Acne scars are caused by inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris.[30] The scar is created by abnormal healing following this dermal inflammation.[31] Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris.[30] 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.[32]
For those with acne-prone skin, it can be tough finding a sunscreen that doesn’t clog pores and meshes well with your skincare regimen. Oily sunscreens often lead to breakouts. In addition to the wash, toner, moisturizer and treatments, the Clear Start kit includes an acne-safe (read: oil-free) sunscreen in its lineup — perfect for those wanting the best of both worlds in avoiding all types of red faces.
What it is: Spironolactone is a prescription medication in tablet form used to treat certain patients with hyperaldosteronism (the body produces too much aldosterone, a naturally occurring hormone), low potassium levels, and in patients with edema (fluid retention) caused by various conditions.1 Learn more from the U.S. National Library of Medicine.
Shah often recommends over-the-counter retinols or prescription retinoids to her acne-prone patients. “I find that compared to other treatments they are beneficial for not just treating acne but also preventing new acne from forming as they help prevent that initial stage of the follicle getting clogged,” she says. “They can also help with some of the post acne [problems] such as hyperpigmentation.” But keep in mind if you have sensitive skin (or eczema or rosacea), a prescription retinoid might be too strong an option. However, your dermatologist can recommend an over-the-counter retinol with a low concentration (0.1 to 0.25 percent), which might be better tolerated. Retinol also isn’t a quick fix. It takes time to see results, and it’s something you’ll have to keep using to maintain its benefits. Shah also mentions that retinol plays well with other acne treatments on the list. "Retinol can be combined with other over-the-counter or prescription medications such as benzoyl peroxide, topical antibiotics, and oral medications. The right combination depends on the severity of the acne and your skin type."
Corticosteroid injections may be used to treat large, painful lesions. These injections can ease the pain and help clear a large lesion more quickly. A systemic acne treatment that you may have heard about is isotretinoin (aka Accutane). This is the only medication approved by the U.S. Food and Drug Administration (FDA) to treat severe resistant nodular cystic acne, the most severe form. Dr. Turner does use Accutane in appropriate patients, however it is typically a five- to six-month course of therapy, which requires monthly office visits.
Genetics is thought to be the primary cause of acne in 80% of cases.[2] The role of diet and cigarette smoking is unclear, and neither cleanliness nor exposure to sunlight appear to play a part.[2][13][14] In both sexes, hormones called androgens appear to be part of the underlying mechanism, by causing increased production of sebum.[5] Another frequent factor is excessive growth of the bacterium Propionibacterium acnes, which is normally present on the skin.[5]
If you have acne that's not responding to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and of lasting damage to your self-esteem. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions (dermatologist).
Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.

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“You unfortunately cannot determine the strength of a product strictly by the percentage of its active ingredients because how well a product works depends on how well its inactive ingredients help it penetrate the skin,” explains Dr. Green. “In other words, a 2 percent benzoyl peroxide may be more effective than another brand’s 5 percent benzoyl peroxide because there are other ingredients helping out.”
Frequently used topical retinoids include adapalene, isotretinoin, retinol, tazarotene, and tretinoin.[46] They often cause an initial flare-up of acne and facial flushing, and can cause significant skin irritation. Generally speaking, retinoids increase the skin's sensitivity to sunlight and are therefore recommended for use at night.[1] Tretinoin is the least expensive of the topical retinoids and is the most irritating to the skin, whereas adapalene is the least irritating to the skin but costs significantly more.[1][84] Tazarotene is the most effective and expensive topical retinoid, but is not as well-tolerated.[1][84] Retinol is a form of vitamin A that has similar but milder effects, and is used in many over-the-counter moisturizers and other topical products.

Although there is not enough research to determine if certain foods cause breakouts, there are certain changes you can make to your diet to help prevent them. For breakfast, switching to plain oatmeal that has only been sweetened with fresh fruit can help prevent excessive androgen production. When you eat fish, opt for salmon, which is high in omega-3s. One omega-3 called DHA is an anti-inflammatory. Snacking on sunflower seeds can give you more vitamin E in your diet. Vitamin E helps the immune system fight off bacteria before inflammation and cysts occur. Finally, make sure you stay hydrated by drinking plenty of water each day. Your body needs almost half a gallon each day.


The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle.[1] In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle.[10] However, increased production of oily sebum in those with acne causes the dead skin cells to stick together.[10] The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone.[10] This is further exacerbated by the biofilm created by P. acnes within the hair follicle.[44] If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo).[1][10][19] In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).[1][10]

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Although home remedies are generally convenient and popular, some have significant counterproductive effects on the skin. The famous Procter & Gamble product Ivory Soap is probably the world’s most frequently used acne face wash ingredient. It is also probably the world’s worst acne face wash ingredient. Often advertised as “so pure that it floats,” Ivory Soap is depicted with pictures of babies and fair-skinned blondes to imply that it is a good and inexpensive face wash for acne-affected skin. Nothing could be farther from the truth.
Resorcinol – Almost always found coupled with sulfur, this ingredient breaks down hardened, rough or scaly skin, while disinfecting and fighting infections5. This ingredient is often used topically to treat pain and itching stemming from small injuries like scrapes and cuts, burns, bug bites, sunburn, poison ivy and more. It’s also used to treat skin conditions like eczema, seborrhea, psoriasis, warts, corns and other disorders. It is generally found in strengths of up to 2%.
How to Handle It: Consider salicylic acid your secret weapon. "This beta hydroxy acid helps remove excess oil and exfoliate dead cells from the skin's surface to keep pores clear," says Zeichner. Try Clinique's Acne Solution Clearing Gel, a two-time Best of Beauty winner that packs both salicylic acid and sea whip extract — an ingredient with skin-soothing properties — to help counteract the dryness sometimes caused by salicylic acid. The formula does double duty: It works as a spot treatment for mild to moderate acne and as a nightly allover treatment for pimple prevention. And since it dries clear, you can wear it to fight zits whenever, wherever.
This foaming cleanser is a soap-free gel that will clear away clogged pores without drying skin out. Designed not to disturb the skin’s natural moisture balance, the formula is made with astringent lavender extract to minimize pores and balance PH, while the anti-inflammatory balm mint extract soothes inflammation, giving skin a visibly clearer appearance. It uses alpha hydroxy acids and quillaja saponaria to deep clean pores and fight acne-causing bacteria.
Considerations: Side effects are generally mild and short lived. Most common, in 1-5% of people are itching, burning, stinging, and tingling. Other side effects were reported in less than 1% of people. There have been a few reports from darker skinned people of lightening of the skin. Azelaic acid has not been well studied in people with dark complexions.1

In terms of their effectiveness, both these ingredients are beneficial. Any related product worth its salt will have either one of these in their formula. In fact, some products incorporate both. However, in saying this, our research has provided conclusive proof that salicylic acid is the one to choose. Below are the main points as to why we think this is the case:


In terms of their effectiveness, both these ingredients are beneficial. Any related product worth its salt will have either one of these in their formula. In fact, some products incorporate both. However, in saying this, our research has provided conclusive proof that salicylic acid is the one to choose. Below are the main points as to why we think this is the case:
Although home remedies are generally convenient and popular, some have significant counterproductive effects on the skin. The famous Procter & Gamble product Ivory Soap is probably the world’s most frequently used acne face wash ingredient. It is also probably the world’s worst acne face wash ingredient. Often advertised as “so pure that it floats,” Ivory Soap is depicted with pictures of babies and fair-skinned blondes to imply that it is a good and inexpensive face wash for acne-affected skin. Nothing could be farther from the truth.
Beyond making sure the system contains safe combinations of ingredients, a system can also treat all aspects of acne. By picking and choosing individual products, you may miss an important step. Plus, treatment systems contain ingredients like glycolic acid that help smooth acne scars, something you might not think about when you are shopping for products. Did you know probiotics help reduce inflammation? Or that kojic acid and arbutin can lighten brown spots? When it comes to treating acne, you should leave the mixing to professionals. You still can try out a variety of systems to find the one that works best for you.
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