Your Most Pressing Acne
You’ve heard it before, probably way back in elementary school: “If you have a question, someone else probably has the same one.” So, it’s always worth asking. To that end, we gathered all the acne and skincare questions to ask a dermatologist about acne that you’ve always wanted to bring up, but maybe never did. Here, James Del Rosso, D.O., adjunct clinical professor of dermatology at Touro University Nevada in Henderson, NV and an Acne Store advisory board member, addresses those queries—from pimple-picking to sunscreen-skimping.
Q: What happens when you pick a pimple?
Picking and squeezing is not a good thing—you can do more harm than good. By squeezing a pimple, you can worsen the inflammation deep under the skin, increase irritation, and possibly introduce infection. You can also increase the potential for scarring. Even your blackheads go too deep into the skin for your fingers to reach. A lot of people want to excavate them out with their fingernails—that’s not a good idea. You're going to get scars and marks. This is one of the most common acne questions around and we have a clear answer: Picking a pimple can cause more problems than it will solve.
Q: But what if I use one of those extractor tools?
You may have had extractions done with a special tool during a facial or a dermatology appointment, and so you’re wondering why you can’t do the same at home. Professionals know how to remove whiteheads and blackheads, carefully, without damage. Typically, the skin has been prepped so that those lesions are softened and are easier to extract. Maybe it’s been pre-treated with a medication. A lot of estheticians will use steam to create a softening effect. It’s not ideal to attempt yourself.
First off, our skin naturally exfoliates. As you’re reading this, your skin is exfoliating.
Q: What’s the deal with exfoliation—do I need to do it if I have acne?
First off, our skin naturally exfoliates. As you’re reading this, your skin is exfoliating. The top layer of skin, or the epidermis, is constantly turning over. There are certain enzymes and proteins within the skin that allow it to exfoliate individual cells one by one, all while maintaining a proper moisture level—you’re just not seeing this process happen. When your skin doesn’t have the right amount of moisture or your cells aren’t functioning properly, those dead skin cells don’t slough off fast enough and instead pile up on skin’s surface. That’s when you might start to see scaling or flaking—and this is what happens with acne. When you get a whitehead or blackhead, you’re seeing a buildup in the pore of what should’ve been exfoliated.
When you have acne, the goal is to get you skin to naturally exfoliate again. We want those plugs within the pore to stop forming. So, we turn to treatments designed to get the skin to go back to normal. As a dermatologist, I often increase cell turnover with a good topical retinoid. Other times, we may use a product that contains alpha or beta hydroxy acids such as glycolic or salicylic acids, but it has to be done at a level that the person can tolerate. Exfoliation needs to be done properly for the skin type you have. If you overdo it, your skin will get very, very irritated.
Q: If I’m already using a topical retinoid, do I need to do additional exfoliating?
Probably not. The retinoid is already promoting some of that natural exfoliation, so you don’t need a separate scrub or peel. Again, that can compound skin irritation and cause redness, dryness, and scaling. Now, if you’re not using a retinoid, you could use a separate exfoliating treatment, but how often you do so depends on the tolerance of your skin and any other acne medications you may be using. I have some patients who exfoliate once a week, others can only handle it every other week. It’s better to start slow and build up than to jump in with both feet and irritate your skin.
Q: Is that also true of using a harsh cleanser?
Similar to over-exfoliating, cleansing with the wrong product creates irritation. It causes water loss, and then the skin can’t function properly. Ideally, you want to stick to a gentle, basic cleanser. You’re going to rinse it off pretty quickly, so you don’t necessarily need your cleanser to contain a lot of active ingredients. There are some exceptions, like medicated washes for acne, but, in general, I'm looking for the cleanser to remove dirt, oil, and other things on the skin and prep skin for your active treatments without removing too much moisture. So, look for cleansers with fewer ingredients or that are clearly labeled as gentle or mild.
Q: What happens when you don’t use sunscreen?
This is another question dermatologists are asked often. Your skin has a little adding machine inside, tallying up all the unprotected UV exposure you get. Over time, it adds up to damage—sunburn, dilated blood vessels, fine lines, pigmentation, skin sagging, and, of course, skin cancer. The goal of sunscreen is to lessen that cumulative exposure and damage.
And tou don't have to be a sun worshiper to get damage—you just need to be outside and exposed. Even if you’re under an umbrella or an awning, you’re still getting reflected rays if you’re not wearing sun protection. Obviously, there’s a big difference between going outside and playing a game of golf on a very sunny day and hopping in and out of your car, but there is still an effect over time from all those unprotected moments, not matter how brief.
Q: Can sun exposure make acne worse?
Yes, which is why it’s important to use sunscreen regularly, even when you’re breaking out. If you get enough damage to what's called the matrix of the skin—the middle layer—that could make the skin more prone to develop blackheads. That usually occurs over a more prolonged period of time. Also, if you’re sunburned, your skin isn’t going to tolerate your treatment products, so it sabotages your efforts to keep your skin clear.
Q: Is it really that bad to sleep in your makeup?
On a level of one to ten, with ten being the worst, it’s about a three. Just clean it off the next morning and don’t beat yourself up. Sleeping in your makeup doesn’t cause any particular damage that I’m aware of and I’m fairly certain one or two times won’t worsen your acne. Maybe if you snoozed in your makeup on a nightly basis it could have an effect, but if it happens on occasion, it’s not the end of the world. Just try to wash it off as soon as you can.
James Del Rosso, D.O.
Dr. Jim Del Rosso is an internationally renowned dermatologist who has been practicing dermatology since 1986 and a member of the Acne Store Board of Dermatologists. He is Clinical Editor-in-Chief of the Journal of Clinical and Aesthetic Dermatology, has published multiple peer-reviewed articles and textbook chapters, and was President of the American Acne & Rosacea Society, American Society of Mohs Surgery, and the American Osteopathic College of Dermatology. He is Adjunct Clinical Professor of Dermatology at the Touro University Nevada in Henderson, Nevada. Currently, Dr. Del Rosso is Research Director of JDR Dermatology Research and practices at Thomas Dermatology in Las Vegas, Nevada and also serves as Senior Vice President of Clinical Research and Strategic Development at Advanced Dermatology and Cosmetic Surgery in Maitland, Florida. He served as Head of the Section of Dermatology at the Ohio University College of Osteopathic Medicine after receiving his D.O. degree from the same medical school in Athens, Ohio, interning at Doctors Hospital in Columbus, completing a dermatology residency at Atlantic Skin Disease and Skin Surgery in Fort Lauderdale, Florida, and completing a fellowship in Mohs micrographic surgery and cutaneous oncology at OSU.
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