Nearly 50 million Americans are affected by acne each year, making it the most common skin condition, and one without a cure. This is the impetus for many companies putting pedal to the metal in research and development for new zit-zapping treatments, both over the counter and in-office. Here, experts answer nine popular questions about acne, and the best products to keep it at bay.
Dirt, bacteria, stress, excess sebum, diet, climate: All of these can kick-start an acne flare and one pimple can turn into five overnight. But, not all acne is treated the same, and skin type plays a role, too. Los Angeles aesthetician Nerida Joy became an expert in acne because she was fascinated by its nuances. “You have to understand acne does not get put in one bucket—it’s different for everyone,” she says. “Our skin is our largest organ of elimination and a window to our health, hormones and food tolerances.” Bloomfield Hills, MI dermatologist Linda C. Honet, MD understands how frustrating acne can be, but assures that the in-office treatments and skin-care products to help minimize and prevent it are more effective than ever before.
Why do breakouts happen?
“The culprit of acne is overactivity of sebaceous glands—the oil glands—which are very concentrated in the facial skin and make sebum,” says Dr. Honet, noting that excess sebum is due to genetic, hormonal, and possibly environmental or external factors. “Although the cheeks are often affected by acne, the T-zone, especially the nose, has the highest number of sebaceous glands in the face, and therefore is a common spot for breakouts, too. The oilier the area is on the face, the more likely there will be more sebaceous glands, larger pores and more pimples.”
Another reason breakouts occur is an overgrowth of a bacterium called Cutibacterium acnes (aka C. acnes, and formerly known as P. acnes) that ignites a cascade of cell processes in acne, resulting in inflammation, clogged pores, and comedonal and cystic activity, and eventually, this results in scarring. Montclair, NJ dermatologist Jeanine Downie, MD says, “The amount of C. acnes bacteria on the face is one of the biggest contributors to what causes the actual acne pimples.”
Why do I always get pimples on my jawline, but nowhere else?
Miami-based aesthetician Amy Peterson says acne that occurs on the chin or jawline is usually due to hormonal imbalances. “Paying attention to the areas on your face where you usually breakout can help you narrow down the possible causes and allow you to prevent the acne more effectively,” she adds. For her clients with jawline acne, Los Angeles aesthetician Shani Darden recommends they remove dairy from their diets. “Certain hormones in dairy products can lead to acne-causing inflammation,” she says. “Stick to milk alternatives like almond or oat, and see if that helps clear up your skin.”
What does it mean when a pimple is painful to the touch?
“Painful hormonal pimples that hurt when you touch them can appear anywhere on the face,” says Joy. “This indicates that testosterone influences are higher as hormones fluctuate due to menstrual cycles, age and stress.” However, in some cases, what appears to be acne is actually something else. “It may be a completely different skin condition like rosacea, florid keratosis pilaris, cutaneous lupus, or simply flat warts on the face,” Dr. Honet explains. “A board-certified dermatologist can help to distinguish what is acne and what isn’t, and how to best treat it.”
What is the difference between salicylic acid and benzoyl peroxide?
These are two of the most popular ingredients for acne treatment, but they’re very different. “Salicylic acid digs deep into the pores to dissolve acne-causing congestion at the source,” Darden explains, “whereas benzoyl peroxide kills the bacteria on the skin that causes acne.” Benzoyl peroxide can be helpful for oilier skin types and has additional anti-inflammatory benefits. Derms can also prescribe a topical combination of benzoyl peroxide and antibiotics for an as-needed spot-treatment.
Should I be using a retinoid for my acne?
There are multiple retinoids that can reduce and normalize sebaceous gland activity, including tretinoin, adapalene, tazarotene and trifarotene (adapalene is available over the counter now; look for Differin and La Roche- Posay). “They also help decrease the appearance of acne scarring and background sun damage in the skin, as well as regenerate normal collagen and elastin, and reduce wrinkling,” Dr. Honet says.
Ocean Springs, MS dermatologist Lindsey Zubritsky, MD advises her patients to start slow when introducing retinoids, beginning with two to three times a week and working up to daily use. “Use a pea-size amount for your entire face, and if you experience redness and irritation, this is what derms call ‘retinization,’ and it will usually subside in two to four weeks as your skin adapts.”
Did You Know?
Darden says one of the biggest myths about acne is that you should dry out your skin in order to treat it. “This is not true. Drying out your skin will actually cause your skin to overproduce oil, which can end up exacerbating acne.” Joy recommends incorporating skin-care products with hyaluronic acid into your routine for hydration. “Hydrating helps feed the skin, which will help it heal and avoid scarring. Aloe, vitamin K, arnica and zinc can also help.”
Do at-home LED devices really work?
“Blue light works hard to destroy and defend against C. acnes bacteria, making it an effective treatment in helping to clear up existing breakouts and prevent new ones from forming,” explains Darden, whose PRO LED Light Mask is clinically proven to reduce acne (though it boasts a $1,900 price tag). “In a study, 81 percent of people saw a reduction in acne lesions after 12 weeks of use! The power density of Mode 2 with blue LED light is more than half the strength of the professional-grade device I use in my treatment room.”
Joy says that high-frequency devices—they emit a safe electrical current that creates oxygen when applied to skin—are germicidal like blue light and offer another way to treat acne at home. “They can speed up healing and calm inflammation associated with pimples.”
50 million Americans are affected by acne each year
My doctor recommended an oral prescription medication for my acne. Will it really help?
“Harnessing the power of systemic and/or topical antibiotics can help reduce the bacterial load on your skin,” Dr. Honet says. “This may be most helpful during the initial stages of treatment to get the acne under control quicker and mitigate against the early flare-ups and purging due to other topical acne medications. More recently, other topical prescription treatment options have included such active ingredients like dapsone, for its anti-inflammatory and antibacterial properties, and clascoterone, which is an androgen receptor inhibitor and works by blocking androgen hormones in the skin so they don’t make too much sebum.”
Oral spironolactone can also be incorporated into a female patient’s treatment protocol to help block androgen activity, as well as possibly stabilize hormonal breakouts.
When the acne is severe, such as recalcitrant cystic acne that doesn’t respond to conventional treatments, derms may prescribe oral isotretinoin, aka Accutane. Though the side effects can be extreme, Dr. Downie says that in the right patient, with constant monitoring and guidance, Accutane can be life-changing. “For the vast majority of patients, after six to eight months of taking Accutane, they are permanently without acne for the rest of their life.”
What is the new AviClear laser I’ve been hearing about?
“The AviClear laser is a first-of-its-kind, FDA-cleared treatment that uses a specific wavelength to target abnormal sebaceous glands that lead to acne,” says New York dermatologist Dennis Gross, MD. “We have had lasers with specific wavelengths that target skin issues like brown spots, redness, blood vessels and laser hair removal, but there’s never been a wavelength that can target the oil glands—until now. It has become the new go-to treatment at my practice because it is safe and effective on all skin tones, it doesn’t require downtime, and best of all, patients see long-lasting results in just three, 30-minute treatments.”
The clinical results of AviClear are being compared to Accutane, but without the scary side effects. “It’s an excellent alternative, and nearly everyone with mild, moderate or severe acne is a candidate [it’s not advised for those who are pregnant or breastfeeding],” Dr. Gross adds. “I’ve seen great results in teenagers, as well as adults experiencing hormonal and perimenopausal acne. Results can be seen after the first treatment, but they improve after the second and third treatment.”
Did You Know?
“Probiotic supplements can help improve gut health, which in turn can help minimize acne,” says Peterson, noting that probiotics can be taken orally and/or used in skin care. “Probiotics in skin-care products are shown to reduce inflammation, which is one of the main issues associated with acne.”
What are the best treatments for acne scars?
Like acne, the treatment of scarring usually requires a multifaceted approach, addressing all aspects of the scarring, from the depth of the scars to the ethnicity of the patient. Many derms utilize IPL and lasers like Aerolase Neo to remove the scars’ pigment (pigment causes the scars to appear more noticeable). Peterson also relies on “microneedling and microneedling with radio frequency because they can break down scar tissue and smooth out the skin.” The Tixel laser is another great option for resurfacing textured skin, too.
Dr. Honet’s favorite approach for mild-to-moderate acne scarring is a combination of DiamondGlow with microneedling, and possibly a laser. “At times, a chemical peel will be needed adjunctively, or a more ablative laser treatment like CO2,” she says. “An isolated, deeply pitted scar may require a TCA treatment called TCA Cross, or it may need to be cut out. In this case, we can use dermal filler to revolumize the area.”
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