All acne starts out as a clogged pore. Skin normally sheds its dead cells, but the process isn't perfect: Leftover dead skin cells can mix with excess surface oil and block pores, trapping the cells, sebum (the oily substance that keeps skin lubricated) and bacteria inside. The result is inflammation--and red bumps and lumps.
Why acne strikes some but not others isn't well understood. Faulty skin-cell turnover in pores may play a role. Stress also may be a factor because it boosts hormones that stimulate oil production--a theory backed by Stanford University School of Medicine research, which found that students had worse acne during exam periods, when they were more stressed. But one thing is certain: No matter what degree of acne you have--from mild to severe--you need to break the oil-bacteria-inflammation cycle to get clear skin. Here's how.
MILD ACNE
You have it if you notice only a few whiteheads/blackheads and occasional dome-shaped red bumps.
Clear-skin strategy As with any acne condition, treatment (and prevention) begins with regular exfoliation, says New York City dermatologist Debra Jaliman, M.D. In the morning: Wash with a gentle cleanser like Neutrogena Rapid Clear Oil-Control Foaming Cleanser ($6.49; at drugstores). Then swipe affected skin with a salicylic-acid-based toner or pad. (Try Aveeno Clear Complexion Astringent, $7, or Stri-Dex Triple Action Medicated Pads, $3.49-$6; both at drugstores.) At night: Wash with the same gentle cleanser and follow with a 5 percent benzoyl peroxide treatment to kill bacteria. Try Oxy Balance Acne Treatment for Sensitive Skin ($5; at drugstores).
Extra help A serum or moisturizer can blot surface oil (less oil means less bacteria). Clearasil Total Control All-Day Mattifying Moisturizer SPF 10 ($8; at drugstores) is a good choice. Or look for the new Blackhead Eliminating product line from Neutrogena ($6.49 each; at drugstores).
MODERATE ACNE
You have it if, in addition to black- and whiteheads, you have more frequent dome-shaped bumps.
Clear-skin strategy Try the regimen outlined for mild acne for two weeks. If there's no improvement, see a dermatologist. The ammunition you'll be prescribed will be stronger and may include application of a topical retinoid (Retin-A or a derivative like Differin or Tazarotene) as well as bacteria-busting oral or topical antibiotics. "The specific therapies will vary according to your skin's condition and how well it responds," says Alan Shalita, M.D., chairman of the department of dermatology at the State University of New York Downstate Medical Center in Brooklyn.
Another choice is ClearLight, a high-intensity light source (similar to a laser) that kills surface bacteria, explains Arielle Kauvar, M.D., a clinical associate professor of dermatology at New York University School of Medicine in New York City. A series of eight treatments over the course of a month costs about $1,200, and results last anywhere from four to six months. Another option: the Nlite-V, a fast-pulsed dye laser emitting light that can kill acne-causing bacteria and even heal blemishes. Two sessions are recommended; costs range from $600-$1,500 per session; results can last up to three months. (Neither is covered by insurance.) Last but not least are oral contraceptives, which may help by countering the hormonal fluctuations that give rise to some cases of acne.
Extra help To soothe red, angry-looking breakouts, try using a sulfur-based mask once a week. "Sulfur has calming properties," explains New York City dermatologist Linda Franks, M.D. Good options: emerginC deglazing mask, a clay-based mask ($35; emerginc.com) and Mario Badescu Drying Mask ($18; mariobadescu.com).
SEVERE ACNE
You have it if you notice deep, painful cysts in addition to whiteheads, blackheads and red bumps.
Clear-skin strategy Cystic acne is unique because it's deep-set and has no opening. It's also the most likely form of acne to scar, due to the unique way it heals. (Skin tissue is pulled inward and can leave an indentation.) You should still adhere to a good skincare regimen, but topical treatments alone won't be able to penetrate the cysts. One option: Have each cyst injected with a cortisone solution (visit your dermatologist for these shots, which can cost anywhere from $50-$150 per lump). Cysts will begin to shrink within a day, but the method isn't convenient or cost-effective for chronic outbreaks, since it doesn't reduce recurrences.
For that reason, Accutane, taken in pill form to turn off oil production, is used for cases of severe acne that have been unresponsive to other treatments. Accutane does have the potential for serious side effects; these include dry skin, chapped lips, headaches, depression and elevated levels of heart-disease-promoting triglycerides. It's a lot to think about, but results can be extraordinary: One 14- to 15-week cycle can clear acne for several months and sometimes even clears up skin for good, says William P. Coleman III, M.D., a clinical professor of dermatology at the Tulane University Health Sciences Center in New Orleans.
Extra help A promising but still-experimental alternative to Accutane is the Smoothbeam, a laser that heats oil glands in a way that slows, or often stops, oil production. "I've seen anywhere from a 50-90 percent clearance rate with it," says Tina Alster, M.D., a Washington, D.C.-based dermatologist. Skin clears within a week, and results can last six months. A series of four to six treatments costs from $1,200-$2,400 (not covered by insurance); for more information, click on candelalaser.com.
RELATED ARTICLE: minimize your pores
"Enlarged pores and acne go hand-in-hand," says Robert A. Weiss, M.D., an assistant professor of dermatology at the Johns Hopkins School of Medicine in Baltimore. Gentle, regular exfoliation and keeping oil in check (with over-the-counter blotting serums, makeup and/or prescription medication) can help. Easiest of all: Apply a cream that disguises pore size with optical diffusers. Try Clinique pore minimizer instant perfector ($16.50; clinique.com).
RELATED ARTICLE: the great acne imitators
You may be breaking out in red bumps--but they may not be pimples, says Los Angeles-based dermatologist Howard Murad, M.D. Here, the common skin conditions that are often mistaken for acne:
* Rosacea is a diffuse redness accompanied by tiny acnelike red bumps. It's common in those with fair skin--and may get worse after eating spicy foods or drinking alcohol or hot beverages. Hot showers, saunas and steam rooms also can aggravate it. Prescription treatments include the cleanser Rosanil (rosanil.com) and the topical medication MetroGel (metrogel.com).
* Keratosis pilaris is a condition distinguished by rough bumps; it occurs when the skin has trouble sloughing off dead cells. To treat it, add exfoliating products to your skin-care arsenal every day. (Try Neutrogena Skin Smoothing Body Lotion SPF 15 with exfoliating alpha- and beta-hydroxy acids, $10; at drugstores.)
* Folliculitis is an infection of the hair follicle that's characterized by red bumps and/or whiteheaded pimples and is found primarily in areas where you shave, wax or pluck. To treat it, minimize friction from clothing (which can aggravate it), and prior to hair removal, cleanse with an antibacterial wash like DDF Blemish Foaming Cleanser ($24; at sephora.com).
RELATED ARTICLE: Shape giveaway kiss acne goodbye ... FOR FREE!
We're giving away 200 sets of Neutrogena Rapid Clear Oil-Control Foaming Cleanser, Acne Eliminating Gel and Blackhead Eliminating Treatment Mask (a $19 value!). Log on to Shape.com/neutrogena from Feb. 2-20 for your chance to win these new skin-clearing products. The cleanser helps remove dirt and oil, the gel combines salicylic acid (to treat breakouts) and soothing botanicals (to minimize redness), while the cooling mask penetrates pores to remove stubborn dirt. Log on, and good luck!
RELATED ARTICLE: body acne: how to prevent--and treat--it
* Clean pimple-prone skin at least once a day with an acne wash, wipes or pads. (If you have back acne, use a back-scrubbing brush, available from any drugstore.) Try Noxzema Daily Exfoliating Cleanser ($4.49; at drugstores). Then apply a benzoylperoxide treatment.
* Skin needs to breathe, so wear natural fabrics. If you have butt acne and you're a thong-wearer, know that synthetic-fabric pants, skirts and hose have the same skin-stifling effect as synthetic underwear.
* Change out of sweaty clothes immediately following a workout. This will stop sweat from mixing with sebum, thereby preventing breakouts.
Mary Rose Almasi is a New York City-based freelance beauty and health writer.
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