Acne doesn’t discriminate based on age, race or gender. Between 40-50 million Americans have acne and know the daily struggle of living with this painful skin condition. 20% of them are adults. The other 80% are young people between the ages of 12 and 24, and one-quarter of these young people will suffer permanent scars on their skin from it. That means that 10 million young people will have permanent acne scarring.
Postinflammatory hyperpigmentation (PIH) is usually the result of nodular acne lesions. These lesions often leave behind an inflamed darkened mark after the original acne lesion has resolved. This inflammation stimulates specialized pigment-producing skin cells (known as melanocytes) to produce more melanin pigment which leads to the skin's darkened appearance.[34] People with darker skin color are more frequently affected by this condition.[35] Pigmented scar is a common term used for PIH, but is misleading as it suggests the color change is permanent. Often, PIH can be prevented by avoiding any aggravation of the nodule, and can fade with time. However, untreated PIH can last for months, years, or even be permanent if deeper layers of skin are affected.[36] Even minimal skin exposure to the sun's ultraviolet rays can sustain hyperpigmentation.[34] Daily use of SPF 15 or higher sunscreen can minimize such a risk.[36]

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Comedones (blackheads and whiteheads) must be present to diagnose acne. In their absence, an appearance similar to that of acne would suggest a different skin disorder.[27] Microcomedones (the precursor to blackheads and whiteheads) are not visible to the naked eye when inspecting the skin and can only be seen with a microscope.[27] There are many features that may indicate a person's acne vulgaris is sensitive to hormonal influences. Historical and physical clues that may suggest hormone-sensitive acne include onset between ages 20 and 30; worsening the week before a woman's period; acne lesions predominantly over the jawline and chin; and inflammatory/nodular acne lesions.[1]
Warning: Sulfur smells like rotten eggs. But it is an effective ingredient at drying up pus-filled pimples and whiteheads (you’ve gotta take the good with the bad). It works by sucking up the oil. Sulfur is typically mixed with other active ingredients to get the most efficacy and fragrances to mask the strong scent. You can often find it in masks and spot treatments.
Benzoyl peroxide attacks the P. acnes bacteria. However, one of its main side effects is dryness: If you’re going to use anything with benzoyl peroxide, make sure to moisturize afterwards. Sulfur and azelaic acid are less common and less severe alternatives to benzoyl peroxide. Dr. Peter Lio, assistant professor of clinical dermatology at Northwestern University, says sulfur-based treatments are “a good fit for patients who can’t tolerate the side effects of benzoyl peroxide.”

A big acne myth is that you can wash it away. Although you should wash your face in the morning to rid it of any bacteria and saliva that might be lingering from your pillow, and you should wash it at night to clean away the sweat and grime that accumulated, twice a day is plenty. You also shouldn’t spend more than 30 seconds on this part of your skin care routine. Begin with warm water that is not too hot. When you are finished, you can splash your face with cold water to close the pores or use an astringent. Make sure you get a clean towel each time you wash so that you aren’t patting more bacteria onto your clean face. If you use a washcloth to clean your face, make sure you don’t reuse it.

Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.
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