When your acid mantle is damaged, you’re actually more susceptible to breakouts, enlarged pores, and inflammation. To make matters worse, evaporating all the oil on your face can actually set your sebaceous glands into overdrive, leaving your skin oilier than ever. If any product included a simple alcohol high up in its ingredients list, we nixed its whole kit.
Prescription medications: Doctors can prescribe medications when acne becomes moderate to severe or is not controlled by over-the-counter medications. Prescription drugs can be used effectively alone or in combination with other prescription and nonprescription medications.
If you notice that you’re breaking out right around your period every month, your acne might be linked to hormones. “A sensitivity to the hormones called androgens manifests in the form of cystic acne,” says Linkner. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Birth control, which has estrogen and progestin, helps keep hormones balanced and skin clear. Ortho Tri-Cyclen, Estrostep, and YAZ are all FDA-approved as acne treatments.
Treatment: “Menopausal acne is very different from what you may have experienced as a teen,” Dr. Fusco says. Back then, your zits were probably accompanied by excess oil and shine, whereas mature skin tends to be dry with or without pimples.
The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle. In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle. However, increased production of oily sebum in those with acne causes the dead skin cells to stick together. The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone. This is further exacerbated by the biofilm created by P. acnes within the hair follicle. If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo). In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).
Systemic antibiotics are a mainstay in the treatment of moderate-to-severe inflammatory acne vulgaris.  These agents have anti-inflammatory properties, and they are effective against C acnes (formerly P acnes). The tetracycline group of antibiotics is commonly prescribed for acne. The more lipophilic antibiotics, such as doxycycline and minocycline, are generally more effective than tetracycline. 
As if that wasn’t enough bad news, Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, says the number of woman who will experience acne at some point during adulthood is rising. “It is unclear exactly why this is happening, however it may be due to a combination of stress, dietary factors and changing hormones,” he said.
The acidic property of apple cider vinegar helps lighten pigmentation in the skin, thus reducing the appearance of acne scars. It also stimulates collagen production, repairs cells and removes dead skin cells.
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Globally, acne affects approximately 650 million people, or about 9.4% of the population, as of 2010. It affects nearly 90% of people in Western societies during their teenage years, but can occur before adolescence and may persist into adulthood. While acne that first develops between the ages of 21 and 25 uncommon, it affects 54% of women and 40% of men older than 25 years of age, and has a lifetime prevalence of 85%. About 20% of those affected have moderate or severe cases. It is slightly more common in females than males (9.8% versus 9.0%). In those over 40 years old, 1% of males and 5% of females still have problems.
Modern medicine considers mild to moderate acne an acceptable feature of growing up. If you go to your doctor for help with whiteheads, blackheads, or pimples, chances are you’ll be given a prescription for an antibiotic or benzoyl peroxide, or both, and sent on your way. If you have especially deep skin infection causing nodules or cysts, you may be put on Retin-A or Accutane, and if you have the more aggressive forms of acne that cause pimples to grow together all over the top half of the body (acne conglobata) or the kind of acne that results from the immune system’s attack on an ingrown hair (acne keloidalis nuchae), you will probably get a referral to a dermatologist for laser therapy or surgical reconstruction procedures.