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.
Chemical peels. Chemical peels can reduce the appearance of shallow acne scars and post-inflammatory hyper-pigmentation around a healed acne lesion. A chemical peel may be administered by a doctor, nurse, nurse practitioner, or spa aesthetician and involves applying a chemical to your skin to remove its outer layer, giving it a smoother, more even appearance. Depending on the strength of the acid used, you may experience redness and peeling for a few days afterward.
"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.
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.
Post-inflammatory hyperpigmentation is not an acne scar, but a red, pink, brown or tan skin discoloration where acne has previously flared up. It will usually disappear on its own in a year or so. Many skin lightening products claim to help reduce the visibility of these acne “scars." Their active ingredient, hydroquinone, works to slow melanin production and can reduce dark brown marks, but melanin isn't the cause of red and pink acne discolorations. A better option is to use the best foundation for acne prone skin you can find to hide the marks until they naturally fade away.
Rena Levi is known for her sensitivity towards clients with severe acne and problem skin. In 1968 she moved from Israel to the U.S. and studied with Christine Valmy at the European Esthetic Skincare Institute. In 1975, she opened the Rena Levi Skin Care Salon in New York City. In 1980, she moved to Albuquerque, NM, where she managed the skin care center for Eleganza Salon and further developed and refined her practice. It was there that she became well known for her ability to treat what many considered impossible skin, while also teaching budding estheticians and skin practitioners at the same time, including the then-president of the New Mexico Board of Cosmetology. Here, Levi shares with us one of her most popular facial protocol treatments for treating clients with moderate to severe acne.
Since the UV rays and visible light from the sun can further darken acne marks, all the dermatologists agree it’s essential to wear sunscreen daily. “Sun protection can make a big difference in whether or not these marks remain permanent,” says Nagler, so much so that she’ll often recommend patients wait and see what their scars look like after a year of careful sun protection before opting for an expensive or invasive procedure. This CeraVe oil-free sunscreen is ideal for acne-prone skin, and also contains niacinamide, which is known to help brighten skin and fight inflammation.
Some skin advocates suggest foregoing this method. The pH of baking soda is 7.0, which is far too basic for skin's pH. Optimal skin pH occurs between 4.7 and 5.5, which is an inhospitable environment for p. acne (the bacteria responsible for causing most acne). By raising the pH to a more basic level, p. acne is able to survive longer and cause more infection and inflammation. So try this method with care, and stop using it if it's not effective for you.
Sun exposure is a well-known flare for many rosacea sufferers. Sun protection using a wide-brimmed hat (at least 6 inches) and physical sunscreens (like zinc or titanium) are generally encouraged. Because rosacea tends to occur in mostly fair-skinned adults, physicians recommend the use of an appropriate daily SPF 50 sunscreen lotion, along with overall sun avoidance.
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.
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.