From the What to Expect editorial team and Heidi Murkoff, author of What to Expect the First Year. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.
Skin care clinics and dermatologists across the country offer laser skin treatments for acne scar removal, but is it worth it? The best way to determine which laser acne scar treatment is right for you is to get different professional opinions about which type is best for your skin, and compare pricing, expected recovery time and reviews. Here's how a few laser treatments work for acne scar removal:
For an overnight solution or something that covers a larger surface area (rather than a smaller spot-treatment), Zeichner also recommends Neutrogena’s rapid-clear leave-on mask. The idea is that you spread benzoyl peroxide all over your face, but it’s not a wash-off mask, so you’re getting a prolonged exposure to the antibacterial peroxide. He says it’s helpful for treating the pimples you have and preventing new ones from popping up.
There are two big guns used to take down acne, and they're both great at doing entirely different things. Salicylic acid is a beta hydroxy acid that comes from willow bark and works primarily as an exfoliator, breaking down fatty acids like sebum so your pores don’t clog. (Glycolic acid works similarly but is less effective.) These acids are effective on comedones — whiteheads, blackheads, and other non-red bumps.
Pharaohs are recorded as having had acne, which may be the earliest known reference to the disease. Since at least the reign of Cleopatra (69–30 BC), the application of sulfur to the skin has been recognized as a useful treatment for acne. The sixth-century Greek physician Aëtius of Amida is credited with coining the term "ionthos" (ίονθωξ,) or "acnae", which is believed to have been a reference to facial skin lesions that occur during "the 'acme' of life" (puberty).
How to Handle It: If you've tried the usual anti-acne ingredients, like salicylic acid and benzoyl peroxide (which, we should warn you, rarely work for this), you should consider paying your dermatologist a visit. "You may need a cortisone injection or an oral medication, like an antibiotic, in addition to topical formulas," says Zeichner. He's also a fan of a prescription topical medication called Epiduo Forte Gel, since, he says, it's been shown to be effective at controlling severe acne without the help of oral treatments.
Benzoyl peroxide attacks the P. acnes bacteria. However, one of its main side effects is dryness: If you’re going to use anything with benzoyl peroxide, make sure to moisturize afterwards. Sulfur and azelaic acid are less common and less severe alternatives to benzoyl peroxide. Dr. Peter Lio, assistant professor of clinical dermatology at Northwestern University, says sulfur-based treatments are “a good fit for patients who can’t tolerate the side effects of benzoyl peroxide.”
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In women, acne can be improved with the use of any combined birth control pill. These medications contain an estrogen and a progestin. They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduced acne severity. First-generation progestins such as norethindrone and norgestrel have androgenic properties and can worsen acne. Although oral estrogens can decrease IGF-1 levels in some situations and this might be expected to additionally contribute to improvement in acne symptoms, combined birth control pills appear to have no effect on IGF-1 levels in fertile women. However, cyproterone acetate-containing birth control pills have been reported to decrease total and free IGF-1 levels. Combinations containing third- or fourth-generation progestins including desogestrel, dienogest, drospirenone, or norgestimate, as well as birth control pills containing cyproterone acetate or chlormadinone acetate, are preferred for women with acne due to their stronger antiandrogenic effects. Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills. A 2014 review found that antibiotics by mouth appear to be somewhat more effective than birth control pills at decreasing the number of inflammatory acne lesions at three months. However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions. The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance.
Scientists initially hypothesized that acne represented a disease of the skin's hair follicle, and occurred due to blockage of the pore by sebum. During the 1880s, bacteria were observed by microscopy in skin samples affected by acne and were regarded as the causal agents of comedones, sebum production, and ultimately acne. During the mid-twentieth century, dermatologists realized that no single hypothesized factor (sebum, bacteria, or excess keratin) could completely explain the disease. This led to the current understanding that acne could be explained by a sequence of related events, beginning with blockage of the skin follicle by excessive dead skin cells, followed by bacterial invasion of the hair follicle pore, changes in sebum production, and inflammation.
“Sometimes I see people try over-the-counter products just for a couple of weeks, they get frustrated, they say it’s not working, and they discontinue them,” Arthur says. “But it really does take a while to see the effectiveness. So unless you’re having a problem with the medication, like it’s causing severe irritation or dryness, it’s recommended to give it at least 2-3 months before switching to something else.”
But the milder cases can benefit from some topical over-the-counter treatments, too: “OTC options should be limited to when you have only one or two cysts,” though, says dermatologist Noelani Gonzalez, the director of cosmetic dermatology at Mount Sinai West. “Otherwise you should go see your dermatologist sooner than later to avoid any scarring.” Here, we spoke with three dermatologists to hear more about the most effective cystic-acne treatments to use at home.
Acne, also known as acne vulgaris, is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. It primarily affects areas of the skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide.
Kathyrn Bowling’s son Gus was only two weeks old when she first noticed red bumps spreading on his face: newborn acne. At the time, the Atlanta mom wasn’t concerned about something so common (and harmless) as baby acne. I was worried about so many other things, like how much he was eating and whether I would get enough sleep,” she says. “In the grand scheme of things, a few bumps on his face didn’t seem too bad.”
The Daily Skin Clearing Treatment is an all-over 2.5 percent benzoyl peroxide cream that also touts calming bisabolol and allantoin to alleviate the dryness and irritation that can crop up mid-treatment. Anyone frustrated with oil-slick skin will also love this part of the regimen — it creates a satin mattifying effect, instantly transforming shininess into a glow.
Like acne on your face, back acne occurs when your pores become blocked with oil and dead skin cells. Exfoliating your back regularly might help remove these dead skin cells and pore-clogging debris before they have a chance to block pores. However, you want to take care not to scrub too hard, especially if you're experiencing an active breakout. Use a soft cloth to gently brush away surface impurities as you shower.
Even better than one stand-alone cream is a multipronged combination of acne treatments. “A good place to start is to use a combination of salicylic acid, benzoyl peroxide, and a topical retinoid,” says Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. “Salicylic acid helps remove excess oil from the surface of the skin and exfoliate the dead cells, while benzoyl peroxide kills acne-causing bacteria and helps reduce inflammation.”
The approach to acne treatment underwent significant changes during the twentieth century. Retinoids were introduced as a medical treatment for acne in 1943. Benzoyl peroxide was first proposed as a treatment in 1958 and has been routinely used for this purpose since the 1960s. Acne treatment was modified in the 1950s with the introduction of oral tetracycline antibiotics (such as minocycline). These reinforced the idea amongst dermatologists that bacterial growth on the skin plays an important role in causing acne. Subsequently, in the 1970s tretinoin (original trade name Retin A) was found to be an effective treatment. The development of oral isotretinoin (sold as Accutane and Roaccutane) followed in 1980. After its introduction in the United States it was recognized as a medication highly likely to cause birth defects if taken during pregnancy. In the United States, more than 2,000 women became pregnant while taking isotretinoin between 1982 and 2003, with most pregnancies ending in abortion or miscarriage. About 160 babies were born with birth defects.
Use oil-free makeup. If you wear makeup, you may be stuck in a vicious cycle of covering up acne while simultaneously causing it with your cover-up usage. Find acne-fighting oil-free mineral makeup to help prevent worsening your acne while simply trying to hide it. Power foundations are also recommended. When possible, avoid wearing make-up at all though as it clogs your pores over the course of the day.
Many skin conditions can mimic acne vulgaris, and these are collectively known as acneiform eruptions. Such conditions include angiofibromas, epidermal cysts, flat warts, folliculitis, keratosis pilaris, milia, perioral dermatitis, and rosacea, among others. Age is one factor which may help distinguish between these disorders. Skin disorders such as perioral dermatitis and keratosis pilaris can appear similar to acne but tend to occur more frequently in childhood, whereas rosacea tends to occur more frequently in older adults. Facial redness triggered by heat or the consumption of alcohol or spicy food is suggestive of rosacea. The presence of comedones helps health professionals differentiate acne from skin disorders that are similar in appearance. Chloracne, due to exposure to certain chemicals, may look very similar to acne vulgaris.
If you notice that you’re breaking out right around your period every month, your acne might be linked to hormones. “A sensitivity to the hormones called androgens manifests in the form of cystic acne,” says Linkner. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Birth control, which has estrogen and progestin, helps keep hormones balanced and skin clear. Ortho Tri-Cyclen, Estrostep, and YAZ are all FDA-approved as acne treatments.
First, let’s talk about what causes acne. Pimples form when the oil and dead skin cells on your skin combine to form a plug that blocks the pores. “As the P. acnes bacteria that naturally live on skin overgrow within this plugged follicle, the area becomes inflamed and this is when you start to see papules, pustules, and cystic lesions,” RealSelf dermatologist Sejal Shah, M.D., tells SELF. The treatments ahead work to exfoliate away dead skin cells, suck up excess oil, stop inflammation, and kill the P. acnes bacteria. There are even a few treatments that target hormonal acne specifically.
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Acne appears to be strongly inherited with 81% of the variation in the population explained by genetics. Studies performed in affected twins and first-degree relatives further demonstrate the strongly inherited nature of acne. Acne susceptibility is likely due to the influence of multiple genes, as the disease does not follow a classic (Mendelian) inheritance pattern. Several gene candidates have been proposed including certain variations in tumor necrosis factor-alpha (TNF-alpha), IL-1 alpha, and CYP1A1 genes, among others. The 308 G/A single nucleotide polymorphism variation in the gene for TNF is associated with an increased risk for acne. Acne can be a feature of rare genetic disorders such as Apert's syndrome. Severe acne may be associated with XYY syndrome.
Microneedling is a procedure in which an instrument with multiple rows of tiny needles is rolled over the skin to elicit a wound healing response and stimulate collagen production to reduce the appearance of atrophic acne scars in people with darker skin color. Notable adverse effects of microneedling include postinflammatory hyperpigmentation and tram track scarring (described as discrete slightly raised scars in a linear distribution similar to a tram track). The latter is thought to be primarily attributable to improper technique by the practitioner, including the use of excessive pressure or inappropriately large needles.
Globally, acne affects approximately 650 million people, or about 9.4% of the population, as of 2010. It affects nearly 90% of people in Western societies during their teenage years, but can occur before adolescence and may persist into adulthood. While acne that first develops between the ages of 21 and 25 is uncommon, it affects 54% of women and 40% of men older than 25 years of age, and has a lifetime prevalence of 85%. About 20% of those affected have moderate or severe cases. It is slightly more common in females than males (9.8% versus 9.0%). In those over 40 years old, 1% of males and 5% of females still have problems.
Acne usually improves around the age of 20, but may persist into adulthood. Permanent physical scarring may occur. There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts. Another psychological complication of acne vulgaris is acne excoriée, which occurs when a person persistently picks and scratches pimples, irrespective of the severity of their acne. This can lead to significant scarring, changes in the affected person's skin pigmentation, and a cyclic worsening of the affected person's anxiety about their appearance. Rare complications from acne or its treatment include the formation of pyogenic granulomas, osteoma cutis, and solid facial edema. Early and aggressive treatment of acne is advocated by some in the medical community to reduce the chances of these poor outcomes.
Get at least eight hours of sleep. Sleeping kills two birds with one stone, as it helps to relax your body as well as detoxify it. If you aren’t getting enough sleep, chances are your skin hasn’t had the time or ability to renew its skin cells. Regulate your sleep cycle by going to bed at a consistent time every night and sleeping for a minimum of eight hours at least.
We suggest avoiding spot treatments. “Benzoyl peroxide, when placed on red spots, can actually cause more irritation and inflammation to the area. It’s best used to prevent red bumps and pustules, and applied all over the area you want to treat,” said Townsend, who was also quick to naysay a spot-treat-only approach: “Acne affects all of the pores. If someone is going to spot treat against my advice, I still suggest they spot treat one day and treat the whole face the next.”
Doctors aren’t certain what causes it, but the leading theory is that, just like with teen acne, hormones are to blame. “Babies get a surge of Androgen hormones when they’re around a month old, and those hormones can cause enlarged oil glands and, ultimately, acne,” says Dr. Kahn. Oxytocin and Prolactin, which are the hormones that your baby gets from breastfeeding, don’t tend to cause pimples, she adds.
Shower twice a day. Take a shower or bath in the morning and at night. Alternatively, take a shower in the morning and then again after physical activity, like exercise, or sweating. Wash your entire body with a mild cleanser and use shampoos that limit oil production in your hair. Be sure to always shower after exercising to remove the dead skin cells your body has sloughed off through sweating.
Clascoterone is a topical antiandrogen which has demonstrated effectiveness in the treatment of acne in both males and females and is currently in the late stages of clinical development. It has shown no systemic absorption or associated antiandrogenic side effects. In a direct head-to-head comparison, clascoterone showed greater effectiveness than topical isotretinoin. 5α-Reductase inhibitors such as finasteride and dutasteride may be useful for the treatment of acne in both males and females, but have not been thoroughly evaluated for this purpose. In addition, the high risk of birth defects with 5α-reductase inhibitors limits their use in women. However, 5α-reductase inhibitors can be combined with birth control pills to prevent pregnancy, and are frequently used to treat excessive hair in women. There is no evidence as of 2010 to support the use of cimetidine or ketoconazole in the treatment of acne.
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.