Nothing you've tried has worked
Pressmaster/ShutterstockMost people think that breaking out is limited to the teenage years, when everything seems to be soaked in humiliation. Sadly, the truth is, while the most prone people to get pimples and acne are teens, bad skin can haunt you through adulthood. Your acne may even be trying to tell you something important.
You've likely spent a pretty penny investing in over-the-counter treatments for curing acne. (Make sure you don't fall for any of these acne myths.) Treatments shouldn't take more than four to six weeks to prove their magic, so if you've been relying on OTC acne products for several months and your acne hasn't improved, it's time to seek out something stronger.
"Prescription treatment comes in many different forms," says NYC dermatologist Whitney Bowe, MD, "including superficial chemical peels and light-based therapies, topical over the counter skincare products, dietary modifications and counseling, topical prescription therapies, and even oral prescription therapies."
You're painfully self-conscious
Alliance/Shutterstock"If someone is self-conscious as a result of their breakouts, that alone is enough to justify treatment," says Dr. Bowe. Dermatologists won't critique your decision to seek help, so make an appointment. (Have you ruled out these possible causes for your breakouts?) It may not be as bad as others' skin, but when even the little bit you have just won't quit, there's no shame in raising your hand for help.
"Some patients come to see me and with simple changes in stress management and diet, their skin can turn a corner. So I firmly believe that you needn't wait until your skin is scarring or your acne is severe to make an appointment with your derm!" says Dr. Bowe.
You have severe acne
385615120/ShutterstockOver-the-counter products are really best for treating or preventing minor breakouts. Severe acne is a whole different story, and many dermatologists recommend OTCs in conjunction with prescription acne therapies.
Severe acne is distinguished with greater amounts of inflammation. You will have papules (red bumps on the skin), pustules (whiteheads), comedones (little bumps across the skin's surface that aren't red and inflamed), nodules (large, inflamed lesions that feel like hard, painful lumps under the skin), or even cysts.
Cystic acne is usually caused by hormonal imbalances, and it won't respond well to topical treatments. Here's where you can learn more about hormonal acne. According to Dr. Bowe: "Hormonal acne usually shows up as painful cysts on the lower face (chin, jawline), that flare right before your period. That type of acne is best treated with an oral medication called spironolactone."
Your skin is beginning to scar
frank60/ShutterstockYour acne may eventually fade, but the scars that come with it can be permanent—and that's a sign that you should act quickly. If you're noticing the skin starting to divot or raise above the surface, it's time to schedule an appointment with your dermatologist. The cause of acne scarring is usually the result of severely inflamed lesions. You'll want to begin using a prescription treatment immediately, otherwise you may have to use heavy-duty lasers down the line to combat those facial scars.
But while a treatment may be of necessity, Dr. Bowe urges that you don't plan to rely on it for too long. "I'm not a big fan of relying on topical or oral antibiotics for longer than three months," she says. "I find that longer use of antibiotics can lead to resistant organisms on the skin, and even cause problems in the gut by affecting the healthy bacteria that live there."
You have acne on your back or chest
Oksana-Volina/ShutterstockAs if unsightly acne on the face isn't enough, if it has spread to your chest, back, or both, it's time to put down the OTCs and pick up the phone. Ever wondered what dermatologists notice about you?
Sometimes body acne can be the simple result of not showering soon enough after excessive sweating. Try bathing a bit more often—if your back and chest acne persists, it's time to seek prescription treatment. Controlling this type of acne is tough to do with topical creams. You may need a combination of oral and topical prescription to treat it, says Dr. Bowe.
You're experiencing acne for the first time
Dragon-Images/ShutterstockPerhaps you haven't had persistent acne for years, or aren't experiencing severe acne, but if you've always had normal to great skin and are just now having moderate to severe breakouts. There's likely to be a pesky culprit to uncover, and a dermatologist can help with that.
"Blackheads and whiteheads respond beautifully to a topical prescription retinoid such as tretinoin," says Dr. Bowe. "I also find these types of lesions respond very well to superficial chemical peels, especially those containing salicylic acid."
Or, says Dr. Bowe, you may just need to change your lifestyle a bit. "Many of my acne patients are also benefiting from dietary changes such as increasing antioxidants, probiotics and even omega-3 fatty acids in their diet," she says. "Topical probiotic products are also very successful for many of my acne patients, and we are seeing more and more of these come to market."
Other culprits could be hormonal changes and increased stress levels. Here are 37 stress management tips to keep you calm.
You're concerned there's an underlying cause
ldutko/ShutterstockSometimes what you see on the surface is far from the full picture: There are inflammatory conditions like polycystic ovarian syndrome, or a rarer, very serious condition called SAPHO—synovitis, acne, pustulosis, hyperostosis, and osteitis. Seeking out a dermatologist is beneficial in the sense that they are trained to recognize such conditions, and refer patients to a specialist who can help get you healthy from the inside out.
Skin conditions like rosacea and keratosis pilaris are sometimes confused for acne as well. (Make sure can recognize eczema with these tips.) A dermatologist can help determine what's up with your skin, and take proper action from there.