What's Going On: If it's big, red, and painful, you're probably experiencing cystic acne, one of the more severe types. "Cystic pimples are caused by genetics and hormonal stimulation of oil glands," says Zeichner. Not only are they large, but they're also notoriously tough to treat. They often recur in the same place, because even if you manage to get rid of one, it can keep filling up with oil again and again, like an immortal pimple.
But Accutane has mixed reviews for a reason. It makes the skin super dry and sensitive, which means it’s important to keep moisturizers and lip balm nearby while you’re on the treatment. Oh, and don’t even think about waxing your eyebrows (just imagine your skin ripping off). There’s another downside to Accutane: It requires a lot of paperwork and office visits. Since isotretinoin can cause birth defects, you have to come into the dermatologist once a month to get a pregnancy test and take a lengthy survey with embarrassing questions about your sex life to prove that you are using sufficient birth control. These precautions are intense, but dermatologists agree that the final results for Accutane are like no other. “This is one of the few medicines that I can look [patients] in the eye and guarantee them it will work,” says Friedman.
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All acne is not, actually, created equal. This makes perfect sense, seeing as there are so many factors — i.e. hygiene, hormones, and genetics — that can both lead to and exacerbate your breakouts. But knowledge is power, and just knowing that there are different types, and that each kind requires its own plan of attack, puts you ahead of the clear-skin curve. Once you figure out what you're working with, it gets far easier to treat. Here, your ultimate guide to identifying, and then taking down, every type of acne out there, according to dermatologists. Find out how to identify and deal with the different kinds of acne, including blackheads, whiteheads, blind pimples, and cystic zits.
When regular light is used immediately following the application of a sensitizing substance to the skin such as aminolevulinic acid or methyl aminolevulinate, the treatment is referred to as photodynamic therapy (PDT). Many different types of nonablative lasers (i.e., lasers that do not vaporize the top layer of the skin but rather induce a physiologic response in the skin from the light) have been used to treat acne, including those that use infrared wavelengths of light. Ablative lasers (such as CO2 and fractional types) have also been used to treat active acne and its scars. When ablative lasers are used, the treatment is often referred to as laser resurfacing because, as mentioned previously, the entire upper layers of the skin are vaporized. Ablative lasers are associated with higher rates of adverse effects compared with nonablative lasers, with examples being postinflammatory hyperpigmentation, persistent facial redness, and persistent pain. Physiologically, certain wavelengths of light, used with or without accompanying topical chemicals, are thought to kill bacteria and decrease the size and activity of the glands that produce sebum. Disadvantages of light therapy can include its cost, the need for multiple visits, time required to complete the procedure(s), and pain associated with some of the treatment modalities. Typical side effects include skin peeling, temporary reddening of the skin, swelling, and postinflammatory hyperpigmentation.
Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties. It opens obstructed skin pores and promotes shedding of epithelial skin cells. Salicylic acid is known to be less effective than retinoid therapy. Dry skin is the most commonly seen side effect with topical application, though darkening of the skin has been observed in individuals with darker skin types.
Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It doesn't necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
No one knows exactly what causes acne. Hormone changes, such as those during the teenage years and pregnancy, probably play a role. There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and pimples are not caused by dirt. Stress doesn't cause acne, but stress can make it worse.
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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).
Alternative and integrative medicine approaches used in the treatment of acne include fish oil, brewer's yeast, probiotics, oral zinc and topical tea tree oil. More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and traditional Chinese medicine. Talk with your doctor about the pros and cons of specific treatments before you try them.