Acne scars are caused by inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris.[31] The scar is created by abnormal healing following this dermal inflammation.[32] Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris.[31] Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or loss at the site of the acne lesion.[33]
Antiandrogens such as cyproterone acetate and spironolactone have been used successfully to treat acne, especially in women with signs of excessive androgen production such as increased hairiness or skin production of sebum, or baldness.[10][47] Spironolactone is an effective treatment for acne in adult women, but unlike combined birth control pills, is not approved by the United States Food and Drug Administration for this purpose.[1][36][100] The medication is primarily used as an aldosterone antagonist and is thought to be a useful acne treatment due to its ability to additionally block the androgen receptor at higher doses.[36] Alone or in combination with a birth control pill, spironolactone has shown a 33 to 85% reduction in acne lesions in women.[91] The effectiveness of spironolactone for acne appears to be dose-dependent.[91] High-dose cyproterone acetate alone has been found to decrease symptoms of acne in women by 75 to 90% within 3 months.[101] It is usually combined with an estrogen to avoid menstrual irregularities and estrogen deficiency.[102] The medication has also been found to be effective in the treatment of acne in males, with one study finding that a high dosage reduced inflammatory acne lesions by 73%.[103][104] However, the side effects of cyproterone acetate in males, such as gynecomastia, sexual dysfunction, and decreased bone mineral density, make its use for acne in this sex impractical in most cases.[103][104][105] Hormonal therapies should not be used to treat acne during pregnancy or lactation as they have been associated with birth disorders such as hypospadias, and feminization of the male babies.[47] In addition, women who are sexually active and who can or may become pregnant should use an effective method of contraception to prevent pregnancy while taking an antiandrogen.[106] Antiandrogens are often combined with birth control pills for this reason, which can result in additive efficacy.[36][107]
Like baby acne, eczema is very common in newborns, but it’s usually caused by dry (not oily) skin. Mild eczema can cause lots of small bumps, similar to baby acne. Since it often starts on the cheeks, it’s easy to confuse with baby acne. But, if it spreads into a rash that covers the skin or develops in other areas of your baby’s body, such as the folds of his elbows and knees, then it’s probably eczema, not acne. Eczema isn’t usually serious. You can treat it by using a gentle hydrating lotion on your baby’s skin after bathtime.

To many parents’ dismay, their beautiful newborn’s face breaks out with red bumps at around 3 to 4 weeks of age. This is called baby acne. It tends to occur at about the same age as the baby’s peak gas production and fussiness. How attractive! (This all coincides with parents’ maximum sleep deprivation.) Parents are often quite concerned both about how these bumps look and about their significance.


Dermal or subcutaneous fillers are substances injected into the skin to improve the appearance of acne scars. Fillers are used to increase natural collagen production in the skin and to increase skin volume and decrease the depth of acne scars.[146] Examples of fillers used for this purpose include hyaluronic acid; poly(methyl methacrylate) microspheres with collagen; human and bovine collagen derivatives, and fat harvested from the person's own body (autologous fat transfer).[146]
The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use oral prescription medications for acne.
Have you tried treating your acne with no luck? You might simply be using the wrong product for the type you have. Whether you have periodic breakouts or more stubborn cystic acne, there's a solution. We asked Dr. Neal Schultz, an NYC dermatologist, to share the best treatments for every type of acne. Read on for his expert product recommendations, along with some editor favorites, that'll give you clear skin in no time.
Risk factors for the development of acne, other than genetics, have not been conclusively identified. Possible secondary contributors include hormones, infections, diet and stress. Studies investigating the impact of smoking on the incidence and severity of acne have been inconclusive.[2][38][39] Sunlight and cleanliness are not associated with acne.[14]

This at-home skin peel available at Sephora tightens pores, reduces oil, helps retexturize skin and diminishes dark spots. It's paraben and sulfate free, non-comedogenic and isn't tested on animals. Use this peel each week as part of your clear skin regimen to help even out skin tone and gently remove unhealthy top skin layers, revealing new, healthier skin underneath. 
How to Handle It: Think of these as bigger, pissed-off whiteheads. Your best bet, says Zeichner, is to stock up on benzoyl peroxide, which kills the bacteria. A spot treatment like Murad Acne Spot Fast Fix ($22) should do the trick. Also, try not to pop them — as tempting as that may be. Since they're inflamed, they're more likely to scar if you go the DIY route.
What's Going On: You might be all too familiar with these, which tend to make their debut when you’re in high school. "Blackheads, like whiteheads, are blocked pores," says Zeichner. What gives them their namesake color, though, is the oil. It's already dark, but blackheads also have a larger opening at the surface than whiteheads do, meaning air can enter and oxidize that oil sitting inside the pore, turning it even darker.
Postinflammatory hyperpigmentation (PIH) is usually the result of nodular acne lesions. These lesions often leave behind an inflamed darkened mark after the original acne lesion has resolved. This inflammation stimulates specialized pigment-producing skin cells (known as melanocytes) to produce more melanin pigment which leads to the skin's darkened appearance.[35] People with darker skin color are more frequently affected by this condition.[36] Pigmented scar is a common term used for PIH, but is misleading as it suggests the color change is permanent. Often, PIH can be prevented by avoiding any aggravation of the nodule, and can fade with time. However, untreated PIH can last for months, years, or even be permanent if deeper layers of skin are affected.[37] Even minimal skin exposure to the sun's ultraviolet rays can sustain hyperpigmentation.[35] Daily use of SPF 15 or higher sunscreen can minimize such a risk.[37]
Most people find themselves suffering from an acne outbreak at some point usually during their adolescence when they go through puberty. Whether it's due to hormones or stress. Contrary to popular belief, pimples don't necessarily mean your skin is dirty or unclean — in fact, over-cleansing can irritate your skin even more. However, hormones aren't uncontrollable, and there are simple changes you can make to eliminate your breakouts. You can have your glowing, healthy, and pimple-free skin back in no time.
Castor oil has anti-inflammatory and antibacterial properties that can speed up healing, making it ideal for breakout-prone skin. Though I recommend using it in very small amounts with jojoba oil, hemp seed oil or coconut oil, along with one of the essential oils above, it’s high in unsaturated fatty acids, vitamin E, proteins and minerals, which can help reduce acne-causing bacteria and inflammation associated with breakouts. It can even help heal scars caused by acne.
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Acne is different for everyone, but there may be some simple solutions to having clear skin. From the foods you eat to the stress in your life and the products you use, it may take a little time to find what works for you, but positive changes can greatly affect your life and the life of your children that may be affected by acne. If using essential oils, make sure to use pure oils and take it slow. Check with your doctor before using anything new.
Another vice that can lead to worsened acne is alcohol. As we mentioned, your diet and acne are related. One glass of wine won’t trigger a breakout – even contains beneficial antioxidants! – but excessive alcohol consumption can alter your hormone levels. Making matters worse, many people drink due to stress, which also affects acne-inducing hormones. Alcohol impairs the liver’s ability to purify toxins, and if the liver is compromised, toxins are expelled through different channels such as your skin. It’s full of that sugar we just warned you about and weakens your immune system, which inhibits your body’s natural ability to fight off P. acnes bacteria. If you pass out after a night of drinking without washing your face, your pores are more likely to become clogged and create pimples. Almost everyone enjoys indulging in a drink every now and then, but moderation here is key.
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.”
When we sleep, healing happens, and at the same time, it’s a great time to apply a home remedy and let it get it to work on eliminating toxins that can cause acne. The Psychiatric Clinics of North America reports that stress is a factor affecting all organs. Though it’s easy to forget, the skin is an organ. In fact, it’s your largest organ! Getting plenty of rest can help reduce acne-associated stress. (9) 
This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
Flutamide, a pure antagonist of the androgen receptor, is effective in the treatment of acne in women.[101][108] It has generally been found to reduce symptoms of acne by 80 or 90% even at low doses, with several studies showing complete acne clearance.[101][109][110] In one study, flutamide decreased acne scores by 80% within 3 months, whereas spironolactone decreased symptoms by only 40% in the same time period.[110][111][112] In a large long-term study, 97% of women reported satisfaction with the control of their acne with flutamide.[113] Although effective, flutamide has a risk of serious liver toxicity, and cases of death in women taking even low doses of the medication to treat androgen-dependent skin and hair conditions have occurred.[114] As such, the use of flutamide for acne has become increasingly limited,[113][115][116] and it has been argued that continued use of flutamide for such purposes is unethical.[114] Bicalutamide, a pure androgen receptor antagonist with the same mechanism as flutamide and with comparable or superior antiandrogenic efficacy but without its risk of liver toxicity, is a potential alternative to flutamide in the treatment of androgen-dependent skin and hair conditions in women.[106][117][118][119]
Hypertrophic scars are uncommon, and are characterized by increased collagen content after the abnormal healing response.[32] They are described as firm and raised from the skin.[32][34] Hypertrophic scars remain within the original margins of the wound, whereas keloid scars can form scar tissue outside of these borders.[32] Keloid scars from acne occur more often in men and people with darker skin, and usually occur on the trunk of the body.[32]
What's Going On: Do you tend to get these at the same time every month — say, just before you get your period? Because these are the work of fluctuating hormones, says Joshua Zeichner, a dermatologist and the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. Hormones can put oil production into overdrive, and having an excess of it means that it’s more likely to settle in your pores and cause zits.

How to Handle It: Think of these as bigger, pissed-off whiteheads. Your best bet, says Zeichner, is to stock up on benzoyl peroxide, which kills the bacteria. A spot treatment like Murad Acne Spot Fast Fix ($22) should do the trick. Also, try not to pop them — as tempting as that may be. Since they're inflamed, they're more likely to scar if you go the DIY route.
Whereas acne vulgaris clogs pores from the bottom up, acne inversa (or hidradenitis suppurativa) is a form of acne that clogs pores from the top down. It’s caused by excessively rapid skin growth, occluding the mouth of pores with shed skin cells. When the pores are blocked and clogged, they become inflamed and can create pimples and acne lesions. This form of acne is usually observed in intertriginous skin, where two skin areas may touch or rub together. Induced or aggravated by heat, moisture, maceration, friction and lack of air circulation. Examples of these areas include underarms, folds of the breasts, and between buttocks cheeks.

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Green Tea: Green tea delivers a multitude of benefits, including lower blood pressure, reduced cholesterol levels, improved bone density, improved memory and even the prevention of cancer. With regards to your skin, its anti-inflammatory properties can help fight acne when consumed orally, but its treatment is more effective when applied topically directly onto skin using BioClarity’s three-step process.
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Isotretinoin (previously known as Accutane) is the most effective form of acne therapy and the only one that can actually result in a cure for your acne. After finishing a course 80 percent of people never see acne again. It works so well because it unclogs pores, kills bacteria, reduces oil production and reduces inflammation. It's taken as a daily pill. Isotretinoin has numerous rare and potential side effects that has made it a controversial choice, but for patients with severe acne there is often no other option. Patients taking isotretinoin must also be on highly effective birth control as the drug can cause birth defects. Isotretinoin can only be taken under close medical supervision.
Topical and oral preparations of nicotinamide (the amide form of vitamin B3) have been suggested as alternative medical treatments.[134] It is thought to improve acne due to its anti-inflammatory properties, its ability to suppress sebum production, and by promoting wound healing.[134] Topical and oral preparations of zinc have similarly been proposed as effective treatments for acne; evidence to support their use for this purpose is limited.[135] The purported efficacy of zinc is attributed to its capacity to reduce inflammation and sebum production, and inhibit C. acnes.[135] Antihistamines may improve symptoms among those already taking isotretinoin due to their anti-inflammatory properties and their ability to suppress sebum production.[136]
A 2013 study on acne vulgaris in The Nurse Practitioner concurred that a multidimensional approach to acne is usually necessary because most people have a combination of symptoms. Based on the advice of dermatologists and aestheticians, we turned our focus to regimen sets, analyzing the ingredients of more than 40 kits before finding our top picks.
Not only can the sun prolong PIE appearance, it can lead to premature aging including sun spots, fine lines, and wrinkles. UV damage is DNA damage. Sunscreen is an anti-aging must for all ages young and old--preventing future skin cancer. It is the fountain of youth in a bottle. Prevention is better than treatment. There is no such thing as safe tanning, as tanning is the result of sun damage.
Blackheads appear as small black dots on the skin. They usually occur on the face – especially the nose and T-Zone – but can also be seen on the back, neck, chest, shoulders and arms. Blackheads are one of two types of comedones, or acne lesions caused by clogged pores. Blackhead comedones are open versus closed, leaving the plug at the top of the clogged pore exposed to air on the skin’s surface. It’s this exposure to oxygen that accounts for their color, which can not only be black but also gray, yellow or brown. When melanin – a pigment produced by oil glands and found within sebum – makes contact with air, it oxidizes and turns dark. Blackheads are a mild, usually painless form of acne, as there’s less inflammation associated with this type of lesion.
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Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties.[132][133] It opens obstructed skin pores and promotes shedding of epithelial skin cells.[132] Salicylic acid is known to be less effective than retinoid therapy.[20] 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.[1]
Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.
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