For many, acne is like the plague—it shows no mercy. And as summer heats up, you may see your breakouts worsen.
“UV rays from the sun stimulate oil production and thicken the outer layer of your skin, leading to blocked pores and an increase in breakouts,” says David E. Bank, MD, assistant clinical professor of dermatology at Columbia Presbyterian Medical Center. Bacteria multiply in hot, sticky weather, and increased sweating and dehydration—in other words, both humid conditions and dry desert environments—also contribute to the problem. Furthermore, “in hot weather, if you wear anything that’s occlusive—makeup, a baseball hat—it can exacerbate acne,” adds Cameron Rokhsar, MD, assistant clinical professor of dermatology at Mount Sinai Hospital.
And it doesn’t only affect teens: Bank, author of Beautiful Skin: Every Woman’s Guide to Looking Her Best at Any Age, acknowledges a substantial growth in adult or hormonal acne, specifically in women over 20.
Nip It in the Bud
When it comes to pimple prevention, dermatologists advise several things. A clean face is key. Bank suggests washing twice a day (use a formula that contains benzoyl peroxide or an acid like glycolic, lactic or salicylic), avoiding touching your face and cleaning phone screens with alcohol pads. For those who get oily, Rokhsar suggests using toner pads or prescription antibiotic pads.
One of Rokhsar’s favorite ways to stifle hormonal acne is with an oral prescription for spironolactone (not recommended for pregnant or breastfeeding women), a diuretic that reduces testosterone, a trigger of acne. Meanwhile, exfoliation is a “double-edged sword,” he notes. “If you use a cleanser with a little acid, it keeps your skin clear and prevents cystic breakouts, but the downside to using exfoliating stuff in the summer is that it takes away the top dead layer of skin, so you’re more susceptible to getting a sunburn.” Translation: Be careful of how many acid-based products you use.
In the hot summer months when SPF is (hopefully) being used liberally, beware of heavy formulations. “It’s important to use a sunscreen that is either a light lotion, gel or powder,” says New York City dermatologist and Skin Rules author Debra Jaliman, MD. “Not using SPF will cause the inflammation from acne to turn into post-inflammatory hyperpigmentation,” which is difficult to reverse. Go for a sunscreen with a high concentration of anti-inflammatory zinc oxide, as opposed to chemicals that can irritate. Also avoid any that are labeled as “sports” or “water-resistant,” as those contain oil that is the number-one acne culprit. Try EltaMD’s UV Clear Broad-Spectrum SPF 46 or, come July, Murad’s new sunscreen specifically for acne-prone skin: Anti-Aging Moisturizer Broad Spectrum SPF 30 | PA++.
Treat it Right
Topically speaking, dermatologists favor retinoids and retinols because, contrary to popular belief, they can be great for clearing up sensitive skin. Bank suggests prescription Duac or Onexton gels that contain benzoyl peroxide for spot-treating pimples. In the midst of a breakout, cortisone shots ($75 out-of-pocket cost) can decrease inflammation dramatically in 24 to 48 hours. “If a cyst comes up, it should be injected the same day or the next so it doesn’t fester. Never pick your acne,” says Jaliman. In dire situations, Rokhsar also prescribes an oral antibiotic, while Bank opts for prednisone, a prescription steroid (a powerful anti-inflammatory), for severe breakouts.
Then there are the high-tech options. While LED light is frequently used in combination with lasers in a dermatologist’s office, Rokhsar calls the home devices “gimmicky” and equates them to standing under a red traffic light. The suction and light therapy technology of Isolaz (an in-office procedure costing $150 per treatment) is expensive and a bit controversial. Jaliman admits it can be beneficial and remove blackheads, but it also pulls a lot on the skin, which can cause redness and for some may actually spread acne.
“To make acne quiet, I use a treatment called PDT, photo dynamic therapy, in which we apply a chemical to the skin that is activated by a laser,” says Rokhsar of his favorite therapy that also decreases redness and scarring, and can be used on patients at varying stages of remissive or active acne (Bank also uses PDT in his practice). “This combination protocol [used in PDT] has been shown to have a very strong anti-inflammatory response in acne.” The dermatologist does one to three sessions, two weeks apart, at $650 to $750 a session for the full face (it also works great on back acne, he says). One downside: Patients must avoid the sun for 48 hours afterward.
The Scar Stage
When it comes to scars, fresh ones can be treated with prescription Biafine cream or over-the-counter Mederma, says Bank. Jaliman targets older scars with the Clear + Brilliant laser (in a series; $500 per session), microdermabrasion and a combination of light lactic and salicylic acid peels. A thin hyaluronic acid filler like Belotero can be used to smooth deep scars ($750 to $950 per syringe), but generally speaking, these dermatologists prefer laser resurfacing, which encourages the skin to remodel itself over time.
Bellafill, a permanent filler made of PMMA microspheres—essentially acrylic—was approved by the FDA this year to fill pitted scars, but all of the dermatologists we interviewed are uncomfortable with it. “My reservation about a permanent filler is that it’s an inert substance; it’s not biologically active. So if you inject it, your body could reject it. Plastic isn’t meant to reside in our skin for a long time, and that’s the issue I have with Bellafill and why I would be hesitant to adopt it in my practice,” says Rokhsar.
The MedLite C6 laser ($750 for full face, $350 for cheeks) is very effective for scars and requires no downtime, and the Regenlite pulsed dye laser ($350 per treatment) is safe and effective, and improves scars by using low-frequency visible light to penetrate blood vessels, says Jaliman. It also kills acne-causing bacteria, helping prevent further breakouts. One thing to remember is that “any change made in the skin with lasers is permanent,” she adds.
Bank, Rokhsar and Jaliman all use the Fraxel laser for acne scars as well, recommending four treatments given four weeks apart ($500 to $1,500 per treatment). “The Fraxel laser is my number-one choice for run-of-the-mill acne scars,” says Rokhsar. “It can be used to stimulate collagen and help fill in indented scars.” For more stubborn rolling scars (from patches of long-term acne), he uses subcision, which involves the placement of a special cutting needle to free up the vibrios tissue that tethers the skin down and causes the pucker or rolling scar ($300 per treatment).
Diet, Exercise, Sleep
Finally, beyond the medical and high-tech advancements, there are a few other lines of defense. Internally speaking, studies have shown that dairy can exacerbate acne. Jaliman also suggests a diet that eliminates high-glycemic foods that are processed—think donuts, candy, chocolate, pasta and white bread. And Bank notes that exercise and sleep are also extremely important factors in preventing or mitigating acne.
Other tips: Be religious with a treatment plan, don’t pick at blemishes and wear lots of the right kind of SPF.