If you had asked teenage Sarah about her skin, she\u2019d have told you vehemently (with exaggerated arm gestures for added melodrama) that it was a zit colony, where all the disgusting pustules got together to party and make her life hell. It\u2019s true that I spent a significant amount of time thinking about my zits, trying all the remedies from home jobs (tea tree oil, nail polish remover) to almost every product from Bonne Bell to Benzoyl Peroxide trying to kill the little colonies off (my skin barrier still has PTSD from it). But now, with a couple decades of hindsight and a career writing about such things I can tell you objectively that my skin wasn\u2019t that bad. My three or four semi-permanent spots were just \u201cnormal\u201d, and leveled out to a predictable solo spot on my chin to celebrate the beginning of PMS each month. Despite what 16-year-old me would have you believe, I was lucky. <\/p>\n

But a lot of my friends were less so, breezing through a relatively zit-free high school, only to be faced with a much more brutal beast in their 20s and 30s: adult acne. These are the decades you\u2019re supposed to be getting your sh*t together, not agonizing over your pores so not surprisingly it hits different. One friend, Penny, told me \u201cI would never let anyone see me without makeup, not even my close friends, and especially not boys. I\u2019d get up every morning and apply a full face before they woke\u2026 I think it wrecked my dating life at the time because I just couldn\u2019t relax.\u201d After suffering for eight years and trying every over-the-counter remedy clever marketers could spin, she eventually went to a dermatologist who prescribed Oratane, which cleared it for good. <\/p>\n

Sherine, a beauty journalist (and my partner-in-crime at gloss etc<\/a>) went through a similar thing \u2013 except it coincided with landing her dream job as a beauty editor, proving that life can be a real jerk sometimes. \u201cHonestly, I had spectacular skin as a teen, I didn’t go through any of the acne agony that my friends experienced, and I took it all for granted.\u00a0And then at 30, I got my dream job with a side of cystic acne around my jawline. The lumps were deep, they were red, and they were incredibly painful. Sometimes, it got to the stage where I couldn’t sleep on my side. It was so demoralizing and depressing, especially as I was going out to all these beauty events and meeting PRs.\u201d There was no rhyme or reason either; it just was a \u201chormonal imbalance\u201d. <\/p>\n

The biggest slap in the face was that she has every professional therapist\/ treatment\/ product at her disposal \u2013 but nothing helped. \u201cThe upper portion of my face was super glowy, but nothing helped the acne. After about a year of frustration and tears (not gonna lie), I finally went and saw a dermatologist, and then things started changing.\u201d Like Penny, she was put on a prescription oral medication (sprinolactone) for about two years (six months to work up to the dose, one year on the dose, six months to come down) combined with topical cream and some tweaks to her diet (less red meat, chicken and dairy) \u2013 and wouldn\u2019t you know \u2013 it worked!<\/p>\n

\u201cI know readers can get annoyed when beauty journalists are all \u2018see a dermatologist!\u2019 but it really, really REALLY helps. Like, if you had a heart problem, you wouldn’t go to your GP\u2014you’d see a cardiologist. Your skin is an organ, and if you’re dealing with a serious issue that’s stressing you out, you have to see a specialist. That’s my advice, anyway.\u201d And she\u2019s right. Because obviously acne sucks (unless it\u2019s the Swedish clothing kind), but with the right care \u2013 and knowledge \u2013 it doesn\u2019t have to be forever. Here, New York based esthetician and owner of Sofie Pavitt Skincare<\/a> (a results-driven facial studio in Downtown NYC) answers everything else you wanted to know about acne.<\/p>\n

When does the odd spot officially become acne?<\/strong>
\nIt depends on the regularity and consistency or the breakouts. While a pimple every now and then is most likely environmental, if it\u2019s consistent Sofie says she\u2019d consider your skin \u201cacneic\u201d aka: having a general predisposition to breakouts. <\/p>\n

Know your type<\/strong>
\nWithin the acne family there\u2019s many members, all with incredibly unsexy names that make you want to shudder a little. Sofie explains that acne is measured in grades from 1-4 (4 being most severe) and it can either be inflamed (cysts, nodules, pustules and papules) or non-inflamed (whiteheads). However, they all start the same – as a microcomedone, which forms after a blockage of the sebaceous (oil) duct. Sofie says, \u201cIt\u2019s normal to have both inflamed and non-inflamed acne, and you can suffer with either with any skin type. Everyone is different and you need to tailor your approach to clearing it.\u201d Hormonal acne (the kind that both Penny and Sherine suffered from) is almost always cystic and inflamed and hits women post teens (20s, 30s, and even 40s). It\u2019s linked to \u2013 you guessed it \u2013 hormones (usually testosterone) and will usually pop up around the jawline\/ below the nose. <\/p>\n

It\u2019s not just about oil<\/strong>
\nIf only it were that simple. Sofie says that oil production is only one part of the problem, and that your skin can be bone-dry and still have cystic acne. \u201cThere\u2019s three main factors to consider when understanding how acne forms: the presence of dead skin cells congesting the pore; excess oil production which mixes with these dead skin cells and C acnes bacteria that is present in the skin and then eats this dead skin\/oil causing inflammation and infection within the pore.\u201d And of course hormones have a part to play because they trigger the sebaceous glands (the oil producing ones).
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\nWhat about diet?<\/strong>
\nThis may be a contentious one and the Internet would have you believe you can fix acne with food alone, but Sofie\u2019s take is that it\u2019s only one part of the bigger picture. \u201cI believe that a lot of skin conditions begin in the gut but not so much acne.\u00a0Sugar generates an insulin response in the body that can increase oil production so yes it can be a factor.\u201d <\/p>\n

It\u2019s not you\u2026 it\u2019s genetics <\/strong>
\nYes, environmental and even emotional factors (hello, stress acne and maskne) can play a part but Sofie says if you\u2019re predisposed to it, the genetic predisposition never goes away. \u201cIt can lay dormant for years and then flare up suddenly,\u201d she says, noting that people can also experience it when coming off birth control, entering peri menopause or going through periods of high stress.<\/p>\n

So, how do you fix it? <\/strong>
\nAh, the million dollar question. And the answer is: it\u2019s complicated. See, there is no one-size-fits-all solution to acne, because it really depends on the type and severity of the acne \u2013 and determining that is best left to an expert. Even over-the-counter products (which can actually be helpful in some instances) should be chosen alongside a professional so as Sofie says you\u2019re \u201cnot playing the game with the wrong set of instructions\u201d. \u201cAn esthetician can determine a home-care routine to treat your particular type of acne, and if you don\u2019t see results within 12 weeks I would then recommend your next step to visit a dermatologist, who may be able to prescribe some medications\u201d she says. But Sofie also emphasizes the need for home-care in addition to medication, \u201cI see myself as a supporting actress to dermatologists, we provide a deep clean treatment and plan home-care to assist what the derm has prescribed.\u201d As far as over-the-counter remedies are concerned, Sofie name-checks salicylic acid, benzoyl peroxide, Mandelic acid and retinols as some of her favorite pimple-fighting ingredients, but again speak to a professional before you dabble so you\u2019re not too aggressive (or too gently) in your approach. <\/p>\n

And finally\u2026 is it really that bad to pop a pimple? <\/strong>
\nWe know it\u2019s tempting \u2013 we\u2019ve seen the YouTube videos \u2013 but is it really as bad as skin whisperer\u2019s say it is? Uh, yep. \u201cYou\u2019re causing trauma to the skin, and can also spread the infection from one pore into a wider area,\u201d says Sofie. On top of that, hyperpigmentation is more common in picked areas so you\u2019re just adding to your skin concerns, and you can even potential cause structural damage is you\u2019re really overzealous in your popping crusade. The bottom line: step away from the zit, and leave its treatment to the pro\u2019s.
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