The ultimate guide to acne removal & treatment
Hey there! You’re probably here because you have acne and looking for ways to remove acne scars. And guess what? You’re far from alone. Acne vulgaris is a near-universal skin condition. Approximately 80% of people worldwide have developed acne between puberty and 30 years of age. That’s right, almost everyone you know has had this.
And while it’s true that acne occurs most commonly in teenagers aged 13 to 18, it’s not a problem confined to youthful skin only. For many long-term adult sufferers, acne is psychologically painful and an emotional burden.
The good thing about acne is that it’s manageable. By determining the best treatment method and using suitable skincare, you’ll see an improvement within months, if not weeks. But how? Read on as we break down how acne forms, your treatment options, and best practices to keep the zits at bay.
Everything you need to know about acne
Acne manifests as small, painful bumps that form on the surface of the skin. Sometimes it erupts in a pimple, sometimes it’s more stubborn group of spots and sticks around for months. But, what is it exactly?
A dermatologist would classify acne as an inflammatory disorder. This occurs when an overproduction of oil in sebaceous glands clog hair follicles. Hair follicles are also called pores.
See, bacteria known as Propionibacterium Acnes, P. Acnes for short covers human skin. A buildup of sebum and dead skin cells create ideal conditions for this bacterium to multiply in the follicle. This triggers inflammation and as it begins to invade surrounding tissues.
Okay, at this point, let’s mull over the different types of breakouts you’ve survived through in the past. If it all begins the same way, why did it appear different each time? And why does acne vary so much in severity between, say, your friends and yourself? Are certain skin types more acne-prone?
The answer lies somewhere in the interaction between skin cell regeneration, sebum production and bacteria. Each of these factors can is connected to several others, from diet to hormonal changes. More on that in a bit. For now…
Broadly, acne can be categorized into non-inflammatory and inflammatory acne. These two categories can be further broken down into many other types. Let’s look at non-inflammatory acne first.
Blackheads are dark spots found across the nose, forehead and chin, are open comedones. Open pores exposes the melanin pigment in the pore to air. This results in a blackhead’s dark coloration of grey, black or brown.
Whiteheads or closed comedones, are pores covered with a thin layer of skin. Underneath, the dead skin cells and sebum, form a plug. These are minor, uninfected and tend to clear up within a week. Remember the P. Acnes bacterium? It’s what infects the follicles to cause inflammatory acne. Painful and more visible, they tend to take longer to treat and heal. There are four types of inflammatory acne to look out for: papules, pustules, nodules and cysts.
Papules are tiny, red, raised pimples surrounded by inflamed tissue. They may be sore when touched.
Like papules, pustules tend to be small and reddened but have a pale yellow or whitish tinge in the centre. The white blood cells in the pus is your immune system’s way of sending help to an infected pore. Tempting as it may be to pick at a pustule, don’t. You could cause scarring and dark spots.
Painful to the touch, nodules are hard, inflamed bumps that occur deep under the skin. There, it can remain for weeks or months. Nodules may or may not appear reddened on the skin’s surface. Both these and cysts are classified as severe acne.
At the most painful, damaging end of acne are cysts. Identify them by the large, red, pus-filled lesions that take root from deep within the skin.
Not acne: Sebaceous Filaments
They may resemble blackheads, but the groupings specks observed on the nose and forehead might be sebaceous filaments. They are simply natural oils that collect in hair follicle glands as they bring sebum to the skin’s surface. How to tell the difference? Sebaceous filaments appear greyish or tan instead of black, and if you squeeze a sebaceous filament, nothing will come out.
Acne Vulgaris is most commonly discussed form of acne, yet it may be helpful to be able to identify other forms of acne as well.
These can occur when there is excessive and prolonged friction on skin. Culprits include snug clothing, sporting gear, helmets, headsets, backpacks and even musical instruments.
A rare and severe form of nodulocystic acne. Cysts and nodules form together deep under the skin, ultimately leading to scabbing and heavy scarring.
similarly uncommon condition, but with breakouts tending to stay open and weeping.
Two acne-like conditions are Pyoderma Faciale, which resemble acne and rosacea, and Gram-Negative Folliculitis, an infection caused by certain types of bacteria.
To find out if you’re likely to develop acne, look to your family history for clues. If both parents developed acne, their child will likely have the condition too.
Propionibacterium Acnes is the most abundant bacterium found on human skin. Benign before infecting pores, its overgrowth in sebum-clogged pores sets off acne inflammation.
Puberty kicks off sebum overproduction in teenage skin, paving the path to adolescent acne. Women experiencing hormone fluctuations from menstruation, menopause, or the condition polycystic ovarian syndrome may also develop acne.
Certain drugs increase androgen and corticosteroid levels, which ramps up sebum production leading to an acne or an acne-like reaction. These include lithium prescribed for bipolar disorder, bromides and iodides prescribed for cough medication, sedatives, anticonvulsants and androgenic steroids.
Heat and friction stemming from skin rubbing against tight clothing and gear may cause Acne Mechanica.
What else can affect acne?
Some lifestyle factors may disrupt the skin’s sebum balance, increase the likelihood of clogged pores and affect hormones. This includes pore-clogging makeup, unsuitable skincare, climate effects, smoking, and stress.
And while types of food have been inaccurately linked with acne, there is one category that is definitely a cause — high glycemic index foods.
Carbohydrates from starches and sugar cause rising blood sugar levels. The glycemic index ranks food on a scale of up to 100, illustrating how fast carbs are processed and absorbed into the bloodstream. When higher glycemic index foods like white bread (75) and sugary milk tea (78) are consumed, they spike sugar levels that lead to inflammation. On top of that, high GI foods increase hormones that speed up oil gland activity. This eventually causes acne to form.
Common at-home treatments for acne run the gamut. They range from folk remedies like masks made of honey and oatmeal, tea tree oil spot treatments and apple cider vinegar toners. More extreme – and frankly, harmful – methods include toothpaste and lemon.
Home remedies may have therapeutic qualities, but they are not a replacement to scientifically-backed, expertly formulated skin care, which remains the most effective treatment for mild-to-moderate acne.
Makeup removers and face washes remove dirt, grime and excess oil on the skin to prevent acne. Some types of cleansers also include gentle exfoliants, encouraging skin cell turnover.
2. Spot treatments
The most classic acne cure is the spot treatment. Apply directly onto the affected area to kill bacteria and draw out impurities.
3. Hydrators and exfoliants
Used together, lotions and serums that hydrate and exfoliate are effective for maintaining skin health. As exfoliants encourage dead skin cells to shed, hydrating skincare fortifies the skin’s oil and water balance, something particularly important for oily, acne prone skin.
Sun exposure doesn’t induce acne, but it does aggravate existing breakouts. When shopping for sunscreen, look out for thin, lightweight oil-free formulas which are less likely to clog pores.
What else can affect acne?
Skincare ingredient lists can seem incomprehensible. Yet even if you’re not studying for a cosmetic chemistry degree, it’s helpful to know what acne-busting actives work.
Here’s a tip: the first five listed ingredients usually constitute the bulk of the formula. And yet, a low percentage of actives doesn’t mean a product is going to be ineffective. Retinoids and salicylic acid, for example, usually make up under 5% of over the counter treatments, and yet they are some of the most reliable.
1. Benzoyl Peroxide
A classic anti-acne ingredient, benzoyl peroxide is in everything from cleansers and spot treatments to masks and serums. The bactericide penetrates pores to deliver oxygen where P. Acnes bacteria is abundant. The bacteria cannot survive in an oxygen-rich environment and ends up dying. Start use of benzoyl peroxide at low concentrations to prevent dryness, flaky skin, and redness.
A popular topical anti-wrinkle ingredient, synthetic vitamin A derivatives offers many skin benefits. Retinoids treat acne, encourage dead skin cells to shed, stimulate collagen production and tackle hyperpigmentation. As he antioxidant can cause skin to peel and redden if the formulation is too potent, they are usually used in tandem with soothing ingredients.
3. Beta Hydroxy Acid: Salicylic acid
Another mainstay of acne treatments is salicylic acid, a pore-unclogging powerhouse that smoothes skin texture and calms redness and inflammation. You will also find it labeled as Beta Hydroxy Acid (BHA) because it’s by far the most popular BHA.
4. Alpha Hydroxy Acids:
- Azelaic Acid
- Glycolic Acid
- Lactic Acid
- Mandelic Acid
- Tartaric Acid
- Citric Acid
While they don’t penetrate as deeply into the skin as much as salicylic acid, Alpha Hydroxy Acids share its ability to improve skin texture, clear pores, even out the skin tone and reduce inflammation. AHAs for skincare are derived from food such as milk (lactic acid), sugar cane (glycolic acid), and bitter almonds (mandelic acid), and are more commonly employed in overall anti-aging skincare formulas.
It may smell of rotten eggs, but sulfur is an essential antibacterial ingredient. Like benzoyl peroxide, sulfur is used in oil-absorbing, chalky spot treatments but may lend itself better to sensitive skin because it’s less drying.
Niacinamide is an antioxidant which minimizes inflammation in existing breakouts while preventing infections. A form of vitamin B3, it improves skin’s elasticity as well as its barrier function, protecting against transepidermal water loss.
An ancient skincare ingredient, clay can be found in products that aim to dry out swollen, reddened acne lesions. Among the varieties of clay used in acne treatments are kaolin, bentonite, rhassoul and red clay. Each possess specific benefits but in general, clay is deployed to unclog pores of excess sebum and tighten the skin.
Zinc oxide is both an antibacterial and an anti-inflammatory, making it particularly effective for the treatment of acne. Applied topically, zinc manages oil production on the skin’s surface, lessens inflammation and balances skin flora.
According to doctors, the recommended first- and second- line treatments for acne include some form of topical agents. However, applying a spot treatment at night isn’t enough to keep acne away. Generally, clearing acne demands a regimen that manages each dimension of the condition: skin cell turnover, sebum regulation and bacteria. Here’s a recommended routine to get you started, including explanations for each step.
Please note that everyone’s skin different, with different skin care needs. And for that reason, your mileage may vary.
It’s important to identify your skin type and test different formulations and product combinations to see what’s right for you and your acne. For example, if you have combination skin, you could use start off by toner on the T-zone only, while oilier skins stand to benefit from oil-free formulas.
A note for those with sensitive skin
If you’ve got sensitive skin, it would be wise err on the side of caution. Many acne-targeting skincare can further dry out the skin and cause more inflammation if too potent. Avoid sensitizing fragrances and use lower concentrations of actives when available. When using a new product, observe how your skin responds so you can then determine frequency of use. It may also be helpful to supplement your skincare routine with soothing ingredients. Some common examples include allantoin, bisabolol, gotu kola, burdock root, licorice and curcumin from turmeric.
Removing dirt, sweat and environmental pollutants is key in an acne skincare routine. The right way to do this is with a cleanser suited to your skin type. A gentle, gel type face wash that’s not overly foamy is generally effective on all acneic skin.
Cleanse skin twice a day, AM and PM, and pat (never rub) with a towel skin to dry. If you wear makeup, it can be beneficial to use a water-based makeup remover before cleansing.
2. Exfoliant and/or Toner
Exfoliation keeps pores clear and unclogged, removes dead skin cells and improve skin texture. However, there are toners that exfoliate and toners that don’t.
Toners that do exfoliate do so with AHAs (glycolic, lactic, mandelic acid) or BHA (salicylic acid). Toners that don’t exfoliate are usually formulated for soothing and calming, or to further strip any dirt left on the skin after cleansing. We don’t recommend the latter, as they usually contain alcohol and other harsh ingredients that over-cleanse the skin.
You can use both soothing toners and exfoliants in the same routine. However, if your skin is on the sensitive side, reserve the exfoliant for night time only as it increases photosensitivity, making the skin more reactive to sun exposure.
3. Hydrating Essence
Did you know that skin can be oily and dehydrated at the same time? Hydration refers to the water equation of the oil-water balance, and is important for healthy, comforted and glowing skin. This is a good time to talk about how not every product in an acne skincare routine has center around zapping acne. It’s just as important to improve skin health over the long term.
When using a liquid essence, dispense in the palm of your hand and pat into the skin in the morning and at night.
Serums are a catchall term for skincare with a higher concentration of active ingredients targeted to a specific need. They can be a gel, cream or liquid formula. Serums marketed for acne come in many varieties, including those to clear congested pores, exfoliate and retexture scars. We recommend looking for acne serums containing anti-inflammatory ingredients designed to minimize redness.
Serums can be applied both morning and night.
Many people still think that those with acne-prone, oily skin can forgo moisturizer. But it’s not true. The right moisturizer for your skin keeps your moisture levels balanced while also calming the skin to decrease inflammation and the urge to pick.
Use a generous amount of moisturizer day and night.
6. Spot treatment
Dab individual zits with a spot treatment for shrinking and killing bacteria. On the ingredient list, look for benzoyl peroxide, salicylic acid, sulfur, niacinamide or zinc.
Some treatments are clear and can be worn under makeup, others with zinc or benzoyl peroxide tend to leave a white mark, yet some treatments come in the form of zit stickers. You may save the more conspicuous treatments for before you sleep.
As mentioned earlier in this guide, sun exposure can aggravate existing breakouts. What’s more, several ingredients used in acne treatments can increase sensitivity to UV rays, making sunscreen a top priority. Apply at the end of your skincare routine in the daytime, and reapply every 2-3 hours to protect against both UVA and UVB rays.
Alternatives: In-clinic & Prescription Treatments
Acne severity is graded in a system known as the Comprehensive Acne Severity Scale (CASS).
Zero means clear skin, one is almost clear, two is mild (comedones, papules and pustles; less than half the area involved), three is moderate (comedones, papules, pustules; more than half the area involved), four is severe (combination of papules and pustules and a few nodules and cysts; entire area involved). The final, fifth grade refers to very severe acne, such as skin with highly inflammatory nodules and cysts covering the affected area.
The reason this scale is useful is because while all acne benefits from skincare, more severe or persistent cases may call for in-clinic interventions. This includes medically-prescribed topical treatments, oral medications and physical therapy.
1. Topical Treatments
The first line of acne treatments that doctors prescribe is essentially skincare. You may notice that many topical agents such as retinoids, benzoyl peroxide and AHAs match ingredients in the skincare market. However, clinics are able to dispense higher, prescription-only concentrations of these agents.
The exception here are topical antibiotics such as clindamycin, erythromycin, and dapsone, which can only be accessed through a doctor.
2. Oral Treatments
In addition to topical treatments, doctors also prescribe drugs to take to manage bacteria (antibiotics), regulate hormones (oral contraceptives and anti-androgen agents) and lower sebum production (oral isotretinoin).
3. Physical Therapy
In the most severe cases of acne, doctors can prescribe patients with several types of physical therapy. They include:
Extractions: The removal of blockages, fluid and pus from inside a pimple.
Light Therapy: The exposure to specific light frequencies do well to improve the skin. Blue LED light used kills acne bacteria, while red light boosts collagen production.
Steroid Injections: Also known as a cortisone shots, diluted corticosteroids injected directly into a spot is a popular quick treatment for bringing down acne. However, the treatment is associated with risks including pigmentation and dipping in the skin’s surface.
Laser: Most popular acne-related laser treatments such as CO2 Laser, Erbium YAG, Fraxel and IPL are, in fact, used to heal acne scarring through resurfacing the skin and boosting collagen production. But newer treatments such as Isolaz can clear pores and kill bacteria in existing cases.
Chemical Peels: Think of in-clinic chemical peels as the powered-up versions of home based acid exfoliation. Professional supervision means higher concentrations of AHAs can be used— doctors may administer up to 70% strength and aesthetic salons, 30% strength.
There are no one-size-fits-all rule books for acne. But best practices exist to maximize the skincare benefits you’ll be reaping from your newfound acne skincare regimen.
Most of these ideas may sound like common sense, but they are good reminders that skin care is not limited to creams and treatments. Good skincare is really a discipline that stems from cultivating self-care: it’s also what you consume, how you take care of your body and the little things that matter.
1. Remember To Drink Up
Water isn’t a cure-all, but a lot of us simply aren’t drinking enough. Eight glasses is not a hard and fast rule, as everyone requires different amounts, but do take sips regularly throughout the day. Don’t wait to feel thirsty. You’d be surprised at what being adequately hydrated can do for the skin.
2. Food Matters
Excessive consumption of high glycemic index foods can lead to acne. High GI food spans a list of starchy, sugar-laden food like white bread, potatoes, rice, many processed breakfast cereals, soda, and juice.
Balance starches with non-starchy fruit like guava, custard apple, and pears. Or swap fries for vegetables like leafy greens, cauliflower, radishes, bell peppers and mushrooms. Once in a while, try lentils, barley and chickpeas instead. And avoiding milk and ice-cream is also worth a shot. Many acne sufferers report that cutting out dairy products improved their complexions.
3. Use Clean Makeup Brushes
If washing your face is so important, it makes little sense to then use a dirty makeup brush on clean skin. Used makeup brushes that are left to sit harbor bacteria that you don’t want anywhere near a vulnerable and already inflamed complexion. In an ideal world, brushes would be washed after each use with soap. In a pinch, use a spray-on brush sanitizer-cleanser instead, making sure to gently swish bristles in circular motions on a kitchen towel to remove excess gunk.
4. Stash a Facial Cleanser in Your Workout Bag
While exercise is essential, sweat can worsen clogged pores. After a workout, wash your face as soon as you can. Some athletes find a cotton pad soaked in cleansing/micellar water works best when you’re on the go. No rinsing required. You can then do a proper cleanse once you’re home.
Now that you’ve learned all the things you need to do to clear acne, here are our recommendation of habits to avoid.
1. Cleanse Till Your Skin is Squeaky Clean
An unfortunate claim about acne is that a lack of hygiene is to blame. And for some sufferers, the logical solution is washing their face as much as possible, with the foamiest of face washes. Clean is equated with squeaky, tight-feeling skin.
This is not only false, it can severely impede healing. Over cleaning skin strips it of its natural barrier and protection against the elements, leaving it prone to irritation and inflammation. You want to use gentle, well-formulated cleansers and never soap.
There’s always that person who claims that it’s a myth that you shouldn’t pick. That they’ve done it all their lives and that it’s OK for them.
But for everyone who understands the right, most sanitary way to pick, is fortunate enough to not have caused more harm, or just has resilient skin, there’s someone else whose acne has gotten exponentially worse from DIY attempts.
If there’s anything you need to leave to the professionals, it’s this.
3. Using Cleansing Wipes Only
We get it, cleansing wipes are a truly handy invention. But if you are only using wipes everyday, they’re much more likely to slide makeup and grime around your face than clean effectively. In this case, it pays off to take an extra couple of minutes for a face wash.
4. Harsh Scrubbing
Exfoliating is key in acne skincare, but it’s best to avoid grainy, abrasive scrubs and spinning facial brushes. They can be too aggressive on the skin, creating tears in acne lesions. Instead, stick to chemical exfoliants that lift and remove dead skin cells.
5. Using Toothpaste as Treatment
This old school trick does not work. Minty toothpaste may sting like a spot treatment, but it doesn’t contain the active ingredients needed for dealing with acne. What’s worse, mint oil may only serve to irritate the skin, and sulfates can dry it out.