I know everyone knows it: the pimple. Everyone had one. But unfortunately if they are unstoppable it become a nightmare. You feel uncomfortable and you might be even afraid to leave the house without make-up. Now we talk about acne. Acne is a disease, so it is treatable. But not with internet homemade things, but with science. I am Dr Liv Kraemer and a dermatologist with my clinic in Zurich/Switzerland. My focus is skincare and skinfood. A lot of my patients are asking me how to get rid of acne. On my YouTube channel people also like to ask me different questions about how to treat acne, how to prevent acne and what do to against acne scars. Let me answer some questions for you here on my webpage: What is acne? What triggers acne?Is acne contagious? How to prevent and treat acne at home? What can you do to minimize breakouts? Which food can you eat and which food you should avoid? Sometimes, unfortunately, my patients are visiting me too late, and scars have already developed.
Table of Contents
What is acne?
A lot of people in different ages are suffering from acne. Even stars are suffering from acne. So you are not alone. The clinical picture of acne includes papules, nodules, blackheads, whiteheads and last but not least the residue: the acne scars.
Men are more likely to suffer from acne during puberty and have more extreme and severe cases of acne than women do. Women are more likely to suffer from acne in adulthood. More specifically, the rates of acne increase for women from ages 20-40 and changes are noted in the menstrual period. In fact, 1/20 of adult women have acne, while just 1/100 of adult men do.
Just think: estimated over 80% of people experiencing acne in some point of their life.
Acne does not appear just because you overate chocolate or too many french fries. It also does not happen overnight. It happens because a couple of incidences took place. I always tell my patients they have to compare it with a Swiss Watch. Many wheels have to move before the big hand is moving. 🙂 ⚙️
Another part is the genetic factor, unfortunately. Acne most commonly appears on your face, but also on neck, chest, back and unfortunately even on your shoulders. I know, acne can be distressing and annoyingly persistent.
I have a lot of different patients in any age. The patient’s age is ranging from 15, with a peak around their late 20’s and even up to their mid-30’s and 40’s. Acne in the 40’s is the so-called “late-onset acne”. But please, don’t be afraid. Don’t give up! There are solutions!
How does acne look like?
There are different forms of acne. Also remember just because you have once in a while a pimple, some blackheads around your nose or some breakouts you do NOT have necessary acne.
So what are we dermatologists looking for if we examine your face? We look for something like blackheads, called comedones. As we have to differentiate towards rosacea. We ask you about your stress level, about your hormones, about your menstruation cycles, -if you are a women, we also like to check your hormones or sent you to a gynecologist first. We ask also about your diet, your fitness and of course your skincare regime. Why? Because there are different reasons of acne and so many things which can also make acne worse.
- pustules (you call it pimples)
All these blemishes are associated with the medical term acne. There are really severe acne where people get even fever and less severe acne with just some blackheads and nodules around the nose and cheeks.
How the acne types look like?
These little tiny white pumps on top of our skin. These little pus and dead skin cells filled papules look a little bit like the Toblerone chocolate mountain. The mountain with a white snow top. Ok lets stop kidding. But indeed these areas around a hair shaft or hair follicle (we call it pores) are sticked with dead skin cells, sebum and bacteria. The whiteheads can vary in sizes. Sometimes there are so small that you almost can not see them. But they can grow intensively. Before they are turning into whiteheads they start as blackheads, but they are closed with skin cells on top. Therefore we call it closed comedon.
A blackhead also called open comedon. It is a hair-shaft or hair follicles (pores) filled with bacteria, dead skin cells and sebum. It is like a white head, but it is “open”. Thus not closed by skin cells. Through the trapped oil is oxidized and therefore causing the black color. Technical it is not acne. It can stand alone but is seen in acne and not in rosacea. We mostly see the blackheads around the nose. If sebum production is increasing -because of hormonal changes occur- we can also see them all around the face, neck, shoulders, decollate and chest. Do not touch them. As soon as the get inflammed they will turn into whiteheads or even pustules.
Papules (regular pimples)
Tender small red bumps raised form your skin. You would call it a breakout or a pimple. In terms of acne these papules -which can be seen in other skin diseases as well- are slightly inflammed. The papules are much more painful than whiteheads or blackheads, but less than pustules or cysts. They are soft and filled with fluids or excess oil. The papules are most common type of pimples. Most of you think of them as acne or discribed them as “zits”
Pustules are a kind of large pimples. They occur when papules worsen. They get filled with even more fluid and excess oil. The skin tries to deal with the problem alone. Most people have a mixture of pimples and pustules. We dermatologist call these kind of acne: acne papulo-pustulosa. It is not easy to deal with them. In particular if you have a lot of them. So over the counter products will not be sufficient. And remember! You want to treat them properly in order to avoid scarring.
Big solid lumps mostly painful in the depth of your skin. You see them mostly in more severe type of acne. They are very deep and mostly very painful.
Acne cysts are in the depth of your skin. They never actually come to a poppable stage. Cystic acne is the severe form of inflamed acne. We dermatologist call it acne conglobata. Do not wait and do not manipulate! Do not try to wait them out! Visit us dermatologists. It is a medical condition which has to be treated correctly in order to avoid scarring. Anyhow, acne cysts look like boils on your skin. They are characterized by being red, inflamed, large pus filled and mostly tender and painful. They could be very small but grow up intensively. If you do not know if you have cystic acne or nodular acne: it doesn’t matter: visit a dermatologist and get your right treatment! Because nothing is worse than the development of scars.
Where acne appears?
All acne blemishes can appear on:
- upper arms and buttocks
Why does acne appear?
Unfortunately, nobody knows that exactly. It’s just like a Swiss watch. There’re a lot of different wheels moving before the big hand is moving. It’s called a “multifactional” reason. So there’re many reasons which can cause in a combination acne or even make acne worse. One reason for sure is an overgrow of certain bacteria which we call acne bacteria propriones. Hormone imbalances, enhanced horn formation (hyperkeratosis) and the wrong skincare are possible reasons. Which „wheel“ is like responsible for the outbreak is not clear.
What are the clinical names of acne?
There are different types of acne:
- Light acne (acne comedonica): Just light acne, more of the blackheads, no deed inflammations or nodules. If you do not pick, this kind of acne heal without acne scars.
- Middle light acne (acne papulopustulosa): You find also blackheads but also whiteheads and papules with pus. Try not to pick, visit a dermatologist to get the right treatment in order to avoid scars
- Heavy acne (acne conglobata): A lot of bumps, heavy inflammation with papules, nodules and cysts. Without treatment by a dermatologist this acne will not heal by itself without scarring.
What other kind of acne forms exist?
Acne inversa is also called hidradenitis suppurative. This type of acne is in a different place. Instead of being on the face or back, it is on the armpits and even in the genital area. Acne inversa is not easy to treat. It is most of the time a severe disease. So please watch out for a dermatologist who has a lot In the end, it does not matter what type of acne you suffer from. The most important thing is to avoid acne scars! For this you need to treat your acne early enough. Do not follow wrong advice and instructions, go to a dermatologist for a proper examination.
Who suffers from acne?
Many people from different age groups suffer from acne. It used to be called “fin rash”. Acne existed even in ancient times and was very common there. Maybe you should take a look at old paintings. For example, strong acne scars are visible on some faces. Even stars and starlets suffer from acne. Do not despair: you are not alone. But the clinical picture of acne can be very different: it contains the medically called papules, nodules, blackheads, whiteheads. Unfortunately, the acne scars are the last to remain. This must be avoided at all.
Do men or women more often suffer from acne?
Men are more likely to get acne at puberty. They usually suffer from more extreme and severe cases of acne than women. Women, on the other hand, are more likely to suffer from acne in adulthood. More specifically, the acne rate increases in women between the ages of 20 and 40 and changes during the menstrual cycle. A fact is that 1/20 of adult women have acne. While only 1/100 of adult men are affected. Think about it: it is estimated that over 80% of people experience acne at some point in their lives.
What worsens acne breakouts?
Unfortunately, everything can worsen your acne. Your hormone cycle, what you eat, your wrong beauty skincare routine, a wrong treatment or even no treatment. Even certain food can worsen your acne. That’s the reason why you should visit a dermatologist. Acne is a skin disease and has to be treated medically and medicine cosmetically.
What are comedones?
Blackheads or comedones come from the Latin word “comedo”. It means “to eat”, “to consume”, “to eat with”. A distinction is made between open and closed comedones. We call comedones primary efflorescence. What does that mean? We dermatologists differentiate between what comes first and what follows.
What is a closed comedon?
In so-called closed comedones, the exit from the hair follicle is closed. We call these small cysts filled with sebum (sebum) and keratin (skin cells). We see them as small raised skin-coloured nodules that may shine through whitish or yellowish.
What are open comedones?
In open comedones, the channel of the hair follicle is closed due to strong keratinization with sebum. The content oxidizes due to the oxygen and the black colour is formed. Blackheads alone are not necessarily acne. You can also have comedones without immediately suffering from acne. So comedones can appear alone. But we see comedones in acne and not in rosacea.
Where do comedones appear?
We usually see blackheads around the nose when sebum production increases. Because of hormonal changes, we can also see them on the face, neck, shoulders, décolleté and breast. Do not touch them. As soon as they are touched, they turn into inflammatory little pimples or even pustules.
What causes acne?
Myths about acne are as common as acne itself. As I said before, there are many reasons why acne develops. It’s like a Swiss watch. Several wheels turn until the big hand turns. Cornification disorder, too much talc production, and overpopulation of bacteria. We call these propioni bacterium or acne bacteria propionis. Of course, an increase in the level of androgens (hormones) plays an important part in the production of the sebaceous glands. This leads to a high production of sebum, which can break down the cell walls in the pores. Emotional stress and other hormonal changes can also have a major impact on your skin. It is therefore important to reduce bacterial growth, counteract cornification disorders and reduce sebum production. It starts with the right skin care routine. This includes how to wash your face properly (see my other video “How to wash your face” etc.)
Is acne caused by bacteria? Is acne contagious?
Of course the answer is a double NO. We all have millions of bacteria and fungi on our skin. Of course the balance between skin and bacteria can be destroyed. Only when this happens is there a higher chance of getting skin problems. One of them is the skin disease acne. So please keep in mind: acne is not contagious! The propionibacterium does not spread like a contagious disease. You can not get acne if you are out with your friends who have acne. Acne in this case is not contagious. But tell your friends that there is a solution for acne. Send them to a dermatologist. If acne is not treated early, acne scars will remain for the rest of your life.
Acne bacteria propionis
How can you prevent acne yourself, from home?
First, I beg you: Do not treat acne yourself! Seek help from a dermatologist. Please visit a dermatological clinic. Preventing acne is the key to avoiding acne scars. But if you get acne, try to avoid scars as soon as you can. There are many products and treatments that can help you to prevent an outbreak. Your daily behavior is important too. My patients have typical behaviors, like constantly touching their face and asking why they get acne on their chin.
What you should do:
- Wash your face twice a day (morning and evening)
- Wash it with lukewarm water and try to avoid too hot water.
- Use a medium towel for your face, only for your face! Wash the towel at 60° Celsius or higher, you can get rid of all bacteria.
- Do not use greasy cosmetics or dirty beauty products.
- Wash your face, but not too often. Two times a day is good, just don’t overdo it.
- Do not change your skin care products or medical products all the time. Give the products time to take effect. 6 to 8 weeks is normal. Compare it to your fitness exercises. You won’t see any results under this time period.
- Be consistent.
- Nothing is worse than scarring, treat it early.
What you should avoid with pimples:
- Please do not touch your face.
- Do not squeeze out your pimples. Why? Because acne scars do not look good!
- Don’t scratch.
- Do not use herbs or tips from unprofessional people on the internet.
- Avoid dairy products and foods with a high glycemic index.
How to wash your face properly
Do mechanical peelings help against acne?
No, they don’t! Please do not damage your sensitive skin. Most people tend to rub too hard and end up with dry skin (this is why your skin produces more oil and you get acne breakouts or inflamed pimples). There are also many bad body scrubs with perfume or with essential oils. Avoid skin care cosmetics or lotions with essential oils or perfumes. They irritate your skin or even help with scarring. Watch my Video how to wash your face right.
What is acne toilet?
Sounds very disgusting, I know. But yes, it means exactly what you think it does. The skin gets “cleaned”. Another word is deep facial with extractions. In this case a professional beauty therapist cleans your face and uses steam and extraction tools.
Nutrition and acne
Is there a diet against or to prevent acne?
Many of my patients ask me how to prevent acne and pimples. Unfortunately, there is not much good medical research in this area. But studies show the same results.(1) So in general:
- Try to avoid milk proteins. If you use protein powders for your physical training, read the food labels. Most protein and sports shakes and powders contain lots of milk proteins. Use protein products with alternatives to milk proteins. I suggest hemp proteins. Be careful with soy proteins, as it acts as a phytohormone in high doses and can affect your hormone levels.
- Be careful with too many extra vitamin B products and look for labels when you take protein powders, bars or sports shakes. Vitamin B in healthy foods like avocados or nuts is not the problem. But the extra high doses in energy shots, protein bars or powders need to be carefully monitored.
- Avoid convenience food, it contains a lot of sugar! Take your time and cook your own meal or eat a fresh salad with a healthy oil like pumpkin seed oil.
- Finally, try to reduce your sweets, really! I know, in the office, at school or at the store: cookies or candy everywhere. But try to avoid too much sugar in general. In particular, try to minimize the intake of sugary drinks, energy drinks, chips and sweets. Products with a high glycemic index show in some studies that they have a harmful effect on your body. This also applies to your skin, especially and your acne. Watch my Youtube video on ” Eating and acne”.
Acne skin – which foods can help?
The consumption of the right food can work a miracle against winter acne. For example, try foods with a high zinc content. Meat, spinach and porridge are delicious and give your skin what it needs.
Vitamin C is also important. Why vitamin C? Because vitamin C does not only act as a great antioxidant, but is also helpful for collagen production.
Foods rich in selenium can help protect the skin against oxidative stress. Nuts and fish are high in selenium and are delicious tools for a healthy diet – try it!
Acne and milk proteins
According to new studies as established by the AAD (American Academy of Dermatology), there is a connection between milk and acne. In another medical journal, the Journal of American Acadademy of Dermatology shows that the risk of acne increases with the consumption of dairy products, but more with skimmed milk than with yoghurt or cheese in general. Therefore, further scientific research is still needed.
Acne and nutrition
There are even small studies on antioxidants like zinc, probiotics or fish oil for acne, but the evidence is not strong enough that the AAD (American Academy of Dermatology) can make recommendations regarding these nutritional factors and acne.
Acne and food and sugar- an overview
A researcher from the University of Sydney published an excellent paper in the American Journal of Clinical Nutrition on high and low-glycemic foods. If you want to learn more about the glycemic index, click here to read the medical article.
Acne at 20, acne at 30 or even at 40?
It is not abnormal to get acne after teenage age. You can also get acne later. Even if you have never suffered from acne before.
What is late onset acne?
So acne after 20 is also called adult acne, late acne or late onset acne. I see many patients every day who tell me that they still or only now in their late 30s or even 40s suffer from acne. There is a research that shows that more and more women are suffering from acne, especially in their adult life.
As I said before, men suffer from acne more often in their teens, while women suffer from pimples, comedones and bumps much later. Read my interview about adult acne i.
What is the difference between teenage acne and adult acne at 20, 30 or 40?
The place, the place and again the place. Teenage acne is mainly on the forehead and cheeks. Adult acne is mostly located on the chin and neck. However, it can also be triggered by a change or sudden discontinuation of the contraceptive pill or by the hormone coils.
What can you do with adult acne? What could help me?
The treatment for acne in adolescence or in adulthood is always the same. (See below in the article). But it is best to find a dermatologist as soon as possible and treat it before it is too late: before you get scars.
What causes winter acne?
The frequent change between the cold outside air and the warmed inside air makes your skin barrier more sensitive. Your skin is irritated.
Skin barrier problems during the winter season
Due to the barrier problems just described, bacteria can now also go through the skin barrier much easier.
So if you wear scarves, this is the perfect “party place” for bacteria. Cross your heart! How often does your scarf or cap fall down? Are you sure that you only touch your scarf or bobble hat with clean hands? And how often do you really wash your scarf or cap? Uh-huh. Right.
So what happens is this: First, the fabric irritates your weak skin barrier system even more. Secondly, any bacteria cultivated on it can now penetrate your skin much more easily. Suddenly you get red and itchy skin around your neck, cleavage or forehead. Exactly where your scarf and hat touch your skin all the time. You even rub the bacteria inside when you snuggle up in your scarf.
Sometimes my patients even suffer from more pimples on their décolleté or back. In winter you should only wear cotton shirts. Under synthetic fabrics your skin tends to sweat a lot more. With your dead skin cells and the heat that creates a nice environment for the growth of your bacteria, the possibility of getting pimples increases even more in synthetic garments. But there are more things you can do to prevent this!
What are the reasons for dry skin in winter?
What is dry skin? You can compare the top layer of your skin to a cobblestone wall. This surface of this cobblestone wall is usually well sealed at the top. Furthermore, the mortar between the bricks is well sealed. Nothing can get through the brick wall. This is exactly how it works with your skin.
Your skin is usually – as said – well sealed. But in winter the sealed surface can become brittle. Especially if the low humidity in the winder weakens the skin barrier system even further. This makes the “mortar” between the skin cells brittle. Water can escape. Your skin starts to become itchy and dry.
The frequent change between the cold outside temperatures and the heaters inside makes your skin barrier more sensitive. Your skin is irritated: on the one hand, the cold outside tells it to produce more sebum. On the other hand, if you then go into a heated room, the command for the sebaceous glands is: “Reduce production immediately!” The skin is literally “irritated” – it does not know exactly what environment it should adapt to.
What can you do to avoid acne in winter?
So: How can you treat winter acne? And the most important thing: How can you prevent winter acne?
To avoid skin problems during the winter, you have to pay special attention to the following…you probably know it: Your clothes. With acne, clothing is crucial, especially in winter. This scarf and hat only need this extra treatment to protect your skin.
You know the latest trend is big scarves, big, bigger, gigantic… as New York Fashionweek showed us. Vogue Magazine and friday magazine now present these new trends. But be careful with scarves around your neck and face while you suffer from acne.
First of all:
- Wear a scarf made of 100% natural cotton. It irritates your sensitive skin less and you can wash it at 60° Celsius. (You can not wash cashmere scarves – dry-clean only).
- If you also suffer from pimples and irritations on your back or décolleté, try to wear only cotton shirts.
- Then you have to make sure that your scarf does not touch your skin. Sounds difficult, I know. But just try to give it some air and wrap it loosely around your neck.
- Then wash or clean your scarf regularly to get rid of bacteria.
- Also try not to touch your face with dirty hands. This can be very difficult because we usually do it unconsciously. Avoid too much touching your face with your hands.
- And of course you should wash your hands regularly.
- Do not use too greasy creams if you suffer from pimples. This only does more harm than good.
Which brings us to the next question…
Winter skin care: Which creams should be used?
If you suffer from acne, your “base” cream must be very light anyway. Because creams that are too oily only seal your skin from above. This allows bacteria to multiply under this beautiful “cream tent” and more pimples can develop.
Always use a sun cream, because the sun is always shining. You don’t want to damage your skin even more, as you already do anyway. If you need vitamin D, put your elbow in the sun for five minutes. Why should you expose your face to the sun and risk causing wrinkles, pigmentation or redness?
Dry skin and acne: ideal food for ideal skin
Great, healthy food is always an asset. And yes, it can also do wonders for your skin! Does your daily diet already support skin health? Here’s what you should try to eat regularly to help your skin look good again.
Dry skin- which foods help the skin?
Fish! Omega-3 fatty acids help you with dry skin and protect your skin’s barrier function – and they’re good for your health in other ways too. For the vegans among you: Microalgae also act as an omega-3 supplier and are excellent for supporting your skin barrier system.
Nuts are high in Q10, which also helps to improve the condition of your skin. Other great nutritional ingredients to improve your skin and make it less dry and vulnerable to damage are flaxseed oil and gamma linolenic acid. Flaxseed oil is rich in good unsaturated fat. Gamma-linolenic acid is contained in borage oil (20%), evening primrose oil (10%) or hemp oil (3%).
You can also take a look at what else you should avoid if you have dry skin. Read my blog about atopic dermatitis.
Stop acne, stop your stress!
For most people the winter season is a difficult time. That’s why you feel tired. Even the darkness of this time of year makes you feel tired. You can’t even enjoy your walk in the fresh air because of the cold. But it is important to go outside. Enjoy a walk in the park or a short excursion in the mountains. A healthy circulation keeps your body young and vital.
You might ask yourself this: Didn’t she just say that temperature fluctuations are bad for my skin? So I shouldn’t stay indoors all the time? No, it’s not that easy and your skin is no excuse to be lazy! The bloodstream carries waste products and free radicals from the work cells. So: You will notice an improvement in your skin condition when you breathe fresh air in winter!
But of course you should follow my advice to protect your skin. And don’t forget to use sunscreen! Use it every day! Remember: Never without sunscreen if you want to avoid wrinkles, redness and pigmentation!
Watch my video tutorial on how to apply sunscreen correctly. Click here to see it.
Important winter acne advice to share with your friends
Just to wrap it up quickly, here is my advice against winter acne in a nutshell – share it with your friends!
- Cotton is the best way to prevent winter acne – wear a scarf and other clothing made from 100% natural cotton.
- Try not to touch your skin with your scarf and dirty hands.
- Wash your scarf and cap regularly.
- Do not use too greasy creams while you suffer from pimples and winter acne.
- Choose foods carefully to fight pimples and dry skin – try fish, meat, nuts, spinach…
- Avoid stress!
Which acne treatments are available?
The best option is to contact one of us dermatologists to treat acne. There are several ways to treat acne. Do not wait too long. There are local medications, but also from the inside. Don’t be afraid. With proper guidance from your dermatologist you can safely treat acne. But please remember that it takes time to heal the damaged skin. Please start the treatment as soon as possible. Because you want to get rid of your pimples and not get scars. Because acne scars are not easy to treat, if at all.
Why treat acne at all?
Always remember: Your skin can become pimple-free again if you follow the instructions of your dermatologist! You need to understand the variety of acne causes and therefore treat them. For example, there are over-the-counter products available that you can use yourself. But in the gym, you have a trainer who shows you the exercises first so that you don’t make any mistakes. It’s similar with us doctors: we show you what exactly you need to do and which ingredients are best for you. So please visit a dermatologist in your area who can help you. Because we dermatologists can also prescribe products that have a stronger effect and are therefore only available on prescription. If necessary, we dermatologists can also prescribe tablets so that you can wake up without pimples.
What works against acne?
- Benzoyl peroxide reduces the P. acne bacteria.
- Antibiotics reduce the number of Proprioni acne bacteria.
- Salicylic acid, or BHA, reduces inflammation and minimizes increased cornification
- Fruit acid like the AHA (glycolic acid, lactic acid) removes the excess dead cells and makes the skin more even (Try the great fruit acid wash foam from Dr Liv)
- Vitamin A retinoids, such as adapalene gel, increase cell production, reduce cornification and sebum production. These can be prescribed as a cream or tablets.
How can you get acne scars?
Scars are the result of untreated acne. It’s a destruction of your skin layers. Our body wants to make sure that nothing could enter our body, therefore it build up the upper layer of the skin. We call epidermis. It is like a couple stone wall. Like the chinese wall. The wall was build as a defence so as your outer skin layer. If there is a disruption by huge inflammation, our skin builds up a kind of kit substance – aspecial kind of collagen without hair and without sebaceous glands. Most of my patients or youtuber think that the small red dark point which appears after a pimple is a scar. Noooo. These dark spots are –so called post inflammatory hyperpigmentatons – they go away with the right products and an UV protection. But scars are retractions or bulges we call them e.g. icepoick scars. The scars are usually white and can be seen well against the light as indentations. Please don’t wait too long with your right treatment. Just visit a dermatologist to get the right treatment to avoid long lasting scars. Always thik: prevention is better than repair.
What helps against acne scars?
Please let your acne be treated. Why? because acne scars will never disappear. Acne scars can not totally be removed. Don’t scream. Of course there are possibilities to make them appear less visible. There’re treatments like fruitacid products, fruitacid serum, fruitacid cremes and fruitacid peelings. Also retinol cremes increase the cell turnover, hence let scars appear less visible and less drastic. Therefore, everything what makes the skin look more even, makes your scars look less severe too. Compare it to a mountain region. If you remove the hills, the valleys (our scars) wouldn’t be as deep visible. Furthermore, there are treatments that aim to produce new collagen to replace the scar tissue. These include medical cosmetic treatments such as microneedling, microneedling radiofrequency and fractional lasers.
If you want to learn more about the right skin care treatments to improve your skin health and appearance: how to treat or prevent acne, make an appointment for a detailed consultation with Dr Liv Kraemer. Click here to make an appointment with Dr Liv Kraemer.