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.
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.
You’re a typical hormonal-acne patient if, well past puberty, you’re breaking out around your period, usually in the jawline area, says Anolik. A consistent routine is key—as is enduring a waiting period of two to three months for said routine to work, he continues: “Even powerful prescription treatments can take a few months to really clear things up, and that’s our biggest challenge. People who get frustrated and don’t stick to their treatments get stuck in a cycle of trying and quitting too early, and feeling like nothing works.”
Topical vitamin C serum: "Vitamin C serums block abnormal pigment production and can brighten spots that have already developed," says Dr. Zeichner. "They can be layered underneath your sunscreen in the morning." These serums can also help build collagen and promote healing, says says Dr. Shah, who suggests trying "SkinCeuticals C E Ferulic to do the trick.
With its natural inflammation-fighting properties, a 5 percent solution of tea tree oil is less harsh than a 5 percent benzoyl peroxide solution and can be just as effective against acne, though it may clear up a little less quickly. Mix a few drops of tea tree oil with between 20 and 40 drops of witch hazel, then use a cotton swab to apply. Try this remedy up to twice a day; more could dry your skin and make the acne worse.
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.
Like microneedling, fractionated skin resurfacing sends skin a signal to respond to damage. Specifically, microscopic columns of injury are created causing minute perforations in the treatment area, while leaving healthy surrounding tissue intact and untouched. "The specific zones of injury trigger the patient's natural neocollagenesis (collagen rebuilding process)," explains Engelman, who characterizes the treatment as both revolutionary and non-invasive. This new collagen rejuvenates the skin and improves its appearance. "Improvements continue over time (up to six months post-procedure) as new collagen continues to rebuild," she says.
Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). Most cases of acne, however, are not drug related.