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In the Clear
Forget what your parents told you—acne isn’t just for teenagers. But with the latest blemish-fighting treatments, the future is looking a whole lot clearer.
By Janelle Thomas

It’s the most common skin disease in the United States, affecting approximately 50 percent of adult women, according to the American Academy of Dermatology. And to make matters worse, there’s no single cause of acne, nor any magic pill to fix it. As anyone battling with blemishes already knows, breakouts can be annoying, frustrating, and even embarrassing. The good news? According to the experts, help is on the way. Today’s skin-care products are more effective than ever at managing acne, and there are also a few treatments in the works that promise even better, longer-term relief. Want to hear about how to deal with acne now and what you can look forward to in the future? Read on to learn more.

Understanding Acne
Before you can begin to address acne, it’s important to understand its origins. In the most mechanical sense, “acne is caused by an interplay between the scaly overgrowth of follicles, bacterial colonization, increased sebum production, and inflammation,” says Omeed Memar, assistant clinical professor of dermatology at Northwestern University. More fundamentally, “the most common cause of acne is hormones,” he explains, adding that a family predisposition is a strong indicator and that stress can also play a role. Although most doctors believe that diet is not a contributing factor, some dermatologists, and many nutritionists, maintain that it is. Nevertheless, they all agree that, in general, blemishes aren't the result of poor hygiene (although many sufferers attempt to treat their symptoms by overcleansing and vigorous scrubbing, they're only making matters worse).

Seeing Spots
From mild forms of acne to the more severe, women may experience several kinds of blemishes. In all cases, they should never be squeezed or picked at.
Closed comodones: Also known as whiteheads, they are completely blocked clogged pores filled with pus.
Open comodones: Referred to as blackheads and most commonly seen in the T-zone, they’re clogged pores whose exposure to the skin’s pigment, melanin, and oxygen generates a black tip.
Papules: Small pimples that don’t have a tip; instead, they’re round, red, and tender. (Beware: Papules often travel in packs.)
Pustules: Pustules are similar to papules, except that they’re filled with a white or yellow pus; they’re also often referred to as whiteheads.
Nodules and cysts: These types of acne are usually firm, red lesions seen in more severe forms of acne; they can be painful, last for several months at a time, and leave scars.

Skin Solutions
Although manageable, there is still no quick fix for adult acne. A treatment program may involve topicals, oral antibiotics, hormones, light therapy, or some combination thereof. In fact, many solutions are combined to yield optimal results. Topicals like benzoyl peroxide often team up with erythromycin and clindamycin, while salicylic acid is often paired with sulfur. Any of these might be combined with oral antibiotics, such as doxycycline, or oral contraceptives, which have become popular acne-fighting options in recent years. The right course of action for you? That depends largely on the severity and frequency of your acne.
Menstrually Related: If blemishes appear once a month, before your period, it's most likely due to hormonal changes associated with the menstrual cycle and can be addressed in a few ways. Beyond over-the-counter options, like salicylic-acid and benzoyl-peroxide products (which can be helpful in preventing and combating various forms of mild acne), many women opt to take birth control pills, like Ortho Tri-Cyclen, which have been proven to prevent premenstrual breakouts. The newer low-dose oral contraceptive, Yasmin, may be an appealing alternative for those who experience negative side effects from other oral contraceptives, and since its synthetic progestin influences the anti-androgenic hormone property, it directly affects sebum production. However, oral contraceptives aren’t for everyone, and retinoids, such as Tazorac and Retin-A, can also be helpful in accelerating the shedding of skin cells and reducing the chances for clogged pores.
Occasional or Stress-Related: If your have infrequent flare-ups, and they’re not related to your period, they may be brought on by stress. Because stress releases cortisol, which, in turn, produces sebum, it can trigger blemishes (this is why you should never worry about zits, of course). Again, salicylic acid, benzoyl peroxide, and retinoids can all be helpful. And if a blemish pops up a few days before a big event (like, say, your wedding), a dermatologist may be able to inject the pimple with cortisone, which will usually make it disappear overnight. Or you may be able to enjoy similar results at home with the Zeno Acne Treatment Device. In addition to stress, behavioral factors may be to blame. If blemishes tend to appear on certain areas of your face, you’ll need to pinpoint the source. Hands are, of course, a common culprit, which is why you should always limit their contact with your face (even doctors who don’t believe that diet contributes to acne are quick to point out that the transfer of greasy food substances can encourage it). If zits usually erupt along the chin or jawline, your phone may be to blame, and if they most often pop up on your forehead, bangs or hair products may be a factor. Other lesser-known acne-inducers: extreme temperatures, sun exposure, headbands that come in contact with skin, pore-clogging (non-comedogenic) makeup, and sweat-promoting exercises.
Severe Acne: In cases of chronic acne, topical antibiotics, like tetracycline, and oral contraceptives can still be helpful, but they aren’t always enough to significantly improve skin. As such, treatment may be an ongoing process requiring a doctor’s supervision. Although Accutane has been on the market for some time and is perhaps the most effective treatment for severe acne, it remains controversial and comes with a long list of possible side effects, so be sure to discuss it in depth with your doctor beforehand. Cryotherapy is another treatment used in severe cases that employs materials such as liquid nitrogen or solid carbon dioxide to reduce skin temperature to very low levels. But perhaps the most intriguing option for moderate to severe acne is laser therapy. Performed in a doctor’s office, lasers such as the Smoothbeam and Aramis typically take 30 minutes to an hour to work, depending on the areas being treated, and require a total of six to eight appointments. Although it’s basically painless with few side effects, some patients report that their skin feels like it’s being snapped with a rubber band and experience mild redness afterward. Further research has also yielded a newer spin on the light-treatment trend—photodynamic therapy, a process that targets the sebaceous glands, which are attached to the hair follicle, where pimples are born. The treatment begins with the application of a light-activated medication, Levulan. After setting, it is washed off, the skin is exposed to light, and oxygen molecules eliminate the acne. For many doctors, the jury is still out on photodynamic therapy, but some patients have reported excellent results. The downside to all this advanced technology? It doesn’t come cheap—a package of six laser treatments, for example, typically costs between $1,000 and $5,000.

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