Ultimate anti acne guide by dermdoc Dr Liv

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 content

  • What is acne
  • How acne looks like?
  • Acne types
  • location of acne

Read my tips about acne, pimples, breakouts and what to do and what to avoid.

What is acne?

A lot of people of 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, black heads, white heads 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. Womenare 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 acne looks 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 we dermatologists are 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.

  • whiteheads
  • pustules (you call it pimples)
  • nodules
  • cysts
  • blackheads
  • papules

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.


What are blackheads?

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.

What are 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 painfulthan 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

What a pustules?

Pustules are 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.

What are nodules?

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.

What are cysts?

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 looks 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:

  • chest
  • neck
  • face
  • back
  • shoulders
  • upper arms and  buttocks

What are the clinical names of acne?

Light acne (acne comedonica)

just light acne, more of the black heads, no deed inflammations or nodules. If you do not pick this kind of acne heal without acne scars.

There are different types of acne:

  1. Light acne (acne comedonica)
    • just light acne, more of the black heads, no deed inflammations or nodules. If you do not pick this kind of acne heal without acne scars.
  2. Middle light acne (acne papulopustulosa)
    • you find also black heads but also white heads and papules with pus. Try not to pick, visit a dermatologist to get the right treatment in order to avoid scars
  3. 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
    • acne inversa also called hidradenitis suppurative. This kind of acne is located an inverse therefore different location. So instead of face and back, acne inverse is located under the armpits, in the

In the end it doesn’t matter what the acne is called as you are suffering from it. The most important thing is: not to get acne scars!!!…Therefore treat your acne as early as possible! Do not follow fake advise, go to a dermatologist and get your right treatment!

What triggers acne?

Myths about acne are as common as acne itself. As I said above, there are many reasons why acne appears. The pores are clogged, and the bacteria which are on your skin become dominant. We call the guys propionibacterium or acne bacteria propioni. If there’s an imbalance of these bacteria, acne can occur at the same time the gland oil production gets increased. Of course, a rise in androgen levels plays a role in your oil glands production. This leads to a high production of sebum which can break down the cellular walls in the pores. But emotional stress and hormonal changes can also be a key trigger.Therefore it’s essential to reduce the bacteria overgrow, by using the right skincare routine, washing your face right (watch my other video “how to wash your face”) or using a face towel.

Is acne caused by bacteria? Is acne contagious?

The answer is therefore of course double NO. We all have millions bacteria and fungus on our skin. Just if the right skin bacteria balance is disturbed, we are getting problems. Acne is one of them. So please remember: acne is really NOT contagious! The propionibacterium can’t spread like an infectious disease. So you can’t get acne while spending time with friends who have acne. Acne is therefore not contagious. But tell your friends that there is a solution against breakouts and acne. Send them to a dermatologist. Because if acne is not treated quickly acne scars remaining your whole life.

Acne bacteria proprioni

Propionibacterium acnes.jpg

By CDC/Bobby Strong – http://phil.cdc.gov ID#3083, Public Domain, Link

How to prevent acne at home by yourself?

First of all, I beg you: don’t treat acne by yourself. Seek help from a dermatologist. Please visit a dermatologist clinic. Preventing acne is the key to avoid scars. But if you get acne, try to treat it as early as possible to avoid scars. There are a lot of skin-smoothing products and treatments which help you to prevent a break-out. Also, your daily behaviour is essential too. My patients have typical behaviours, like touching their face constantly and wondering why they get acne on their chin.

Do’s to prevent acne

  • Wash your face twice a day (in the morning and in the evening).
  • Wash it with lukewarm water and try to avoid too hot water!
    Use a midsize towel for your face, only for your face!
  • Wash the towel at 60° or higher, so you can get rid of the bacteria
  • Don’t use greasy cosmetics or dirty beauty tools!
  • Wash your face, but don’t wash it too often. But twice per day is enough, do not overdue!
  • Don’t switch your skincare and medical products all the time. Give them time to work. Six to eight weeks is normal. Compare it with your body exercise. There you never will see the results on your body earlier neither.
  • Be consistent
  • Nothing is worse than scarring therefore treat it early

Dont’s to prevent acne and acne scars

  1. Please do not touch your face!Neither pick or pop your pimples. Why? because acne scares do not look good?!
  2. Don’t scratch the sensitive skin!
  3. Do not use any herbs or remedies recommended by unknown not professional sources in the internet
  4. Do not pick with your hands in order to avoid severe acne scars
  5. Avoid milk products and high glycemic index food

Watch my video about how to prevent acne while sleeping

How to wash the face right

Do scrubs help with acne?

No, they do not! Please do not harm your sensitive skin. Most people tend to rub too rough and end up with dry skin (therefore your skin produces more oil and you get acne breakouts or inflamed pimples). Also there are a lot of bad body scrubs with perfume or worse organic once with etheric oils out there. Try to avoid skincare cosmetics or lotions with essential oil or perfume, they will irritate your skin and do not clear them out or even help with scarring. Watch my Video how to wash your face right.

Should I

Food and acne

Is there a diet to prevent acne or treat acne?

A lot of my patients are asking me how to prevent acne and pimples. Unfortunately, there is not a lot of good medical research out there. But studies show the same results.(1)  Therefore generally speaking:

  • Try to avoid too much of milk protein.If you use protein powder for your body work-out, read the food labels. Most of the protein and sports shakes and powders include a lot of milk protein. Use protein products with alternatives to milk protein. I suggest hemp protein, be careful with soy protein as it works as a phytohormone in high doses and may affect your hormonal level.
  • Be careful with too much of extra Vitamin B products as well.Again, look at labels if you take protein powders, bars or sport shakes. Vitamin B in healthy food like avocados or nuts is not the problem. But the additional high doses in energy shots, protein bars or powders have to be carefully watched.
  • Try to avoid convenience food, it contains a lot of sugar! Take your time and cook a meal by yourself or eat a fresh salad with a healthy oil like pumpkin seed oil.
  • Last but not least, try to cut down on your sweets, really!I know, Christmas is coming and there are cookies everywhere. But try to avoid too much sugar in general. Particularly try to minimise your intake of sugary drinks, energy drinks, crisps, sweets in general. Products with a high glycemic index show in some studies to have a harmful impact on your body so as on your skin particular on your acne. Watch myYoutube video  ” Food and acne connection”

Acne skin – which food can help?

The consumption of the right food can work wonders against winter acne. For example, try to eat foodthat is high in zinc. Meat, spinach, even porridge are tasty and give you skin what it needs.

Vitamin C, too, is important. Why vitamin C? Because Vitamin C is not just working as a great antioxidant but also helps with the collagen production.

Food high in seleniumcan help to protect your skin against oxidative stress. Nuts and fish contain lots of selenium and are tasty elements of a healthy diet – just try it!

You also can watch my Youtube video on which food to avoid when having acne…click here to watch! 

Acne and milk protein

According to new research and as stated at the AAD (American academy of dermatology) there is an influence between milk and acne. In an other medical journal he Journal of Am Acad Dermatology shows that the risk of acne increases with the consumption of milk products but rather with skim milk than with yogurts or cheese in general. So further scientific research is needed.

Acne and diet

Even there are small studies about antioxidants like zinc, probiotics or fish oil on acne, but there is not the evidence is not strong enough that the aad (American Academy of Dermatology) can give strong recommendations regarding these dietary factors and acne.

Food and sugar – an overview:

A researcher from the University of Sydney published in the American Journal of Clinical Nutrition an excellent paper and table of high and low glycemic food. If you want to read more about the glycemic index, click here to read the medical article.

Acne with 20, acne with 30 or even 40?

It is not uncommonto get acne after the teenage time, even you never had it before. I see a lot of patients every day who telling me that say either still suffering from acne or just got their acne in their late 30 or even 40.There is research showing that more and more women are suffering from acne in their adulthood. As said before in teenage time more men are affected from acne whereas in the later years more women are suffering from pimples, commodores and bumps. Read my interview about adult acne (German only).

What are the difference between teenage acne versus acne in the 30 or 40?

Location, location and again location.Whereas the acne in teenagers are more located on their forehead and on checks, adult acne is more often seen around chin and the neck area.

What causes winter acne?

Skin barrier problems during the winter time

The frequent changes between the cold outside and heated air inside, makes your skin barrier more fragile. Your skin is irritated: On the one hand, the cold outside tell it to produce more sebum. On the other hand, if you then go into a heated room, the order for the sebaceous glands is: “Reduce production immediately!” The skingets, quite literally, “irritated” – it doesn’t quite know which surroundings to adjust to.

Because of the just described barrier problemsbacteria, too, can now enter the skin barriermuch easier. So if you are wearing scarfs, this is the perfect bacteria “party spot”. All bacteria will stay on the fabric and grow.

Hand on your heart! How often does your scarf or hat fall down? Are you sure that you are touching your scarf or bobble cap with clean hands only? And how often do you really wash your scarf or cap? Uh-huh. Exactly.

So what happens is this: First of all, the fabric is irritating your weak skin barrier system even more.

Secondly, all the bacteria cultivated on it can now enter the skin much easier. Suddenly you will get red and itchy skin around your neck, decollete or forehead. Exactly the spots where your scarf and your hat are touching your skin non-stop. You are even rubbing the bacteria insidewhen you cuddle up with your scarf.

Sometimes my patients are even suffering from more pimples on their decollete or back. Of course, there are different reasons for acne, and what is helpful for one patient might not be for the other. But try these things first if you observe you’re getting more pimples in winter – they are the most essential acne remedies everyone should try before going into the more fancy acne treatments.

During winter time, try to wear cotton shirts only. Under synthetic fabric your skin tends to sweat a lot more. With your dead skin cells and the heat creating a nice environment for your bacteria to grow, the possibility of getting pimples increases even further in synthetic garments. But there are more things you can do to prevent that from happening!

What are the causes of dry skin in the winter time?

What is dry skin?You can compare the surface of your skin to a cobblestone wall. This wall is normally well-sealed on top. Also, the mortar between the bricks is well-sealed. No water or bugs can enter the brick wall. That’s exactly how it works with your skin.

Your skin is normally well-sealed. But during the winter time the sealed wall can be destroyed particular if humidity weakens the skin barrier system even more. Therefore the “mortar” between your skin cells gets cracky. Water can disappear. Your skin is starting to become itchy and dry.

The frequent changesbetween the cold outside and heaters inside, too, make your skin barrier more fragile. Your skin is irritated: On the one hand, the cold outside tell it to produce more sebum. On the other hand, if you then go into a heated room, the order for the sebaceous glands is: “Reduce production immediately!” The skingets, quite literally, “irritated” – it doesn’t quite know which surroundings to adjust to.

What can you do to avoid acne in the winter time?

So: How to treat winter acne?And most importantly: How to preventwinter acne altogether? To avoid further problems with your skin during the winter you should pay particular attention to… you guessed it: your garments. With acne, clothing is crucial, especially in winter. This scarf and this hat just need that extra treatment to protect your skin.

I know the latest trends are big scarfs…big, bigger, huge …as New York fashion week just showed us. Vogue Magazineand  friday magazine are just featuring these new fashion statements. But be careful with scarfs around your neck and face while suffering from acne.

First of all:

  • Wear a scarf made of 100% natural cotton. It will irritate your sensitive skin less and you can wash it at 60° Celsius. (You cannot wash cashmere scarves – dry cleaning only.)
  • If you also suffer from pimples and irritation on you back or decollete, try to wear cotton shirts only, too.
  • Then you need to make sure your scarf doesn’t touch your skin. Sounds difficult, I know. But just try to give it some air and wrap it around your neck loosely.
  • Then wash or dry-cleanyour scarf frequentlyto eliminate bacteria.

Also try not to touchyour facewith your dirty hands. That can be hard, since we do it unconsciously most of the time. Just try to create awareness for what you do with your hands as much as possible and avoid too much touching. And certainly, you should wash your hands frequently.

Keep your skin moisturized, but do notuse creams that are too fattywhen you suffer from pimples. That only does more harm than good. Which brings us to the next question…

Winter acne skin care: What kind of creams to use?

If you are suffering from acne prone skin, your “basic” creamhas to be a very lightone anyway, as too fatty creams are just covering your skin from the top. Suddenly, then, your bacteria can grow under this nice “cream tent”.

Always use a suncream. Because the sun is alwaysshining. You don’t want to damage your skin more than necessary. If you need Vitamin D, put your arm wrist into the sun for five minutes. Why would you want to expose your face to the sun – risking to cause wrinkles, pigmentation or redness?

So take care of your skin with the right behavior.

Dry skin and acne: great skin food

Great, healthy foodis always an asset. And yes, it also can work wonders for your skin! Is your daily diet already supporting skin health? Here’s what you should try eat on a regular basis to make your skin look great again.

Dry skin – which skin food can help?

Fish!The omega-3 fatty acids help you with dry skin and protection of your skin barrier function – and they are also otherwise great for your health. For the vegan people among you: Microalgaealso work as an omega 3 supplier and they are great to help your skin barrier system.

Nutsare high in Q10, which also helps improve the condition of your skin. Other great food ingredients to improve your skin and make it less dry and prone to damage are flaxseed oiland gamma linolen acid. Flaxseed oil is rich in unsaturated good fat; gamma linolen acid can be found in the oils from currents.

You also can have a look what else to avoid while having dry skin. Click here to read my other blog post about dry skin.

Stop acne stop your stress !

For most people winter seasonis a hard time. They feel tired, the darkness of the season tends to wear them out and the cold makes them enjoy a walk in fresh air much less. But it is so important to go outside. Enjoy a walk in the park or a short trip to the mountain. A healthy circulation keeps your body young and vibrant.

Maybe you are wondering: Wait, didn’t she just say the changes in temperature are bad for my skin? So shouldn’t I just stay inside the whole time? No, it is not that simple, and your skin is no excuse to be lazy!

The blood flow carries away waste products and free radicals from working cells. So: You will see an improvement in your skin condition, if you take a breath of fresh air in winter! But of course you shound follow my advice above to protect your skin. And do not forget to use sunscreen! Use it every day! Remember: Never without sun cream if you want to avoid wrinkles, redness and pigmentations!

Watch my tutorial video how to apply sun cream the right way. Click here to see it.

Key advice for winter acne to share with your friends

Just to wrap it up quickly, here’s my advice against winter acne in a nutshell– share it with your friends!

  1. Cotton is best to prevent winter acne – wear a scarf and other garments made of 100% natural cotton.
  2. Try not to touch your skin with your scarf and with your dirty hands.
  3. Wash your scarf and hat frequently.
  4. Do not use too fatty creams while suffering from pimples and winter acne.
  5. Choose food wisely to help beat pimples and dry skin – try fish, meat, nuts, spinach…
  6. Don’t stress yourself out!

Which acne treatments are available?

The best option is to consult one of us dermatologist to treat acne. There are different acne treatment options available. Don’t wait too long. There are local medications but also internal once available. Don’t be so afraid. With a proper guidance from your dermatologist you can for sure treat acne. But please remember, it takes time to heal the damaged skin. So start the treatment as soon as possible to get rid of your pimples. Your skin can recover if you follow the instructions your dermatologist gives you! You must attack the variety of acne causes. For example, over the counter products are available. But maybe try to follow the regime of your dermatologist. Nevertheless some examples:

  1. Benzoyl peroxide decreases the P. acne bacteria
  2. Antibiotics decrease the P. acne bacteria as well
  3. Salicylic acid cuts down the inflammation and unclogged pores
  4. Glycolic acid removes the excess cells which clog the pores
  5. Retinoids, such as adapalene gel, increase the production, unclog pores and reduces oiliness

If you would like to learn more about the skincare treatments to enhance your skin health and appearance, how to treat acne or how to prevent it, request a consultation. Click here for a personal consultation with Dr.Liv