Treating Stubborn Acne
While I often recommend acne washes, lotions, and gels to my patients who are having breakouts, these at-home treatments are sometimes not enough to control the problem. For stubborn or severe acne, I perform these procedures in my office:
Extractions (also called acne surgery) help remove pockets of oil and dead skin. I use a few different sterile instruments to safely drain whiteheads, blackheads, and small cysts. Extractions must be done carefully by someone with experience or they can turn a small pimple into a festering boil, which can become infected and take weeks to heal. This is the reason doctors usually recommend that pimples not be squeezed; without the right instruments and technique, you can scar your skin.
Large cysts (such as those that result from hormonal breakouts) can be treated with dilute cortisone injections, which shrink the inflammation under the skin, often within a day or two. The amount of cortisone is very small, but the injection must be done by a skilled doctor — if not, it can cause your skin to become pitted.
Acne peels with alpha and beta hydroxy acids can help unclog pores and reduce blackheads, especially if there are many little bumps and pimples. My favorite solutions are salicylic, lactic, and lipo-hydroxy acids, which target the oil glands to loosen dead skin and oil. Peels generally cause pinkness and flaking for a few days. For an at-home treatment, try Olay Regenerist Microdermabrasion and Peel System, which contains lactic acid, or Ren Glycolactic Skin Renewal Peel Mask, which contains four fruit acids.
Laser and photofacial treatments can help kill acne-causing bacteria and shrink pores, although the effect is temporary. For best results, these treatments are done once every three to four weeks, so they can become costly. However, little to no recovery time is needed. I often recommend lasers to reduce red scars after a breakout is under control.