Acne can push even the best of us to extreme, sometimes dangerous measures to rid our skin of the dreaded spots.
From putting toothpaste on our faces, to scraping and picking away at our skin and cotton-budding harsh chemicals or neat alcohol on open sores, many of us have tried some relatively unadvisable things in a bid to banish our blemishes.
Here, we're breaking down the most legitimate ways to get of acne and finally achieve clear, healthy skin without any unnecessary risks.
What Causes Adult Acne?
'Adult acne is the result of a problem with the oil chemistry,' says dermatologist Dennis Gross, MD. 'As hormones change, oil does too. It becomes more viscous and as it flows through the gland and out through the pore, it gets stuck.'
So how can we banish those sore, unsightly bumps for good? The good news is, there are plenty of doctor-approved things to try...
1. Ditch The Dairy
While facialists have dismissed dairy for decades, clinical studies have only recently established a link between milk consumption and acne.
'Milk contains testosterone precursors, which increase sebum production,' says dermatologist Francesca Fusco, MD. 'What's fascinating is that one study found that of all milk, skimmed milk has the strongest correlation with acne, and some hypothesise that skimmed milk has less oestrogen than whole milk.'
The thing is, switching to organic milk won't remove your exposure. 'All milk naturally contains androgens and IGF-1 (Insulin-like Growth Factor 1, a hormone that may be a precursor to breakouts),' says Kavita Mariwalla, MD. 'There's no such thing as hormone-free milk. Plus, milk contains sugar, a lactose, so it stimulates insulin.'
Nutritionist and wellness coach Amie Richmond suggests opting for nut, rice or oat milks instead – and the same goes for yoghurt. 'Replacing milk and yogurts with with coconut-based, dairy-free varieties will not only help eliminate the compounds that trigger acne, but they have the added benefit of high protein levels which is great for your overall health.'
Another recent study suggests that following a low glycemic index diet – that means one with less refined sugars, carbohydrates and sugar-containing foods — may result in fewer acne outbreaks. 'As the glycemic index goes up, it affects insulin production and all the hormones,' Fusco says. 'They are all in a delicate balance: your female hormones are in balance with your thyroid hormones, which are in balance with your insulin. When you have more in one area, it's like a domino effect on the others.'
Since the dietary acne provoker may vary for every person, New York dermatologist Ellen Marmur, MD, recommends keeping a food diary outlining what you eat in the days before a breakout to determine what your triggers are. 'Then you start a very slow re-entry, introducing one new item, like dairy, every six weeks to see what happens on the skin,' says Marmur, who believes that it takes just 48 hours for what you eat to show up on your face.
2. A Skin-Kind Diet
Now we know which types of food to avoid, which groups should we be adding to our daily diet?
'Probiotic rich foods such as oats, chia seeds and sauerkraut, not to mention dark leafy greens like kale, broccoli and cabbage, will help eliminate the toxins that cause acne,' says Richmond. 'Foods packed with zinc, like pumpkin seeds, chia seeds and flaxseeds are also great at boosting immunity to the bacteria that causes spots, but it's food that is high in skin-healing vitamin A, such as spinach and carrots, that is even better.'
While it may sound like a cliche, drinking water is crucial to your skin's health, as acne may be a result of toxins leaving the body. Sipping on water throughout the day helps flush these toxins out.
3. Oral Medication Options
Historically, the premier hormonal mediator has always been the birth control pill, which works by lowering your body's testosterone levels – the male hormone that increases oil production. However, this doesn't have to be your first line of defence.
Marmur points out that while the contraceptive pill may clear up acne, it can also provoke another unsightly reaction: melasma, a noticeable discolouration of the skin that she says is on par with acne in her practice as a top complexion complaint, not to mention mood swings, weight gain, weight loss and headaches.
If you do opt for the pill, figure out an exit strategy first. 'Birth control pills can be very effective, but eight or nine times out of ten, when you stop them, you are right back where you started,' says Bank, and that's where Spironolactone comes in.
'This medication was actually developed for blood pressure and heart failure, but we have evidence that it works in female adult acne by local attention on hormones in the skin,' says consultant dermatologist Dr. Anjali Mahto.
Like many spot sufferers, Bank also recommends Accutane, the prescription-only vitamin A–derived pill, because it continues to work after you stop using it. 'Accutane is still, hands-down, our most effective, lasting anti-pimple medication,' he says, and the results speak for themselves.
Although an Accutane prescription –which you can get from your GP – comes with significant FDA regulation (because of possible birth defects, patients have to agree to use two forms of birth control and undergo regular pregnancy tests during treatment and for one month after), most of the derms we interviewed believe it to be worth the trouble. 'After you stop the medication, many people have a durable response for many, many years,' Mariwalla says.
And we can't forget the buzz surrounding antibiotics. 'There is definitely a move away from them,' says consultant dermatologist Dr. Justine Hextall. 'We are seeing antibiotic resistant P acnes, and while a short course of Tetracycline may be prescribed, there is little evidence that long courses confer much benefit. That's why I prefer topical treatments.'
4. Topical Acne Treatments
Gold-standard topical acne fighters such as retinoids, benzoyl peroxide, and salicylic acid remain the solutions most frequently name-checked by our dermatologists. But according to Mahto, retinoids are by far the most transformative.
'Retinoids, or vitamin A, stimulates collagen production and exfoliates the top layers of skin cells. This really helps to reduce the formation of both whiteheads and blackheads, and improves pigmentation left behind by acne.'
Hextall argues that a combination of spot treatment benzyol perozide and retinoids is even better. 'Interestingly, recent studies have shown that benzyol peroxide can help to prevent antibiotic resistance in acne, but you have to be savvy. It dramatically reduces vitamin E, another important anti-oxidant in skin, so make sure you apply a moisturiser packed with the stuff half an hour later for a healthy, happy complexion.'
Found in a myriad of affordable, over-the-counter spot creams, gels and pastes, exfoliant salicylic acid is favoured by many dermatologists for its ability to help break down the outer layer of skin, so it doesn't mix with sebum, while speeding up the resolution of whiteheads. 'It's also a common agent in chemical peels which I'd suggest for sufferers with moderate to mild acne,' says Mahto. 'It helps to banish acne lesions, pigmentary change and to diminish superficial scars.'
Finally, there's a new kid on the block – azelaic acid. Anti-bacterial and anti-inflammatory, it works by killing the acneic bacteria on the skin while simultaneously calming redness and irritation. Look for a product that contains azelaic acid alongside glycolic acid, as together they'll resurface and clear the skin without feeling too harsh
And the crucial thing to remember when starting a new skincare product? Patience. As Marmur notes, it takes only two days for a pimple to crop up, but you need to give any topical preventive measure 42 days to kick in. 'The lifespan of a pimple is about six weeks, so that's the magic number for how long you should use a product before you give up,' she says.
5. Microneedling
As far as picking goes, it's hard to resist the lure of the magnifying mirror. But while it may appear that your clogged pores number in the thousands, many of those little dots, particularly on the nose, are entirely normal hair follicles. Resist the urge to squeeze; leave extractions to the professionals. 'If you have a well-trained medical aesthetician working under the auspice of a derm, they can use acne extractors or microneedles to actually get in there for the more difficult whiteheads,' says Neil Sadick, MD.
Dermatologist Hextall agrees: 'Often, traditional acne treatments quickly clear the typical papules and pustules but the comedones remain. I have found that microneedling is getting very good results, so book in with a dermatologists if you have constant flare-ups.'
All this talk of needles might make you feel a little queasy, but the proof is in the clear skin. In fact, Mahto even suggests opting for a steroid injection, especially for single, isolated, stubborn acne lesions such as cysts. 'This method is particularly useful is a quick response is required, for example, if you have an upcoming social event. The cyst usually flattens within 48 hours – your dermatologist will be happy to discuss any side effects.'
6. Laser Acne Treatment
According to Hextall, 'IPL (or intense pulse light) treatments can often calm down outbreaks.'These treatments are fantastic at reducing post-inflammatory redness,' she says. 'It is this redness that responds to the treatment; it attracts the laser brilliantly and shrinks the outbreak.'
While IPL is a great place to start, Mahto mentions that it's worth talking to a cosmetic dermatologist on the General Medical Council register to decide which treatment is best for your skin. 'As well as IPL there are pulse dye lasers and other light sources that can help. Although, they may be a little pricey, starting from £300 and upwards on average, and multiple courses are sometimes required.'
7. LED Acne Therapy
LED sits a rung down on the intensity scale to IPL, emitting coloured light to the surface of the skin, rather than pulses that penetrate deeper. In short, LED works more on surface-level issues, whether it's active acne, scarring or discolouration.
'There is an increasing interest in the anti-inflammatory and rejuvenating properties of LED treatment to diminish acne,' says Hextall. 'Blue light is anti-bacterial to P Acnes in the skin, while red light is anti-inflammatory. Together, they are very effective and a lot of great work has been done to show that.'
In-salon LED treatments aren't cheap, but the good news is there's now a host of at-home devices available – so you can top up on bacteria-killing light without moving from your sofa.
8. A Simpler Skincare Routine
'I am struck by how much cleansing and exfoliating occurs as soon as acne appears,' says Hextall, 'and in my view, this often makes things worse.'
That's right: constant washing, especially using soap or alcohol-based products, will disrupt the skin's naturally acidic pH, in turn disturbing the skin barrier. If the skin is stripped of oil, it'll only produce more to compensate. Yes, it's a scary thought, but there's no need to worry!
'Using a gentle, slightly acidic wash and applying a light moisturiser on top can be one of the most important changes when it comes to treating acne,' says Hextall.