The latest bare-faced beauty trend on Instagram is—surprise!—#freethepimple, a.k.a. acne acceptance (the skin-confident spinoff of the body positivity movement). Even The New York Times is asking, “Is Acne Cool Now?” We say, you should never feel ashamed of your skin—but you also don’t have to resign yourself to painful breakouts. Here’s how to treat your acne and knock your spots off.
WHAT CAUSES ACNE? AND WHAT ARE THE DIFFERENT TYPES OF ACNE?
Acne is a chronic skin disease that’s super common. In fact, those who never break out are rare unicorns: “About 85 percent of people aged 12 to 24 will get acne at some point, whether mild, moderate or severe,” says Dr. Jason Rivers, founder of Pacific Derm in Vancouver, clinical professor of dermatology at the University of British Columbia, and president of the Acne and Rosacea Society of Canada. The issue doesn’t always go away once you’re past the raging hormones of your teen or college years either. In one survey, 35 percent of 30-something women and 26 percent of 40-something women still reported getting acne.
The condition is multifactorial, meaning there are several culprits. First, if you’re acne-prone, you have “[hair] follicles that are more ‘glued up,’” says Dr. Rivers. That means oil doesn’t flow freely from the follicles (pores), and your sticky dead skin cells clump together inside those pores. Your skin also tends to make too much sebum (hormones can stimulate production). This oil then serves up an all-you-can-eat buffet for P. acnes, the bacteria that causes acne.
The result: clogged pores that lead to whiteheads and blackheads (both are types of comedones, considered a mild type of acne). What’s the difference between a whitehead versus a blackhead, you ask? A whitehead is basically gunk inside a closed pore, whereas a blackhead is open at the end; the air allows the clog to oxidize and darken.
The walls of plugged pores can break, and when they do, your immune system will try to fight infection by sending in white blood cells. But this inflammatory response can also turn blemishes into papules (little bumps, inflamed right under the skin surface) or pustules (the classic pimple, typically pus-y, inflamed at the skin’s surface). The most severe types of acne include the cystic or nodular kind, where the inflammation is lodged way down deep (see “How to get rid of a cystic pimple”).
If your breakouts happen around your period, you’re not alone. Post-adolescent hormonal acne comes in cycles, typically showing up as deep, tender nodules on the lower face and jawline. Why there? “We think the oil glands in the jawline are differently sensitive to hormonal triggers,” explains Dr. Shannon Humphrey, medical director of Carruthers & Humphrey, and clinical assistant professor in the department of dermatology and skin science at the University of British Columbia.
HOW TO PREVENT ACNE
If your case of acne is mild to moderate, prevention will typically involve keeping your pores as clear as you can (that means exfoliating) and controlling acne-causing bacteria. Some of the best acne medications will do both at once: “The two most common over-the-counter treatments are benzoyl peroxide and salicylic acid,” says Dr. Humphrey. “Benzoyl peroxide’s primary mechanism is anti-inflammatory and anti-bacterial, whereas salicylic acid’s primary mechanism is through exfoliation.” But as a secondary skill, each ingredient will also do what the other does, she says.
If you’re trying to figure out which is the best acne treatment for you, benzoyl peroxide is a bit better for inflammatory acne, says Dr. Humphrey. Salicylic acid is a little better for comedonal acne (whiteheads and blackheads). The challenge with both ingredients, however: they can cause skin dryness, irritation and redness. Dryness means your skin’s barrier function has weakened—and this can make all manner of skin issues worse. So play it conservative, advises Dr. Humphrey. Pick one of the ingredients to start (like a low-concentration, alcohol-free benzoyl peroxide gel or cream), and if your skin can tolerate it, consider adding the other.
As for AHAs, like glycolic acid, they are a “great option as an add-on,” says Dr. Humphrey. They’re particularly good for women with adult acne, since they also brighten and exfoliate skin, so you look glowy. “They help a little bit with acne—but they’re not real powerhouses for patients with more moderate or nodular acne.”
Lastly, Dr. Rivers considers retinoids “the cornerstone of all acne treatment.” Although they’re sometimes thought of as an anti-aging ingredient, these vitamin A derivatives help clear up acne, too. “They help peel the skin a bit and open up the pores by normalizing cell differentiation within the hair follicle,” says Dr. Rivers. Translate: the cells don’t get as clogged up. Ask your doc about retinoids (available by prescription), or look for products with retinol (the over-the-counter version).
HOW TO GET RID OF ACNE
The best defense is a good offense. Warding off flare-ups in the first place (see “How to prevent acne”) is better than trying to do damage control after the fact. But if you’re looking for an acne spot treatment, “the only drugs that have been shown to help would be benzoyl peroxide, and possibly a topical antibiotic like clindamycin,” says Dr. Humphrey. Benzoyl peroxide may reduce inflammation and shorten the lifespan of your pimple, she explains.
Once you’ve gotten rid of any given breakout, remember that the underlying conditions that let it bloom—sticky skin cells, excess oil, acne bacteria—are still there. Acne is chronic, so being consistent with your skincare, even when you think you’re in the clear, is key.
HOW TO GET RID OF A CYSTIC PIMPLE
First things first: what is cystic acne? Unfortunately, it’s a less common but more aggressive form of acne that requires a doctor’s attention. What it looks like: large, hard inflamed bumps embedded deep in the skin. What it feels like: tender, painful and swollen.
Ultimately what causes cystic pimples are the same factors brewing other types of acne: a combination of sticky skin cells, sebum and acne-causing bacteria. But when the bacteria manages to sneak way down into the pore, that’s when you get super sore, lump-like pimples.
“[Whereas] a whitehead is pus under a single layer of dead skin cells, with a cyst or nodule—something that feels like a marble under the skin—the inflammation is much deeper into the dermis,” explains Dr. Humphrey.
Because the inflammation is so far underground, over-the-counter skincare products won’t have much power to get rid of a cystic pimple. “Generally, the topical treatments we have will only penetrate into the top layers of skin,” says Dr. Humphrey. If you just have one deep-down lesion you need to calm down fast, you could consider seeing a board-certified dermatologist for a cortisone shot, which will help it shrink quickly. Warning: with cortisone shots, there’s a risk you could develop a divot (the result of atrophy)—so make sure you see a qualified pro who will inject you very conservatively, says Dr. Humphrey.
If your cystic or nodular acne is recurring, however, “usually you need systemic [oral] medication,” Dr. Humphrey explains. The longer you wait to treat cystic acne, the greater your risk of scarring (think: pits, shallow depressions or bumps that won’t go away). So see a dermatologist ASAP. Your doc can talk about options like prescription drugs, such as the birth control pill (if it’s hormonal acne triggered by your menstrual cycle), an oral antibiotic or, for the most stubborn cases of cystic acne, Accutane (this prescription pill is often considered a last resort because it comes with the risk of serious side effects, such as birth defects).
HOW TO GET RID OF ACNE SCARS
As if taming breakouts isn’t tough enough, the aftermath can be even trickier and more time-consuming to treat. You could be left with raised scars, red acne marks (a.k.a. post-inflammatory erythema) or dark spots (post-inflammatory hyperpigmentation).
Minimize your risk of getting scars and discoloration in the first place, says Dr. Rivers. That means resist the urge to pick or pop your pimples. And don’t wait to see a dermatologist if your acne doesn’t improve within 2-3 months no matter what you try. There’s also a prescription topical, TactuPump Forte (a retinoid plus benzoyl peroxide), that not only treats acne but seems to help reduce the formation of new scars, says Dr. Rivers.
How to get rid of pimple scars once they’ve formed? Unfortunately, once the collagen has permanently changed, there’s not much you can do at home. “We have to resort to physical means,” says Dr. Rivers. In-office options include dermabrasion, surgical procedures (like punch grafting, in which a small hole of skin is removed and replaced with skin taken from elsewhere) or chemical peels, depending on the scars.
How to get rid of red acne marks? Dr. Rivers says many will fade on their own over time. If they don’t, he will often do laser treatment for acne scars and redness. “I prefer to use the KTP 532 nm laser,” he explains. “It’s a vascular laser that interacts with the red in the skin. It shrinks the [blood] vessels, reduces the red and also stimulates a bit of collagen.”
How to get rid of dark spots? Post-inflammatory hyperpigmentation tends to be more common in certain skin tones, particularly darker skin. “On the face, it generally fades with time,” says Dr. Rivers. “But it can last for months, sometimes years.” Brightening ingredients like kojic acid can help lessen the discoloration, though they can take a while—months or longer—to work. If you’re wondering about in-office options for post-inflammatory hyperpigmentation, Dr. Rivers recommends gentle glycolic acid peels or the PicoSure laser.
HOW TO REDUCE PIMPLE REDNESS
Let’s say it’s the day before your first date/best friend’s wedding/big interview and you’re suddenly sporting a pimple that looks like a bull’s eye on your face. Is there a fast fix? “You can actually put Visine on it,” says Dr. Humphrey. (Be sure to try it ahead of time to make sure you like how it looks, since it can sometimes create a white blotch.) Although the eye drop isn’t a long-term solution, in case of emergency “it just takes the red out.” Then “get yourself a really awesome cover-up,” says Dr. Humphrey, who recommends Dermablend. “It’s basically medical-grade camouflage makeup. It’s amazing.”
HOW TO COVER UP A PIMPLE
Start by neutralizing any redness with a green-based colour corrector. Then, even out your overall skin tone by applying a small amount of foundation; go easy to avoid a cake-y mask. Finally, zero in on the blemish by taking a concealer brush and pressing a tiny bit of a high-coverage concealer right on the breakout. Layer if needed, but less is more: piling on too much product will only make the blemish more noticeable. Feather the concealer around the edges to blend.
HOW TO POP A PIMPLE
In weird news, one of YouTube’s biggest beauty trends is the rise of the pimple-popping video. If you haven’t yet seen the gross-out genre, just google “Dr. Pimple Popper,” a.k.a. California dermatologist Dr. Sandra Lee. (Warning: NSFWS—not safe for weak stomachs.) Her, ahem, handiwork is so popular, she has a fan base of “popaholics.” And she’s even landed her own TV mini-series: Dr. Pimple Popper the show will premiere on TLC July 11.
So you might be wondering if it’s OK to pop a pimple, and how to pop a pimple yourself. The answer: it’s almost always a bad idea. “I don’t recommend people squeeze and prod and poke, especially if it’s a deeper, larger spot,” says Dr. Rivers. You could cause the pimple to get more inflamed (red and angry—and thus more noticeable). Plus, you could do damage that leads to permanent scarring or potentially even infection.
It’s true that pimple-popping may feel satisfying in the moment, Dr. Humphrey acknowledges, but the risks are real. “Patients are quite vicious and aggressive with their own faces. I often see patients with wounds, like deep scabs,” she says. To deal with that massive whitehead ready to erupt, you’re better off going to a dermatologist, who can skillfully extract it.
If you can’t see a derm in time, and if you really can’t leave it alone, here’s how to pop a pimple as safely as possible. Remember, this only applies if the pimple is the poppable kind: if it’s a ripe, juicy whitehead on the surface of your skin, and not a throbbing, underground zit or cystic acne. (Don’t mess around with the latter types.) “Be gentle and clean,” Dr. Humphrey says. “Give yourself one gentle go at it. The biggest risk I see is people just gouging at their skin. It’s unnecessary to use sharp objects. Wear gloves. Wash your hands and face first.”
WHAT CAUSES BACK ACNE?
The same factors that cause breakouts on your face can cause pimples on other parts of your body, including your back and chest. Face acne is just more common because you have more oil glands there.
So the same ingredients you’d use to clear up your face (see “How to prevent acne”) will also help get rid of back acne. “I find salicylic acid is especially useful for back and chest acne because it doesn’t stain [clothes, like benzoyl peroxide can],” says Dr. Rivers. Look for salicylic acid in a product you can use over a larger area without irritation, like a clarifying body wash.
FOODS THAT CAUSE ACNE
Researchers have been debating for ages whether diet can worsen acne. The idea that certain foods cause acne was once deemed a myth, but now the situation is more nuanced. Here’s what we think so far:
- Does coffee cause acne? To date, there’s no proof that it does.
- Does chocolate cause acne? There’s a “very limited amount of evidence” suggesting chocolate has a negative effect on skin, but “there is still no clear answer.”
- Does drinking water help acne? We wish—if only it were that easy! “Hydration is so important for overall health. But most North Americans are adequately hydrated from a skin perspective, and drinking more isn’t going to clear acne,” says Dr. Humphrey.
- Does dairy cause acne? There’s some research that yes, consuming dairy may be linked with acne. Experts consider the association weak, and the body of evidence limited. Nevertheless, skim milk appears to be more comedogenic than whole milk (some speculate this is because the skim milk process reduces certain nutrients that may be anti-inflammatory, explains Dr. Rivers), and it’s possible the hormones in dairy (coming from lactating cows) may be to blame.
- Does sugar cause acne? Not necessarily. But there’s some evidence a high-glycemic diet may contribute acne. Foods high on the glycemic index—which cause a quick, sharp spike in blood sugar—include white bread, white rice and potatoes.
Interestingly, the prevalence of acne among non-western populations is considerably lower—and in at least a few fascinating cases, totally nonexistent. For instance, when researchers visited the locals on the remote island of Kitava, Papua New Guinea, they found not even one pimple (!) in the entire study population (!).
It’s thought the junk-free Kitavan diet could be their beauty secret. They consume no dairy, no alcohol, no coffee or tea; negligible sugar and salt; and lots of carbs, but almost entirely from low-glycemic tubers, fruits and vegetables.
Scientific debate aside, if you suspect that eating certain things are causing you to break out, keep a food diary. See if there’s a consistent pattern, and cut out (or limit) the triggers.
The Kit has selected their recommendation for the best products in these acne-related categories:
- Best Cleanser for Acne-Prone Skin
- Best Moisturizer for Acne-Prone Skin
- Best Anti-Aging and Anti-Acne Treatment
- Best Exfoliating Toner
- Best Emergency Spot Treatment