acne tip PAPULES are another type CYSTS occur deep in NODULE is a solid

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1 H O W T O P R E V E N T B R E A K O U T S A N D A C N E F A C E S T E P 01 The pore, which is also the opening of the hair follicle, becomes clogged with dead skin cells, dirt and oil. B A L A N C E O U T Y O U R S K I N To normalize oil production without overdrying the skin, Sonya Dakar Deep Pore Clarifying Serum combines pore-clearing salicylic acid with a blend of Brazilian rain forest botanicals that can be tolerated by even the most sensitive skins. $42, sonyadakar.com H O W A P I M P L E F O R M S Clogged pores, oil and bacteria are three of the main causes of acne, and according to Dr. Kunin, The more points you intervene at during the acne cycle, the better the results you ll get. S T E P 02 P. acnes bacteria feed off the oil in the clogged pore and attract white blood cells to the area. acne H O W T O P R E V E N T B R E A K O U T S A N D > WHEN YOU MI OIL AND BACTERIA IN A CLOGGED PORE, YOU HAVE THE RECIPE FOR ACNE. BUT YOU CAN STOP THE BREAKOUT CYCLE BY TARGETING EACH OF THE ELEMENTS THAT CONTRIBUTE TO PIMPLES AND ENJOY A CLEARER COMPLEION. S T E P03 Your body then responds with inflammation that causes the redness, swelling and pain associated with the pimple. Today s acne treatment options include topicals that combine antibiotics and benzoyl peroxide, but the next generation of prescription products may incorporate retinoids as well, which have the benefit of preventing clogged pores. With so many treatment options, how do you know which one is best for you? That s where your dermatologist comes in, since he or she has the know-how and access to professional-grade treatments that will send your pimples packing. The nice thing about acne is that there are several options, Phoenix, AZ, dermatologist Mark Blair, MD, says. The key is finding the right combination of medications and light-based treatments for each patient. Sure there are over-the-counter products that are great as a first line of defense, but according to Kansas City, MO, dermatologist Audrey Kunin, MD, Patients need to know that if they don t see improvement with over-the-counter remedies in two to three months, or if they have cysts or scarring, they need to see a dermatologist. 122 N E W B E A U T Y types of acne HAVE YOU EVER WONDERED WHY SOME OF US ONLY GET BLACKHEADS WHILE OTHERS GET FULL-BLOWN BREAKOUTS? GENETICS AND THE IMMUNE SYSTEM DEFINITELY COME INTO PLAY, EPLAINS SEATTLE DERMATOLOGIST JENNIFER REICHEL, MD. EVERYONE STARTS WITH A PIMPLE, BUT THE BODY S INFLAMMATORY REACTION VARIES FROM INDIVIDUAL TO INDIVIDUAL. HOW THE IMMUNE SYSTEM RESPONDS DETERMINES IF ACNE WILL PROGRESS TO MORE SEVERE CYSTS AND NODULES. Blackheads and whiteheads are both types of COMEDONES, another term used to describe a clogged pore. These are most common in the T-zone, which is comprised of the forehead, nose and chin. A PUSTULE is a lesion that contains a mixture of white blood cells, dead skin cells and bacteria otherwise known as pus. PAPULES are another type of blemish, but unlike clogged pores, these solid, raised bumps are not squeezable. Papules lend a rough feel to the skin and are caused by a local reaction to the P. acnes bacteria that cause acne. These are most common on the cheeks and along the jawline. Like a papule, a NODULE is a solid lesion. But unlike a papule, a nodule is characterized by inflammation, and this type of blemish extends into deeper layers of the skin, and may cause pain and scarring. CYSTS occur deep in the skin and contain pus. These lesions are larger than pustules, are usually severely inflamed, may be very painful, and can result in scarring.

2 F A C E H O W T O P R E V E N T B R E A K O U T S A N D A C N E H O W T O P R E V E N T B R E A K O U T S A N D A C N E F A C E C U L P R I T 01 bacteria F I N D A B E A U T Y D O CTO R N O W! Doctors reveal inside information on top cosmetic enhancement procedures. Turn to page 169. P R E V E N T I N G A C N E W I T H V I T A M I N C? It may sound too good to be true, but a handful of studies have shown a connection between taking vitamin C orally and the prevention of acne. Vitamin C is considered a super vitamin that plays a role in immunity and preventing infection. In order to reap the potential antibacterial benefits of vitamin C that may be able to prevent breakouts, it s recommended that you take 1,000 to 1,600 mg three times a day. Be sure to check with your doctor before starting any supplements. But Dr. Blair isn t so quick to recommend this course of treatment to patients. Unfortunately there are also studies that say too much vitamin C can cause acne or make it worse, so the jury is still out. IF IT WEREN T FOR A STRAIN OF BACTERIA CALLED P. ACNES, THERE WOULD BE NO PIMPLES. ALTHOUGH EVERYONE HAS P. ACNES PRESENT ON THEIR SKIN, THE BACTERIA BECOME PROBLEMATIC WHEN COUPLED WITH CLOGGED PORES. 03 BACTERIA FIGHTER Light-based treatment 124 N E W B E A U T Y 01 BACTERIA FIGHTER Benzoyl peroxide Often recommended along with antibiotics to treat acne, benzoyl peroxide is available in concentrations ranging from two-anda-half to ten percent. It is also available by prescription in combination with topical antibiotics. One such product called BenzaClin combines five-percent benzoyl peroxide with one-percent clindamycin (an antibiotic). HOW IT WORKS Benzoyl peroxide slows the growth of bacteria and reduces inflammation. RESULTS SEEN Benzoyl peroxide alone can help clear up mild, noninflammatory blackheads and whiteheads within a month or two. SIDE EFFECTS As benzoyl peroxide kills the bacteria, it can dry up excess sebum and lead to redness, peeling and burning. Those with sensitive skin may not be able to tolerate benzoyl peroxide, and it s best used at night. N A T U R A L H E A L E R Tea tree oil has long been used as a natural remedy because of its anti-inflammatory and antiseptic properties. The two-sided Jane Iredale Zap&Hide features this active ingredient on one end to treat pimples, with a creamy concealer on the other side to cover blemishes as they heal. $25, spalook.com A N A C N E - F I G H T I N G V I R U S? Scientists at the University of Leeds in the United Kingdom have found that a virus occurring naturally on the skin attacks and destroys the bacteria that contribute to the formation of acne. These findings show promise in the idea of using a naturally occurring virus to attack the bacteria as a new way of treating acne. At this point, all research has been confined to the laboratory and human studies must be performed to assess its effectiveness. 02 BACTERIA FIGHTER Antibiotics A wide variety of oral and topical antibiotics are prescribed to treat acne, including tetracycline, erythromycin, minocycline, doxycycline and clindamycin. Many factors come into play when choosing the antibiotic, including a patient s age, allergies and if they are pregnant or nursing. Dr. Reichel explains that minocycline is often her first choice, because it s an easy once-a-day dose and it s well tolerated by most patients. HOW IT WORKS Antibiotics decrease the amount of bacteria present in the pores. In addition, they help hinder the inflammatory response once a pore is clogged, thus reducing the telltale redness and swelling associated with blemishes. RESULTS SEEN Dr. Kunin says, No matter the therapy, it takes six to eight weeks to see improvement. SIDE EFFECTS Oral antibiotics can cause yeast infections, and may decrease the effectiveness of birth control pills. Antibiotics can also cause sun sensitivity, so it s important to wear sunscreen during treatment. Early laser treatments designed to address acne used UV light to eliminate blemishes, but these have fallen out of favor due to skin-damaging side effects. Today s most popular light-based acne treatments harness the power of blue light to safely and painlessly treat inflammatory acne without the harmful side effects. According to Dr. Blair, One of the ways blue light improves acne is by creating heat that causes the bacteria to produce suicide proteins, so they essentially kill themselves. Red light may be used in conjunction with the blue light to help treat the inflammation associated with acne. HOW IT WORKS The wavelength associated with blue light is able to zero in on P. acnes bacteria and kill them without affecting other components of the skin. HOW MANY TREATMENTS Generally, eight sessions are given over a four-week period, and each session lasts about 15 minutes. RESULTS SEEN Within the first four weeks, but most patients see improvement after the first two to three treatments. SIDE EFFECTS Any reactions to blue light tend to be mild, and include temporary pigment changes, swelling and dryness in the treated areas. COST Starting at about $250 per treatment N E W B E A U T Y 125

3 F A C E H O W T O P R E V E N T B R E A K O U T S A N D A C N E H O W T O P R E V E N T B R E A K O U T S A N D A C N E F A C E clogged pores C U L P R I T 02 Who hasn t woken up the day before a big event with a gigantic, painful underground pimple? The next time this happens, call your dermatologist for an emergency cortisone injection that can take down the swelling within a day. AS SOON AS OIL AND DEAD SKIN CELLS START BUILDING UP IN A PORE, BACTERIA HAVE A FEEDING FRENZY THAT HELPS THEM MULTIPLY AND EVENTUALLY CAUSES A PIMPLE. YOU CAN PREVENT CLOGGED PORES BY KEEPING DEAD SKIN CELL BUILDUP TO A MINIMUM, AND AVOIDING FACE- AND HAIR-CARE PRODUCTS THAT CONTAIN PORE-CLOGGING INGREDIENTS LIKE MINERAL OIL, LANOLIN AND SHEA BUTTER. 02 CLOGGED PORE FIGHTER 04 CLOGGED PORE FIGHTER Retinoids Isolaz 126 N E W B E A U T Y P O R T A B L E C L O G G E D - P O R E P R E V E N T I O N Featuring the ANSR: Beam, ANSR: Prep, ANSR: Night and ANSR: Day, this all-in-one kit combines light and topical therapies to clear up the skin. The Beam uses blue light to kill bacteria and red light to facilitate the healing process; the Prep Cleanser exfoliates to prevent clogged pores, while the Night and Day Moisturizers contain salicylic acid to hinder excess oil and soothe inflammation. $185, ansr.com 01 CLOGGED PORE FIGHTER Exfoliation Store shelves are lined with countless exfoliation options, including manual scrubs, glycolic and salicylic acids, and gentle enzyme-based products. HOW IT WORKS Similar to in-office exfoliation treatments like chemical peels and microdermabrasion, at-home products and treatments remove dead skin cells that contribute to blemish formation. RESULTS SEEN According to Dr. Blair, Although it can take several weeks to see results, exfoliation is extremely helpful. Retinoids go by many names, including tretinoin, Retin-A, Tazorac, Differin and more, but they are all derivatives of vitamin A that affect the way the skin turns over and prevents dead cells from sticking together and clogging the pores. As if there weren t enough retinoids to choose from, there s also a prescription called Ziana that combines tretinoin with the antibiotic clindamycin to target bacteria as well. Dr. Reichel often starts acne treatment with Retin-A because, in addition to breaking down comedones, it s great for older acne patients who are also concerned about aging. HOW THEY WORK Topical retinoids prevent clogged pores by speeding up the skin s natural rate of exfoliation. By decreasing the stickiness associated with the dead cells, the chances of pores becoming clogged are lessened. RESULTS SEEN Within two to three months, but acne may worsen before it improves. SIDE EFFECTS The most common side effects are dryness and irritation, which tend to decrease with continued use. Starting with every-other-night use and gradually working up to every night can help keep side effects to a minimum. 03 CLOGGED PORE FIGHTER Chemical peels Many different types of peels can be used to alleviate acne as well as scarring, but glycolic acid a type of alphahydroxy acid is the most common. Salicylic acid (a beta hydroxy acid) may be more suitable for sensitive skin, and yet another type of acid, polyhydroxy acid is among the latest generation of acids that results in the least irritation. Your doctor will decide which type of peel and concentration is best for you based on your skin. HOW THEY WORK Chemical peels remove the superficial layers of dead skin cells to prevent pores from becoming clogged. RESULTS SEEN Most peels deliver results within two weeks. HOW MANY TREATMENTS A series of six peels spaced two weeks apart is generally recommended. SIDE EFFECTS Redness, sun sensitivity, possible peeling COST Starting at approximately $150 Stubborn acne needs a multifaceted treatment that covers all of the acnecausing culprits: bacteria, inflammation, oil and clogged pores. A relatively new office-based treatment called Isolaz does just that. Studies show it s safe and effective for mild to moderate acne, says Dr. Reichel, but according to Dr. Blair, Active lesions respond very well to this treatment, but it s not aggressive enough to help prevent pimples from forming. HOW IT WORKS Isolaz uses suction to clean out the pores while pulsed light targets oil and bacteria. RESULTS SEEN Many patients see improvement in their blemishes after the first ten-minute treatment; maintenance treatments every three months are recommended. HOW MANY TREATMENTS On average, four treatments are needed. SIDE EFFECTS As opposed to other light-based acne treatments, Isolaz does not cause any post-treatment sun sensitivity or require any downtime at most, patients may be a little pink for a few hours after treatment. COST $250 to $500 per treatment, depending on location of the practice and size of the area treated N E W B E A U T Y 127

4 H O W T O P R E V E N T B R E A K O U T S A N D A C N E F A C E DERMATOLOGISTS USUALLY POINT THE FINGER AT HORMONES AS THE CAUSE FOR OILY SKIN MAINLY BECAUSE ACNE COINCIDES WITH PUBERTY BUT THE FACT IS THAT GENETICS, THE PRODUCTS YOU USE AND EVEN THE MEDICATIONS YOU TAKE (SUCH AS ORAL CONTRACEPTIVES) CAN REV UP THE OIL GLANDS. WHEN ECESS OIL AND DEAD SKIN CELLS CLOG UP THE PORES, BACTERIA CAN MULTIPLY AND LEAD TO BREAKOUTS. oily skin C U L P R I T 03 T H E R O L E O F H O R M O N E S It s known that the male androgen hormones are responsible for kicking oil glands into overdrive, and a diuretic used for high blood pressure called spironolactone is an effective treatment for hormonally caused acne. This oral medication (which also goes by the brand name Aldactone) delivers visible acne improvement in two to three weeks, but should not be used by women who are pregnant (or thinking about becoming pregnant). It works by blocking the male hormone receptors within the skin with very little side effects, although menstrual irregularities and breast tenderness are possible. Taken long term to manage acne symptoms, spironolactone works differently than birth control pills to improve acne, but the results are very similar. 128 N E W B E A U T Y 01 OILY SKIN FIGHTER Laser treatment In addition to blue light treatments that target the bacteria responsible for acne, other energy sources, such as those that send heat deep into the skin, can be used to suppress the oil glands in an effort to stop the breakout cycle. HOW IT WORKS Smoothbeam is the most popular diode laser used to shrink the size of the oil glands and suppress their activity. According to Dr. Blair, This laser heats the outer layer of the oil gland and creates a mild thermal injury that decreases oil production. In addition to reducing active lesions and preventing new ones from forming, the nonablative resurfacing effect of collagen remodeling also helps reduce scarring. NUMBER OF TREATMENTS Three to six, though more severe acne and scarring may require up to 12. RESULTS SEEN Patients usually see improvement (a 40- to 50-percent reduction in acne lesions) after the first treatment. SIDE EFFECTS Discomfort (topical anesthesia may be given), temporary redness or darkening of the skin COST $200 to $300 per treatment (or $1,500 to $2,000 for a package of six) 02 OILY SKIN FIGHTER Accutane Often considered the last resort for treating acne, Accutane is an oral medication that may be the only effective treatment for persistent nodules and cysts. According to Dr. Reichel, Accutane is the magic bullet for acne that isn t responding to other treatments. HOW IT WORKS Accutane works primarily by reducing oil production, but the drug also appears to reduce cell buildup, bacteria and inflammation. RESULTS SEEN For many patients, treatment usually takes four to five months, but acne may get worse before it improves. However, 85 percent of patients see long-lasting results. SIDE EFFECTS Dryness of the lips and eyes, headaches, depression, increased sun sensitivity SPECIAL CONSIDERATIONS In order to get a prescription for Accutane, you must enroll in ipledge, a pregnancy risk management program, and use two methods of birth control one month before, while taking and one month after taking Accutane since the drug has been found to cause serious birth defects. You also need regular blood tests to assess liver function and triglyceride levels. 03 OILY SKIN FIGHTER Most people have a tendency to break out in the same part of the face most of the time, so if you experience a flare-up in an unusual spot, make an appointment with your dermatologist to make sure it s not some other kind of reaction or irritation. Radiofrequency A relatively new treatment for acne, radiofrequency is often used in combination with blue light and red light therapy to treat bacteria and inflammation. Elos is just one of these treatments, and it uses radiofrequency and blue light. HOW IT WORKS Radiofrequency (the same technology used in the skintightening treatment Thermage) uses heat to inhibit oil gland activity. NUMBER OF TREATMENTS Two per week for four to five weeks RESULTS SEEN Most patients see results after two or three treatments. SIDE EFFECTS Discomfort, swelling, redness, hyper- or hypopigmentation COST Up to $500 per treatment

5 F A C E H O W T O P R E V E N T B R E A K O U T S A N D A C N E H O W T O P R E V E N T B R E A K O U T S A N D A C N E F A C E FOR MANY WOMEN, BLEMISHES IN AREAS OTHER THAN THE FACE ARE A MAJOR PROBLEM. FROM THE BACK AND CHEST TO THE BUTTOCKS, SHOULDERS AND BEYOND, BODY ACNE CAN LIMIT WARDROBE OPTIONS AND CAUSE FEELINGS OF INSECURITY. BECAUSE SKIN IS THICKER ON THE BODY THAN IT IS ON THE FACE, BODY ACNE CAN BE MORE DIFFICULT TO TREAT. P R O B L E M 01 body acne the causes ALTHOUGH THE LOCATION OF THE BLEMISHES MAY BE DIFFERENT, THE BODY ACNE CYCLE IS THE SAME. BUT DEPENDING ON THE LOCATION, OTHER FACTORS CAN COME INTO PLAY AND EACERBATE THE PROBLEM. SWEAT Perspiration acts like a film that traps oil, dirt and debris in the pore. If you work out, shower right away, Dr. Kunin says. CLOTHING Wearing clothing that doesn t breathe especially when perspiring traps sweat against the skin. Irritating fabric can cause breakouts as well, since the skin reacts to the friction. PRODUCTS Skin-care products can clog pores anywhere on the body. Depending on where you re breaking out, consider the products that come in contact with your skin. Hair products, body lotions and even detergents or fabric softeners may be to blame. 01 BODY ACNE FIGHTER 03 BODY ACNE FIGHTER 130 N E W B E A U T Y A C N E A D V A N C E S Acne treatment options continue to expand, as a handful of new products and prescriptions heads our way. Dr. Blair tells us about a new ultrasound treatment that uses focused energy to dramatically decrease oil production. This energy is so safe that it s going straight to home use within the next year, and I believe it will rival the other at-home devices that are already out there. There s also a recently approved topical called Aczone, which features the drug dapsone. According to Dr. Reichel, This is a fairly potent antibiotic that is often used effectively for more severe skin disorders. When taken orally it has a lot of side effects, but the topical version doesn t seem to have these problems. Aczone has a strong antibacterial and antiinflammation capacity to knock out acne. ClindaReach The back can be one of the hardest areas to treat simply because it s hard to apply products, and consistency is key for the success of any anti-acne regimen. The prescription ClindaReach system comes with a tool that lets you get to hard-to-reach areas, plus premoistened antibiotic pads to stop acne at the source. HOW IT WORKS The topical antibiotic clindamycin targets the acne-causing bacteria. RESULTS SEEN Up to two months SIDE EFFECTS May cause stinging due to the alcohol base 02 BODY ACNE FIGHTER Chemical peels Similar to the face, chemical peels on the body target clogged pores, and have an antibacterial effect as well. HOW THEY WORK The acids used in chemical peels stop the acne cycle in two ways: by keeping pores clear and bacteria under control. NUMBER OF TREATMENTS A series of four to six peels spaced three to four weeks apart. Maintenance peels are recommended every two to four months. SIDE EFFECTS Redness, sun sensitivity, possible peeling Salicylic acid and benzoyl peroxide The good news is, since the skin on the body is less sensitive than that on the face, you can combine numerous acne treatment products. First, use a salicylic acid wash to help keep the pores clear, and if acne doesn t respond then try a benzoyl peroxide or salicylic acid pad. If you re still breaking out, you can also use an alphahydroxy lotion or a cream with benzoyl peroxide or salicylic acid. HOW THEY WORK These products address the bacteria and/or clogged pores that are contributing to breakouts. RESULTS SEEN With consistent use, acne should improve within two months. SIDE EFFECTS Depending on the products used, you may experience sun sensitivity. P O W E R F U L W A S H Just like on the face, keeping pores clear is essential for a blemish-free body. Neutrogena Body Clear Body Wash Pink Grapefruit contains salicylic acid to do just that, with a refreshing pink grapefruit scent that might make you forget it s an acne product. $7, neutrogena.com N E W B E A U T Y 131