The only thing more annoying than acne is acne that keeps coming back. Just when you think you’ve finally taken down that one breakout on your chin for good, surprise! It rears its ugly head again, and that’s usually after you’ve spent weeks treating it and had a few good, blemish-free weeks. So what gives? Why does our skin play such cruel, twisted jokes on us? Given that it’s a question we’ve asked ourselves many, many times (most often in front of a magnifying mirror, with our fingers in attack mode), we thought it best to turn to an expert, Dr. Patricia Ceballos of Schweiger Dermatology Group in New York.
Scroll through to find out why your breakouts keep coming back in the same place.
First, more detail on what’s happening when you get a pimple. “In common acne (known as acne vulgaris), the initial lesion is a whitehead or blackhead (the comedo), constituting an enlarged hair follicle pore with secretions consisting of sebum, dead skin cells, keratin debris, and bacteria,” Dr. Ceballos says. “This initial acne lesion results from a defective self-cleaning mechanism within the pore. In acne, the hair follicle pore fails to shed accumulated debris adequately. In other words, the shedding mechanism within the pore is inherently defective.” Basically, when you get a breakout, it’s because you’ve got a faulty pore that’s not functioning at 100%. So the walls of the distended clogged pore are stretched and thinned, which leads to inflammation. And (for some more unfortunate news), inflammation begets inflammation. Additionally, “in many patients, the pores in the affected area have a heightened predilection to dilate and rupture unrelated to external mechanical forces.” Meaning whether you pick it or not, those troubled pores are predisposed to keep causing congestion.
So (bad news), you can’t necessarily “fix” your defective pores—but (thankfully) the story doesn’t end there. “While acne bumps may temporarily ‘heal,’ the tendency toward clogging and rupture of pore contents persists if the underlying shedding defect is not continually treated by medicines designed to ‘decongest’ the pores,” Dr. Ceballos. To keep that recurring breakout at bay, she suggests incorporating anti-inflammatory and antibacterial medicines into your routine. “The best approach is multidirectional, using topical treatments which subdue inflammation and suppress the bacterium implicated in acne, such as Benzaclin, Aczone, Cleocin-T, and Plexion, together with medicines which promote shedding of pore contents (exfoliation) such as Retin-A, Differin, and Tazorac. Some prescription medicines such as Epiduo incorporate ingredients which perform both functions.” (Did you know Differin is now available without a prescription?) Your dermatologist may also recommend undergoing salicylic acid or glycolic peels on a regular basis to help decongest skin.
“Look for products containing salicylic acid (it kills bacteria and exfoliates) or benzoyl peroxide (also bactericidal) as an active ingredient,” Dr. Ceballos says. She recommends Neutrogena’s Rapid Clear Stubborn Acne Spot Gel ($10) or Clean & Clear’s Persa-Gel 10 ($7), both contain maximum-strength 10% benzoyl peroxide. “Gentle exfoliating cleansers containing rice enzymes, green tea, and colloidal oatmeal are helpful. However, daily facial scrubs are not advisable and may harm rather than heal. I recommend a once or twice weekly gentle scrubbing cleanser to exfoliate and dislodge those plugged pores.” Dr. Ceballos also suggests using toners with salicylic acid and/or witch hazel and the occasion sulfur-based mask (like our favorite, Ren’s ClearCalm 3 Anti-Acne Treatment Mask, $45) to keep your skin breakout-free.
What other questions do you have for our dermatologists? Leave them in the comments below!