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Strategies for clear skin: the best treatments for breakouts—from the occasional zit to the most severe acne - BeautyinAction

Shape, March, 2004 by Mary Rose Almasi

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.

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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.

Strategies for clear skin: the best treatments for breakouts—from the occasional zit to the most severe acne - BeautyinAction

Shape, March, 2004 by Mary Rose Almasi

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