The Forever Guide To Perfect Skin

Illustrated by Sydney Hass.
As anyone who has suffered from acne knows, it's the pits. Not only does it always crop up at the absolute worst time, but it saps your self-esteem, makes you want to hide your face from the world, and generally proves nigh on impossible to treat in a quick and painless fashion. Like we said, it's the worst.
If all that wasn't bad enough, turns out not all acne is created equal — or even acne for that matter. That big red bump on your chin could be a run-of-the-mill hormonal breakout caused by your period, or it could be a side effect of everything from your new skin-care cream to your spinning class.
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Because you can't effectively treat your breakouts if you don't know what they are and what's causing them, we went to two pimple pros — Dr. Eric Schweiger, medical director of Clear Clinic, and Dr. Dennis Gross, creator of Dr. Dennis Gross Skincare and founder of 900 5th Dermatology in NYC — to get to the bottom of your breakouts. Using everything from the location of the zit to when you get it and what it looks like, they helped us identify the most common forms of acne and acne imposters, plus their best in-office and at-home protocols to fix them.
While this handy guide won't take the place of a real diagnosis from a licensed derm, it can help you potentially narrow down what type of pimple problem you have and zero in on the right course of treatment. It will also save you time and money on products that aren't right for your particular brand of breakout.
So, read on to get the full scoop on all things acne, and be better prepared to get rid of those stupid spots for good
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Illustrated by Sydney Hass.
The most important thing to remember about acne is that it's a type of bacteria — propionibacterium acnes, or p. acnes bacteria. A blackhead is not a form of this bacteria, but rather, a blockage in the oil gland that gets stuck and causes a plug. Dr. Gross says to think of the oil in your glands like olive oil — fluid and moving. When the oil doesn't flow and gets stuck, it becomes like butter — more solid. This plugs the gland and causes that little dark dot you see on the skin's surface.

According to Dr. Schweiger and Dr. Gross, the best at-home treatment for blackheads is a product with salicylic acid. Dr. Gross also likes willow bark extract and suggests steaming your skin to open pores and get rid of surface debris. In office, Dr. Schweiger prescribes a retinoid like Retin-A. He also suggests regular extractions to help unclog those pores, although cautions not to overdo it as that could cause more skin irritation. Dr. Gross adds to make sure you ask your aesthetician for an exfoliating peel after your extractions: It's essential to detect and kill any remaining acne-causing bacteria before moisturizing.
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Illustrated by Sydney Hass.
A whitehead is what happens when that acne-causing bacteria gets trapped beneath a blackhead. This causes an infection, which causes inflammation of the skin and that telltale white bump.

At home, Dr. Gross recommends a sulfur-based spot treatment to help bring down the redness. "Use one that will draw out the infection and flatten the blemish on the surface of the skin," he says. "The blemish must be flat before it can be eradicated. Once the blemish is flattened and the infection is gone, the redness will begin to subside." According to Dr. Gross, sulfur controls the oil that feeds bacteria, thus reducing spots altogether. Sulfur also relieves the swelling and draws out the infection to flatten the blemish. 

In-office, Dr. Gross says you can get a cortisone shot to help bring down the appearance of the zit if you have a big event. He cautions against popping the zit on your own, no matter how tempting it may be. "When a dermatologist drains a pimple, they apply downward pressure perpendicularly to the skin’s surface," he explains. "But, when people try to do it themselves, they usually squeeze from the sides, which ends up backfiring because it causes infection to go down deeper into the pore. This may permanently enlarge pores or even make the infection worse." If the temptation is too great, he suggests washing your face with a clean washcloth. If the pimple is ready to “pop," he explains, this is all the pressure needed to drain it.
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Illustrated by Sydney Hass.
If you suffer from acne year round, have family members who suffer from acne, and are prone to breaking out on your cheeks, back, and chest, then you've inherited genetic acne. Thank your parents for that one. Explains Dr. Schweiger, "P. acnes bacteria is on everyone's skin, but it's more prevalent on some people. Their genes are programmed to recognize this bacteria as harmful." While genetic acne can happen anywhere on the face, Dr. Gross says it is most commonly on the cheeks, and usually you will also see body acne as well with this type of acne.

More than anyone else, those with genetic acne should make regular appointments to see a dermatologist. Since there is no underlying cause to the breakouts, other than a genetic predisposition, that means you need your doctor to help you craft a regimen that keeps those breakouts under control. Dr. Gross says if the acne is mild, you can try treating it at home with pore-clearing salicylic acid and/or bacteria-banishing benzoyl peroxide.

If OTC creams aren't doing it, he says to talk to your doctor about getting a prescription drug treatment. These can be anything from oral contraceptives to antibiotics like tetracycline, doxycycline, and minocycline that help kill off the bacteria causing the breakouts. Your dermatologist might also prescribe topical retinoic acids, like Differin, to help prevent blockage in the oil glands — because without the blockage, the acne bacteria can't get trapped, meaning no pimple.
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Illustrated by Sydney Hass.
According to Dr. Gross, it is the position of the acne more than anything that tells a dermatologist what kind of acne you are suffering from. Acne can manifest itself in multiple ways — some acne sufferers only get blackheads, while others deal with cysts — but the position helps tell your doctor just what the underlying cause may be. Nowhere is this more true than with breakouts on the jawline, otherwise known as hormonal acne.

The jawline in women is an area where the oil glands are sensitive to hormonal fluctuations, says Dr. Gross. When your hormones fluctuate — be it from your period, pregnancy, switching/going off birth control, or even menopause — that fluctuation will cause you to break out along the jawline. It's why many women who were lucky enough to escape acne in their teens, suddenly start breaking out in their late 20s and early 30s. Stupid hormones.

Since hormonal acne is caused by fluctuations in your hormones, your best bet for controlling it at home, says Dr. Gross, is to be sure to stay consistent when using birth control and remember that you can almost predict when these breakouts are going to happen (around your menstrual cycle). Take extra care of your skin around this time, and use preventative products to help minimize the breakouts as much as possible.

Dr. Schweiger says he has seen success in his more severe patients with prescription spironolactone. "It's an oral anti-androgen medicine to decrease circulating hormones." Dr. Gross says he does bloodwork on his patients to see if they would benefit from hormone-regulating medication.
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Illustrated by Sydney Hass.
Cystic acne is less attributed to a certain cause, says Dr. Schweiger, than it is a way that acne manifests in some people. Just as some people only get blackheads with their acne, some people have a more "vigorous" reaction to the acne bacteria, which causes those deep, red, painful, below-the-surface bumps. Adds Dr. Gross, "It tells you the degree of the severity of your acne, but not the actual cause."

Because they are so deep, Dr. Schweiger notes that cystic acne is much harder to treat from the outside. He recommends seeing your doctor for oral antibiotics, which have shown to be effective with this type of acne. Dr. Gross agrees on how hard this acne is to treat at home, preaching prevention as the best form of defense. "The best treatment is to prevent the blocked oil gland from forming in the first place," he says. "Many people do not realize that a blemish may begin to form two to three weeks before it appears on the surface of the skin. The key to clearing skin is applying a topical treatment all over the face that prevents the clogging of the pores with the skin’s own thickened oil."

In-office, Dr. Gross is a fan of Syneron Candela’s Smoothbeam laser, which he says can be used to treat active acne and prevent future breakouts for up to six months by lessening your oil production. "The laser treats enlarged oil glands, reduces inflammation, and kills bacteria. It's non-invasive, takes about six minutes to treat the entire face, and will result in no downtime. After one use there is an 83% reduction in acne lesions (active breakouts)," he says.
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Illustrated by Sydney Hass.
Because all acne starts as oil clogs in your pores, using a product that either gunks up your pores or causes you to create more oil can indeed cause you to break out. A good indicator of this, says Dr. Gross, is if your blackheads or pimples are centered around your T-zone or hairline. "When you're using a product that clogs your pores, the T-zone is the first place you'll get that breakout," he says. Dr. Schweiger says gunky hair products are to blame for those bumps around your hairline. Dr. Gross adds that you'll usually see a break out within a few days of using the product — if it happens within a few hours, then that's not product acne, it's most likely an allergic reaction (more on that later).

Your first course of action, says Dr. Gross, is to immediately stop using the product that caused the breakout. While it might be tempting to self-treat with acne-fighting products, Dr. Schweiger cautions against this. "If the acne was caused by something you were doing, you don't want to apply more products unless a pro says that's a good idea," he explains. "Oftentimes the best thing is to use a gentle cleanser or moisturizer." He suggests Cetaphil, or Clear Clinic's own Foamy, which is a gentle, non-drying, non-irritating wash. He also suggests seeing a derm for a chemical peel to help unclog pores and stop any further pimples from forming.
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Illustrated by Sydney Hass.
There's been a lot of controversy of late on so-called food breakouts. While there isn't any real, hard-hitting evidence supporting things like dairy or high-sugar foods as a cause of acne, many people swear they break out after eating such foods. Dairy in particular is a hot-button food, with Dr. Schweiger saying that it's possible the hormones in dairy could be contributing to hormone fluctuations that in turn cause pimples. He adds that it's not a scientific thing. "Sometimes people are going to break out no matter what," he says, "and the food is a red herring." Dr. Gross says a food-related breakout is usually immediate — you will normally see a pimple within 12 to 48 hours of eating that food.

When patients come to him claiming foods are triggering their skin problems, Dr. Schweiger says he urges them to keep a diary to track their skin condition in relation to what they are eating, but also in relation to other things like sleep and exercise habits. If that patient continues to have a reaction when eating or drinking a certain food, Dr. Schweiger takes the common-sense approach and simply advises they stop consuming that food.
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Illustrated by Sydney Hass.
If you have generally clear skin, but are breaking out on your butt and thighs, you are most likely dealing with mechanical acne. This type of acne tends to plague cyclists and spin junkies the most, says Dr. Gross. It's caused by pressure on the skin where it's pressed against a harder surface. This physically blocks the glands and clogs them. Sometimes it can also be seen on the chin as a result of the strap of a helmet.

Dr. Gross recommends treating this particular form of acne with a blend of alpha-hydroxy and beta-hydroxy acids. He says anti-bacterial soaps can also help, as well as any products that purge the pores of oil or help normalize the oil chemistry of that skin.
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Illustrated by Sydney Hass.
If being stressed out wasn't bad enough, there's also breakouts to contend with. According to Dr. Schweiger though, it's not the stress that's causing the pimples per se. Rather, it's the constant touching of our faces we do when stressed — cupping our chin in our hands, pressing our forehead against our palms — that's the culprit here. Touching your face can lead to clogged pores, and hence, acne.

Your best bet with stress acne, says Dr. Schweiger, is to find a relaxing ritual that helps you manage and control that stress. He suggests a spa treatment like a massage to help minimize anxiety. He also coaches patients to be aware of what they are doing in times of stress and make a conscious effort to avoid touching their face.
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Illustrated by Sydney Hass.
Acne scars are what's left behind once a pimple has run its course. These can manifest as anything from red marks to dark pigmentation and divets or pockmarks. Scars can linger on the skin anywhere from a few days to a few weeks, or, if you have literal scars, they can be permanent.

For treating pigmentation and red marks on the skin, Dr. Gross suggests looking for products with lightening, anti-inflammatory, and exfoliating benefits. He says to stock up on those that feature ingredients like ferulic acid, bearberry extract, mulberry extract, licorice root, vitamin C, and azelaic amino acid.

For depressed or indented scars, there's sadly not much that can be done at home. For truly effective results, you'll need to visit your derm. Dr. Gross likes Syneron Candela’s Sublative laser for these type of scars because it is good for all skin types and tones. "The laser uses fractionated bi-polar radio frequency precisely directed into skin, which allows for new collagen and healthy skin cells to be produced post-treatment," he explains. "This reduces acne scars while creating a smoother and more elastic skin texture." The laser is done in a series of three to five treatments, one month apart and results are fully visible after three months. Dr. Gross says he also seen success with some patients using injectable fillers on the indented areas.
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Illustrated by Sydney Hass.
Of all the acne imposters out there, allergic reactions tend to be the most common. They usually show up on the skin as small, red, unpoppable bumps, and, according to Dr. Schweiger, they will appear quite suddenly on the skin. Dr. Gross says you will often see dry, flaky patches with this kind of reaction.

More often than not, it's the fragrance in the product that can cause this type of reaction, so if you're sensitive to artificial scents, you might want to switch to a fragrance-free option. To treat at home, Dr. Schweiger suggests using a hydrocortisone cream to provide relief from any itchiness and soothe inflammation. However, you should only use it for up to a week — if the reaction lasts longer than that, you should see your derm for a prescription for Elidel cream, an anti-inflammatory that's safe for longer term use.
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Illustrated by Sydney Hass.
Another type of non-acne, acne rosacea shows up on the skin as a red rash — sometimes with bumps and sometimes without — usually on the cheeks, chin, and near the mouth. A good indicator for this type of breakout, says Dr. Gross, is that you will not see any blackheads. Since it is not caused by oil getting clogged in your pores, there will be no blackheads. While the exact cause of rosacea is not known, Dr. Gross says that some foods can trigger flare-ups — spicy things and alcohol are two big culprits.

Really the only thing you can do for rosacea at home is to soothe irritation, which Dr. Gross says ingredients like green tea, bisabol (a derivative of chamomile), licorice root, and cucumber are all great at. To truly treat rosacea, you'll need to see your dermatologist for LED light therapy. Dr. Gross likes to use both blue and red light on his patients, which he says helps reduce redness, minimize inflammation, and kill acne-causing bacteria.
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Illustrated by Sydney Hass.
If you've ever gotten what looked like a pimple on your bikini line, then you've most likely had a run-in with folliculitis. While technically a form of acne, it's different than the others you may be used to, as it has no relation to the oils on your skin. It appears to be a whitehead with a hair coming out of it and is usually inflammed and irritated. Dr. Gross says folliculitis is caused by waxing products — the wax gets stuck in the hair follicle and creates that plug, and then the acne bacteria builds up and causes the infection. Technically, there is no oil blockage, but the wax is functioning in the same manner as the blackhead and stopping up the follicle, trapping the bacteria. Folliculitis can crop up anywhere you wax, so your bikini line, legs, chin, and upper lip are all prime targets.

At home, Dr. Gross suggests using a mix of alpha- and beta-hydroxy acids to provide gentle, daily, chemical exfoliation. "This will help prevent dead skin cells [from building up] which can proliferate the problem, further blocking pores that already have an oil flow problem incubating the bacteria and leading to acne," he says. He also recommends pore-clearing salicylic acid. As for in-office options, Dr. Gross says your best bet if you are prone to folliculitis outbreaks is to consider laser hair removal — by removing the wax from the equation, you pretty much eradicate the problem entirely.
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Illustrated by Sydney Hass.
Seborrheic dermatitis, besides being a pain in the ass to spell, is also an issue that plagues many women — most of whom don't even realize they have it. Like acne, it's related to oil production, but unlike acne it usually appears on the skin as dry, red, scaly, itchy patches on the skin. While most common on the scalp, Dr. Schweiger says it can also show up in your T-zone.

Since it's caused by bacterial yeast living on your skin, your only real course of treatment is an anti-fungal cream prescribed by your doctor. Don't panic: We all have this yeast living on our skin. But, Dr. Schweiger says that some people's bodies view this yeast as harmful, which causes this reaction in the skin.
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Illustrated by Sydney Hass.
Another tongue twister, pityrosporum folliculitis is caused by that same skin yeast, only this time it's working its way into your hair follicles and causing all types of problems. We'll let Dr. Schweiger explain: "With PF, that yeast overgrows and gets into hair follicles that do not produce hair (a.k.a. pores). When it gets in there, it blocks the pores and inflammation can ensue." You'll see PF usually on the forehead as a bunch of small, uniform, pus-filled bumps.

You'll need your derm again for this one, since there aren't really any at-home options to fight it off. Says, Dr. Schweiger, once your derm has diagnosed you with PF, they will then prescribe an anti-fungal like ketoconazole cream to treat it.
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