, sulfa-based face washes, isotretinoin, and many others. It is important to seek a physician's advice before using random over-the-counter acne medications since they can actually irritate skin that is prone to rosacea. Overall, rosacea skin tends to be more sensitive and easily irritated than that of common acne.
I wear a full face of full coverage makeup every weekday for work. To get it all off, I used to rely on makeup wipes before face wash. I later realized the wipes, while convenient for nights you're ready to PTFO and must, were kind of just sliding product around my face instead of truly cleaning it. Thankfully, a facial with celebrity esthetician Renée Rouleau introduced me to the idea of double cleansing.
As far as combination scars go, Dr. Levine’s go-to acne scar treatment for combination-type scars include a series of treatments with picosecond lasers such as the Picosure or use of the FRAX 1550* Fractional non-ablative laser. “These are newer technologies, and they have less downtime than older lasers, so for me this means I can be more aggressive and see results with fewer treatments.” Older ablative lasers blast off the skin’s top layers, which requires significant downtime, but these newer non-ablative lasers pass through the skin’s upper layers to harmlessly heat the deeper tissues, stimulating collagen and smoothing the scar’s appearance.
20. Know your options. Benzoyl peroxide products are great at fighting pimples, but can be drying to your skin, so use them only once a day (or every other day). If it's drying out or irritating your skin, switch out your cleanser for a gentle formula. (Keep up your regular acne spot treatment, but use just a dab!) It will clear away dirt and oil without stripping your skin of moisture. Salicylic acid (in creams, gels, astringents, or masks) dries less than benzoyl peroxide, so it can be used with more-drying cleansers.
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.
Dermal fillers: "Certain scars can be filled with a substance that elevates the depressed areas, like hyaluronic acid. This can make the surface of the skin more even and get rid of shadows," says Dr. Bowe. Until recently, fillers weren't a lasting solution. But now, if you're over 21 years old, Bellafill is the first FDA-approved dermal filler designed for permanently correcting moderate to severely dented acne scars. Unlike other fillers, it contains two different ingredients to help improve acne scarring. "It's 20% polymethylmethacrylate (PMMA), which helps your body make more protein to allow itself to heal," says Dr. Shah. "PMMA are tiny balls that sort of act as a scaffolding. Most fillers degrade over time, but since PMMA cannot be absorbed into the body, this offers a permanent result," she says. The other 80% is collagen. The procedure takes about 20-30 minutes, and while you may need a touchup a couple months later, some people just need the single treatment, says Dr. Shah.
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.

Dr. Day says another product ingredient to look out for is retinol to "help minimize and even avoid scarring." Dr. Chiu suggests this particular SkinMedica product because it "induces new collagen formation, which can soften acne scars, as well as unclogs pores for acne prone skin while bringing pigment to the surface with its exfoliative properties." Start using it twice a week and you'll notice fine lines start to fade as well.
It starts out as a powder (a blend of raw cacao, bamboo charcoal, soil nutrients, and spices), only releasing its potent healing elements when mixed with water. The resulting mousse heals blemishes, fights inflammation, encourages circulation, and visibly tightens pores pretty much instantly. Use Lindstrom’s facial treatment bowl and brush to mix the paste.
Severe acne. Severe acne consists of deep cysts, redness, swelling, extreme damage to the skin and scarring. You should see a dermatologist to care for this type of acne. Scarring can be prevented with appropriate treatments. Your dermatologist can prescribe oral antibiotics and oral contraceptives. Large inflamed cysts can be treated with an injection of a drug that lessens the redness, swelling, and irritation, and promotes healing.
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.
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.

"I have seen many patients develop a tolerance to prescription acne treatments, and when they stop working, it’s devastating. Treating acne demands a more holistic approach that includes lifestyle, nutrition, and advances in topical skincare. I developed Outsmart Acne™ Clarifying Treatment to be used as part of a whole-person regimen to help skin stay consistently clear."—Howard Murad, M.D., FAAD
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.

Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.


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.
Bacteria. Excess sebum clogs the openings to hair follicles -- especially those on the face, neck, chest, and back. Bacteria grow in these clogged follicles. This makes blackheads or whiteheads, also known as ''comedones,'' form on the skin's surface. Sometimes, this clogging causes the follicle wall to break under the pressure of this buildup. When this happens, sebum leaks into nearby tissues and forms a pustule or a papule -- this is called inflammatory acne. Larger, tender pustules are called nodules.
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.
"I have seen many patients develop a tolerance to prescription acne treatments, and when they stop working, it’s devastating. Treating acne demands a more holistic approach that includes lifestyle, nutrition, and advances in topical skincare. I developed Outsmart Acne™ Clarifying Treatment to be used as part of a whole-person regimen to help skin stay consistently clear."—Howard Murad, M.D., FAAD 

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.
If you have oily or combination skin and are prone to breakouts, you should be using skin-care products labeled "oil-free," "non-comedogenic," or "water-based," Dr. Schultz says. Just one of these will ensure that the lotion you're slathering on isn't going to clog your pores and make matters worse. Try a gel-based moisturizer like Belif The True Cream Aqua Bomb; for an SPF option, we like PCA Skin Weightless Protection Broad Spectrum SPF.
Hormones are ruthless, and all the topical treatments in the world won't make a difference if yours are seriously out of whack. In that case, you need to fix things internally first. "Medications that manipulate hormonal levels, such as oral contraceptives and spironolactone, are helpful in curbing hormonal chin and lower face outbreaks," Dr. Tzu says. Ask your derm about what might work for you.
It starts when greasy secretions from the skin's sebaceous glands (oil glands) plug the tiny openings for hair follicles (plugged pores). If the openings are large, the clogs take the form of blackheads: small, flat spots with dark centers. If the openings stay small, the clogs take the form of whiteheads: small, flesh-colored bumps. Both types of plugged pores can develop into swollen, tender inflammations or pimples or deeper lumps or nodules. Nodules associated with severe cases of acne (cystic acne) are firm swellings below the skin's surface that become inflamed, tender, and sometimes infected.
Spot treatments are key for treating a pimple ASAP. Benzoyl peroxide is often vilified for being harsh, but when it comes to really zapping a zit, it should be your best friend. Just dab it on the trouble spot to dry it out and kill bacteria. For heavy-duty action, try Neutrogena Rapid Clear Stubborn Acne Spot Gel; for something gentler, we like Arithmetic Acne Control Complex, which has soothing ingredients to counter the drying effects and is made with adult skin in mind.

lThis at-home skin peel available at Sephora tightens pores, reduces oil, helps retexturize skin and diminishes dark spots. It's paraben and sulfate free, non-comedogenic, and is not tested on animals. Use this peel each week as part of your clear skin regimen to help even out skin tone and gently remove unhealthy top skin layers, revealing new, healthier skin underneath.
Isotretinoin has a high risk of inducing birth defects if taken by pregnant women. Women of childbearing age who take isotretinoin need two negative pregnancy tests (blood or urine) before starting the drug, monthly tests while they take it, and another after they are done. Those who are sexually active must use two forms of contraception, one of which is usually the oral contraceptive pill. Isotretinoin leaves the body completely when treatment is done; women must be sure to avoid pregnancy for one month after therapy is stopped. There is, however, no risk to childbearing after that time.
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