Q: Help, I have mask-ne! What do I do?
A: Mask-ne has been the most common diagnosis I’ve seen pop up during the pandemic. People are getting breakouts right underneath a face covering because it's like a freaking microclimate under there. But there are a few things you can do.
If you’ve been sweating, spray the inside of your mask with a salicylic acid spray — we have one from SLMD that you can leave in your car or take with you whenever you need it — and it will help clear out the debris and any gunk from inside your pores to stop breakouts from forming.
You should also think about the type of mask you use. The more occlusive the fabric, the more potential you have of increasing the humidity and dirt and debris, making you more prone to acne. The tighter the mask is, the more rubbing on your skin it will do and potential it has to cause a breakout. The most ideal fabric is something that’s cotton or wicks moisture away, but that also means it will be less protective from COVID. So really, if you’re away from people, the best thing to do is take little breaks from your mask outdoors in the shade.
Oh, and wash your mask every day. Think about it like your underwear: would you put the same underwear on the next day? Not a lot of us would.
Q: In a game of “Kiss, Marry, Kill” with acne ingredients, what would you choose: salicylic acid, sulfur, and benzoyl peroxide?
A: I would marry salicylic acid, because that's my staple. That's what I use all the time, every day, really, without question. It can do so much more than treat acne — it also helps with pigmentation, keeps pores clear, keeps my face fresh — but without the irritation.
Kiss would be benzoyl peroxide because every now and then, you get that Mount Vesuvius pimple and you want to give it a little kiss of benzoyl peroxide, just a little smooch right on the top of it as a spot treatment, leave it alone so it can get to work on that bacteria and stuff.
If I were to kill anything, it would be sulfur. Sulfur blemish creams are good to use — I have one, and it’s one of our best sellers — but it's also meant for people who can't tolerate benzoyl peroxide and they need something a little gentler, per se. So, begrudgingly, that's the one I'd have to kill.
Q: What’s the sneakiest cause of acne nobody thinks about, and what’s the easy solve?
Sometimes you can feel like Sherlock Holmes trying to figure out what’s causing your acne, especially if you’re doing your skin care right and everything. People are surprised to learn, when they use a lot of occlusive products in their hairz they can get comedonal acne along their hairline or forehead, or on one side of their face. It’s called pomade acne. When the hair lays against the face, it can leave behind a whole garden of acne bumps.
Things that are occlusive can cause similar reactions, like violinists who get acne on their chin or football players who get acne on their chest. It’s because they're wearing things that are trapping that moisture, oil, dirt. The solution starts with becoming more aware of that behavior. If you can help it, don’t rest your hand on your chin. That kind of thing.
Q: How long does it really take for an acne treatment to work?
Don’t expect your skin to change overnight. It can take a little while for acne treatments to kick in. If I’m starting a patient on any kind of prescription regimen, I ask to see them in another month in case we need to fine-tune things. If you’re talking treatments that aren’t over the counter, but oral medications like antibiotics, that can take two to three months to fully work. You want to devote your time to it.
With topical treatments and retinols or retinoids, you might experience a skin “purge,” a flushing through your system that might make it a little worse before it gets better. Not everybody experiences that, but for some people with moderate acne or inflammatory pimples, retinoids speed up the acne cycle. It can increase the efficiency of cell turnover, which in turn can make any active bumps, blackheads, or whiteheads come to the surface. If that happens, keep with it. Don’t give up.
Q: What’s the best way to cover up a blemish for photos?
Acne can be hard to completely disguise with just makeup, but Dermablend has a really good opaque concealer called Cover Care that comes in a lot of shades, so you can find one that matches your skin tone. If you have a really big, red acne bump that you're trying your best to cover up, consider putting a very thin hydrocolloid or bandage over it and then topping it with makeup. Or angle your chin to the side to block it from the camera. That’s what I would do.
Q: Is there ever a “safe” way to pop a pimple at home?
I don’t like to encourage people to pop them at home because you run the risk of infection or bleeding that persists, or even scarring, which is the worst potential thing that can happen. But I do realize there comes a point where you can’t ignore it and you have to do something because you can’t go anywhere with this thing on your face. I get that.
The most important thing is to do it at the right time in the lifespan of the pimple, ideally when the pus is most superficial on the skin. It’s that pustule you can visibly see, the one that’s ready to pop. The earlier you try to pop a pimple — when you feel it deep under the skin but can’t really see it yet — it’s just going to make things worse. That’s because the deeper you traumatize your skin, the more risk you have of scarring.
How you do it is up to personal preference. Some people use their fingers, others use extraction tools. If you don’t have an instrument, I tell my patients to take some clean Kleenex and wrap them around your two pointer fingers, then gently push the pimple.
Q: What’s the first thing I should do when I feel a breakout coming on?
If you want to hurry up the lifespan of a pimple, apply a warm compress to the spot. That will increase the blood flow to the area and bring it to a head. Conceivably, the immune system cells will go to the area and help push the bacteria and inflammation out of the skin. Otherwise, try to leave it alone as much as you can.
If you feel a big zit under the skin before a big event — like your wedding or prom — that's the ideal time to come see me, a dermatologist. I’ll inject the area with a cortisone shot and it usually goes away within 24 hours. It’s a steroid, so, again, it’s another form of decreasing inflammation locally in that area and calming it down, so that can make it go away.
Q: How can I treat my stubborn post-acne hyperpigmentation and scarring?
Sunscreen is the most important, because if you're out in the sun, those marks or scars will darken relative to regular areas of your skin, so it's going to persist for longer. Then target the areas with hydroxy acids — whether it's glycolic or salicylic acid — to help encourage the superficial layers of the skin to peel off more efficiently, and the dark spots will lighten quicker.
Acne Hacks: What to Do and What to Skip
Going out in the sun: It depends
Yes, it’s true that if you have bad acne on your back and lay out in the sun, it might clear up your skin. The sun is a mild anti-inflammatory, which means it can help a few dermatological conditions like eczema, psoriasis, and acne. But you have to weigh the risks versus the benefits. It ups your chances for skin cancer. You could also get a bad burn, or 20 years down the line you’ve got all these brown spots and wrinkles. Ultimately, there are better ways to treat acne that don’t come with these other risks.
There's not much merit to the toothpaste-on-pimples myth. I think what that came from is that when toothpaste is exposed to air, it dries up and cracks. A lot of times, there's also a little menthol or mint, so it feels like it's evaporative, so it feels like it's sucking up some of the oil. And also, the fact that you have toothpaste there on an area of your face, you're less likely to pick at it. But other than that, I mean, I would much prefer a person use benzoyl peroxide or salicylic acid, acne spot treatment versus toothpaste. And I don't think that toothpaste specifically has any properties in it that are going to improve your acne.
Hydrocolloid bandages: Do
This hack works, but you can't use any Band-Aid; you need one with a hydrocolloid dressing. That’s what is typically used for blister bandages. It contains a gel-like gelatin to trap moisture, and can help draw out excess oil and pus.