Post-Inflammatory Pigmentation: Acne Marks and Discoloration Caused By Pimples

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What Is Post-Inflammatory Pigmentation?
Post-Inflammatory Pigmentation is the fancy term for skin discoloration caused by inflammation. Unlike acne scars, pigmentation usually resolves on its own and is highly treatable. If you read my post on the seven different types of acne, you know that there are four types of inflamed acne and any one of these can lead to discolored marks that last for weeks, months, and even years after the acne itself is long gone. You can even cause a non-inflamed acne lesion like a blackhead or whitehead to become inflamed by picking at it which is why leaving your hands off your face is so important. The most common type of discoloration causes the skin to turn darker or HYPER-pigment although, in rare cases, your skin might HYPO-pigment or turn lighter. There are three types of post-inflammatory pigmentation or discolored marks that can occur from inflamed acne or picking: Postinflammatory erythema which are pink or red marks, postinflammatory hyperpigmentation which are brown marks, and postinflammatory hypopigmentation which are white marks.

How To Prevent Pigmentation
The most effective and sustainable way to prevent pigmentation is to clear the acne itself. If your acne is still active though, there are two keys to preventing pigmentation:

  1. Reducing Inflammation: this is key because it is the inflammation rather than the acne itself that causes the pigmentation in the first place. The two main tools we use to reduce inflammation with our program are icing and using an effective and non-comedogenic benzoyl peroxide product like our Clearing Treatment.

  2. Avoiding abrasion and pressure: pressure and abrasion inflicted on the skin can send signals to our bodies that we are injured which can then set off the inflammatory response that leads to pigmentation. The best way to avoid this is to avoid picking or even resting against your hands or anything else that might put pressure on areas of your face or body that are broken out. Also, avoid any form of mechanical exfoliation (scrubs, exfoliating brushes, loofahs, microdermabrasion) which can tear and damage the skin.

How To Treat Pigmentation
Treating pigmentation should only be done once your skin is completely clear. If your skin is still broken out, you will likely be wasting your time and money treating the existing pigmentation because you will likely just have more pigmentation come up from future breakouts. The methods used to treat pigmentation also typically speed up the cell turnover process which can accelerate the rate of acne movement and trigger an inflammatory response that actually induces more pigmentation. Once your skin is completely clear, the most effective way to get rid of pigmentation is a combination of mild chemical peels and a daily product plan that helps purge the pigmented cells out of the skin. Our serums contain mandelic acid and lactic acid which are two of the most gentle and effective exfoliants for clearing acne and our acne facials include peels that contain a cocktail of ingredients meant to target acne and speed up the lifting and lightening of all three types of pigmentation.

How Long Does Pigmentation Treatment Take and What To Expect
Pigmentation usually takes longer than acne itself to clear out of the skin. With our program, most people see acne clear within 6-8 treatments over 3-4 months but it can take 3-4 times as long for the pigmentation to lift depending on how aggressive your product plan is and what type of peels your skin can tolerate.

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All About Acne Scars

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Acne scars are caused by tissue damage which create textural changes that cause the skin to appear raised or indented. Many people confuse acne scars with pigmentation but they are two different things as discussed in our post Acne Scars and Dark Marks are Two Different Things. Although pigmentation is usually reversible, scars are not since the skin’s tissues can never be completely restored to their original state but certain treatments may improve them. The best way to deal with scarring is to prevent them in the first place through an effective program that deals with acne at the root as well as its various symptoms including inflammation.

What Causes Acne Scars
Acne scars can be caused by two things: inflammation and picking. Inflamed acne types (papules, pustules, cysts, and nodules) and picking can both cause ruptures in the deeper layers of the skin that destroy the skin’s tissues or cause an overgrowth of tissue that is initiated in an effort to “patch up” the wounded area. Genetics largely determine our skin’s natural healing mechanisms and thus how likely we are to develop scarring. Genetics also determine what type of acne we are likely experience and if we suffer from the inflamed acne types, especially cystic and nodular acne, we are more likely to scar as well. Picking is the best way to create a scar and the types of scars that are created from picking are typically bigger, more uneven and less likely to respond to treatment.

Type Of Acne Scars
There are two categories of acne scars. Hypertrophic scars are raised, discolored bumps caused by tissue overgrowth and atrophic scars are caused by tissue loss. There are three types of atrophic scars:

Rolling Scars-depressions with smooth, sloping edges that look like wavy hills
Icepick Scars-small, circular indents in the skin that are shaped like icepicks
Boxcar Scars-depressed indents with sharp, angular edges

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The Seven Different Types of Acne

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When most people think of acne, they think of giant, red bumps but acne actually comes in all different shapes and sizes.  Acne also ranges from mild to severe, it can be occasional or constant, and it can last for a month or a decade. Regardless of how noticeable it is, how often you breakout, or how long it lasts, it all counts! I have experienced every type of acne at various points in my life and I can assure you that having non-inflamed acne sucks just as much as inflamed acne does.

The two main categories of acne

There are two main categories of acne: inflamed and non-inflamed and there are seven different subtypes within those two categories. As you can see from the pictures, these two types of acne look very different and could easily be mistaken for completely different conditions altogether. Inflamed acne is the type of acne that most people identify as “acne” because inflamed lesions are bigger, redder, and can be pus filled and sore. Non-inflamed acne looks like little tiny bumps or seeds underneath the skin and people often describe it as “bumpiness” or “texture” that might only be visible under certain angles and lighting. A lot of people with NI acne don’t even realize they have acne and I have even had clients whose Dermatologists misdiagnosed their non-inflamed acne for allergies! Dermatologists are special….Anyways, non-inflamed acne is basically the baby stage of acne and when it gets bigger, it can become the more grown-up inflamed acne. The most common acne type is combination because most people have some of each type although you might have more of one type than the other and your acne type will likely shift at different points in your acne journey.

 

The seven types of acne

Here are the seven types of acne and each one falls within the inflamed or non-inflamed category. The three types of non-inflamed lesions are microcomedones, blackheads (aka open comedones), and whiteheads (aka closed comedones). The four types of inflamed lesions are papules, pustules, cysts, and nodules. Different types of acne should be handled differently which is why the AES method was designed to handle every type of acne with the appropriate types of care.

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Travel Acne: 5 Products to bring when you travel to prevent breakouts

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Traveling is the second most common time for my clients to fall off of the clear skin wagon.  Even my graduates who have been clear for years tend to come back with a few more zits post-vacay than they left with.  Regardless of what stage you are at in the clearing process, here is a list of travel essentials you should bring with you if you are acne-prone and traveling.

Skincare products: This is #1. Duh. Your product plan is what is facilitating the clearing process so even just a short period of time not following your product plan can allow seeds to form deep inside the skin that might not show up for months later. So bring your skincare products and follow your product plan everyday, twice a day.

Pillowcases and face towel (a body towel too if you are prone to body-acne): When hotels use dryer sheets, fabric softener, and detergents containing fragrance or other pore-clogging ingredients, just sleeping on their pillows and using their towels can lead to new breakouts.  If you haven't yet cut out the dryer sheets and switched over to a non-cloggy detergent, choose an AES approved product from our Acne Safe Household Products Pinterest board and do a load of laundry before you leave.

Popsicle molds: Whether or not icing is a part of your daily product plan, pack a silicone popsicle mold so you can freeze ice and have it ready in case you get an inflamed pimples. Inflammation usually spikes while traveling due to the stress on our bodies from jet lag, increased busyness, etc so it’s a good idea to pack one even if you don’t normally get inflamed pimples. If you do start noticing signs of inflammation (redness, swelling, itching, soreness), whip out the ice and apply it directly to your skin after cleansing for 2-30 minutes (the longer, the better). Make sure to use gentle pressure when icing because too much pressure can cause inflammation to worsen.

Toiletries: Unless you want to risk breaking out around your hairline and mouth while vacationing, bring your own hair products and toothpaste. If pimples around the mouth and forehead is the look you are going for then by all means, use the random toothpaste and shampoo at the hotel. And no, if doesn't matter that you are only traveling for a few days, it only takes ONE usage to breakout from a cloggy product.  If you forget any of your toiletries, take a screenshot of our list of comedogenic ingredients and scout a non-cloggy ingredient at a nearby store (a lot of countries have ingredient lists in English).

Hand Soap: This is one that most people don’t consider but we tend to wash our hands a lot when we travel and if there are cloggy ingredients in whatever hand soap the hotel or Airbnb is providing then it is likely going to get on your face, especially if you wash your hands right before applying your skincare products. So get a travel size container and pack a little acne-friendly hand soap next time you travel to prevent any cloggy residue from making contact with your face and breaking you out.

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Oil Cleansing Is Actually Terrible For Acne

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Oil cleansing is hailed by many wellness experts as the natural method for “clear, glowing, dewy-looking skin, free of blackheads, pimples, cysts, and other imperfections”.  Cosmetic companies capitalize on the trend by selling face cleansing oils that retail for over $100 which is crazy because I can promise you that there are very few oils, if any, on this earth that cost that much to manufacture.  Now, I get why oil cleansing has become popular. Acne sucks, I know. By the time I was 16, I was finishing up my second failed attempt at Accutane and I would’ve stuck my finger in an electric socket if you would’ve told me that would make the pimples go away.  Unfortunately, oil cleansing is one of those beauty trends that sound too good to be true because it is. 

The theory behind oil cleansing
Essentially, oil cleansing attempts to fight oil with oil. Reddit’s oil cleansing guide says that, “The basic idea behind oil cleansing is dissolution theory - or, more simply “like dissolves like” - oil is able to dissolve and remove substances with a similar chemical structure. Lucky for us, this includes stuff like dirt, oil, and makeup.”  In the world of acne treatments where harsh, prescription medicines and harmful side effects are the norm, the oil cleansing method attempts to counterbalance this by providing a natural, organic, solution for fighting acne.  The intention here is good and it makes sense to try something natural and safe if strong, harsh products aren’t working.  Unfortunately, the dissolution theory is just a theory and although there may be some acne sufferers that find their acne improves with oil cleansing, every single one of my clients and I personally have found that rubbing oil on our faces wreaks havoc on our acne-prone skin.   I have never actually met someone whose acne improved with oil cleansing but I never talk in absolutes when it comes to acne and there are exceptions to every rule so there are people out there who have been helped by oil cleansing which is awesome. Also, everyone’s acne puzzle is different so the only way to determine whether or not something is acne-friendly for YOUR skin is to test is and wait for the delayed reaction time.

Just because it’s natural doesn’t mean it’s good for acne
Out of all of the misconceptions my clients come in believing about acne, this is the hardest to deconstruct.  People just assume that if something is “natural”, it’s better for everything but this is absolutely not the case when it comes to acne.  There are many natural foods, products, ingredients, and methods that can actually exacerbate acne and oil cleansing is one of them.

Oil is one of the most potent acne triggers
You probably already know that oil is an essential part of the acne process.  The very first lesson in my E-Course, The 8 Steps To Clear Skin, is all about the acne process and I explain how oil is such a big deal because our sebaceous glands are connected directly to the follicles where acne takes place.  So when the sebaceous glands secrete oil, that oil gets pumped straight into the follicle where there is already a buildup of debris due to Retention Hyperkeratosis. Somehow, marketers have done a great job the past few years making us believe this backwards theory that rubbing oil on our faces is actually a good thing but Dr. James E. Fulton, the Dermatologist and medical researcher whose findings form the foundation of our program, states in his book, “Acne RX”, “...if the complex oils in sebum create such havoc in acne-prone skin, then rubbing more oils into the skin is the worst possible thing an acne sufferer can do…”.  

Acne is a multifactorial disease
I say this in almost every post and I will say it again: Acne is is a multifactorial disease in which genetic, lifestyle, environmental, and dietary factors must all collide to create a ‘perfect storm’.  To effectively and sustainably manage acne, all of these contributing factors must be addressed AT THE SAME TIME. So even if oil cleansing did work by magically reducing oil production, you would still only be addressing a single piece of a puzzle that has many other pieces including the sludging up of skin cells in the follicle, bacteria, inflammation, and hormones.

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5 Reasons Dermatologists Fail To Successfully Treat Acne

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If you suffer from acne, chances are that the first person you turned to for help was your dermatologist.  It only makes sense that you would turn to the medical professional whose job it is to treat skin if you were suffering from a skin condition.  Unfortunately, dermatologists are failing miserably to treat a condition that affects the majority of the population at one point in their lives and here are 5 reasons why:

4 Reasons Dermatologists Fail To Successfully Treat Acne Sufferers | AES Blog

1.  Successful acne treatment is comprehensive.
As both a practitioner who treats acne and a former acne sufferer myself, I know that internal factors like diet and stress have just as significant an impact on acne as external factors.  Most dermatologists prescribe medications that target a single factor in the multifactorial cycle of acne.  For example, Accutane reduces oil production, antibiotics kill bacteria, and Retin-A exfoliates skin cells but successful and sustainable acne treatment targets all of these things and more.

2. Many prescription topical medications contain pore-clogging ingredients.  
Believe it or not, some of the most widely prescribed acne medications contain comedogenic ingredients. The current formulation of Retin-A, for example, contains a highly pore-clogging ingredient called isopropyl myristate.  So while the active ingredient can make skin appear clearer for awhile, this is usually a temporary improvement because the comedogenic ingredient eventually clogs follicles.

3. Dermatologists just don’t have enough time (and they don’t really care).
Effective acne treatment requires time, attention, and investigation because the causes and triggers of acne vary between individuals.  Most patients are forced to wait months for a 5-minute visit with a dermatologist and the visit usually involves no more than a prescription being written.  And let’s just be honest, even if your acne is devastating to you, it is likely the least important condition that a dermatologist is dealing with during their day.

4. Everyone’s skin is different.  
You don’t need a medical degree to figure this one out.  Everyone has a unique skin type, acne type, and maybe an extra skin condition or two thrown into the mix.  Dermatologists prescribe the same medications to just about everyone without taking their unique situation into account.  I have seen many clients with dry, sensitive skin who are prescribed strong medications that cause like tazorac which cause more dryness and peeling.  A good practitioner will clear your acne without leaving with you with other uncomfortable and unsightly conditions.

5. The medical system is based on profit.
The medical system is so intertwined with pharmaceutical companies that the treatments and medications that Doctors and Dermatologists recommend are based less off of what actually works and is good for patients and more off of which medications Big Pharma has chosen to take through the FDA approval process.

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Those aren't actually blackheads on your nose

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The second most common skin concern that I hear after acne is from people wanting to get rid of the blackheads on their nose. Blackheads are a form of non-inflamed acne as I described in my post The Seven Different Types of Acne and although those dark colored dots on your nose look similar, they are actually sebaceous filaments.

Those Aren't Blackheads On Your Nose | AES Blog

What are sebaceous filaments?
Unlike blackheads which are mostly a combination of dead skin cells, oil, and maybe some comedogenic ingredients, sebaceous filaments are oil plugs that are created by the pore's natural sebum flow.  Our pore size is determined by how much sebum is flowing so the more oil, the larger the pore appears and the areas where oil glands tend to be most active are on our nose and our chin which is why these areas are where sebaceous filaments tend to be most prominent.

How do I tell the difference between a blackhead and a sebaceous filament?
Color: Blackheads tend to be a darker black color than sebaceous filaments which tend to be a lighter gray or flesh-color.

Pattern: Blackheads, like all other acne lesions, usually appear randomly and in no uniform pattern. Sebaceous filaments, on the other hand, tend to appear in perfectly even rows because they follow the pattern of our oil glands which are evenly distributed structures in our skin.

Texture: Blackheads usually have a slightly raised border but sebaceous filaments are generally smooth and flush with the skin.

What NOT to do with sebaceous filaments
DO NOT attempt to squeeze them out with your fingers or any other dirty tool in your bathroom because you risk turning it into an actual pimple and damaging the surrounding skin. Haven’t you ever squeezed them and turned your nose red and peely after?  Also, even if you squeeze it out, it will ALWAYS come back as we mention below.

How do I get rid of them?
Unfortunately, there is nothing you can do to get rid of sebaceous filaments permanently and any product that claims to do so is a LIE. There are pore strips and products that may help get rid of them temporarily and squeezing them is also a temporary solution but sebaceous filaments will fill back up in a matter of days because there is no way to shut the oil glands off. Everyone has pores that release sebum onto the surface of the skin and as much as we hate it, it plays a very important function in keeping our skin moisturized and protected.

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5 common products that may be causing your back and chest acne

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Body acne can be just as embarrassing as face acne. If you find yourself avoiding certain clothing or summer events because you want to hide the acne on your chest or back (aka bacne), take a good look at these common everyday products:

1. Scented laundry detergent: Laundry detergents contain fragrances that can clog and aggravate the follicles of acne-prone individuals.  Use a fragrance-free detergent like Tide Free or Arm & Hammer Free instead.

2. Fabric softener: Whether you are using dryer sheets or liquid softener, these products contain a waxy substance that coat your clothes and can clog your pores. Switch to one of the dryer balls on our Acne Safe Household Products Boards instead.

3. Comedogenic hair products: Probably the biggest and least-recognized offender of body acne is actually hair care products.  Whether it is shampoo, conditioner, or styling products, most of them contain comedogenic ingredients and they drip down to our back and chest when we wash our hair.  Common comedogenic ingredients to look out for in hair products include sodium lauryl sulfates, sodium laureth sulfates, coconut oil, and argan oil.  Check out our Acne Safe Hair Care Board for products that contain none of these pore-cloggers.

4. Perfume/Cologne: In addition to containing synthetic fragrances and oils, perfumes contain unknown ingredients that are not required to be clearly listed on packaging. Pair that with the fact that most of us spray perfume on our necks and this can mean unsightly chest pimples.  You can still wear your favorite perfume, just make sure you apply it to your wrists or the back of your arms where our pores are not prone to clog.

5. Body care products: No surprise here, lotions and body washes are some of the biggest offenders when it comes to pore-clogging ingredients.  Check out our Acne Safe Body Care Board and always look out for these common comedogenic products before purchasing body products: safflower oil, cetearyl alcohol & ceteareth 20, coconut oil, avocado oil, and isopropyl myristate.

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How to get rid of blackheads

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Open comedones, aka blackheads, are a form of noninflamed acne.  There are many types of acne but they all develop when dead skin cells, oil, and comedogenic ingredients form a little seed called a microcomedo.  Blackheads are formed when the pore is open and the seed is exposed to air.

Why do none of my blackhead products work?
If you have ever bought a skincare product claiming to reach deep down into pores and wash blackheads away, chances are you have been disappointed.  Whether it was a scrub, a strip, or a machine, there are a few reasons why most blackhead products don’t work:

  • Blackheads are not caused by impurities or dirty skin. No amount of soap will wash blackheads away because their dark color is the result of a chemical reaction called oxidation, not poor hygiene.

  • Blackheads extend relatively deep below the skin’s surface. There are very few products that can penetrate the surface of the skin and those that do cannot physically push an entire comedo out of the pore.

  • Blackheads are the result of a continual process. Getting rid of existing blackheads is usually not effective because dead skin cells are constantly shedding and oil is always being produced in the follicle. Getting blackheads under control requires maintenance, not a quick fix.

Tips to get rid of blackheads:

  1. The fastest way to get rid of blackheads is to have a professional who is skilled at extractions manually remove them. Pretty much all skin professionals perform extractions but very few have special training like we do so that extractions can be done without damaging or infecting your skin.

  2. Do NOT pick! Please do not use scary makeshift tools to perform surgery in your bathroom mirror. Unless of course, you want your blackheads to become red angry zits.

  3. Use an effective product plan that contains a chemical exfoliant that will decongest the follicles where acne forms. Our product kits include serums with mandelic acid which is a highly effective ingredient that exfoliates, evens, and reduces inflammation.

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Comedogenic List: Pore-clogging ingredients to avoid if you have acne-prone skin

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Is your toothpaste, lip balm, shampoo, hair gel, shaving cream, or makeup acne-friendly? If you struggle with breakouts and you don't know the answer to this, you should. Actually, you should even know whether or not your partner's products are acne-friendly if you are prone to breakouts.  Heck, you should know if your baby’s products are acne-friendly!  Comedogenicity refers to the tendency of an ingredient to clog pores and every product that comes in contact with any part of your body can eventually migrate to your face and contribute to a breakout.  Forehead breakouts? Check your hair products. Chin and mouth breakouts? Check your partner's toothpaste and lip products. Breakouts on your cheeks? It could be cuddle acne from your baby’s shampoo.

Learning to determine whether a product is acne friendly or not is one of the most important ways to manage acne long term.  Unfortunately, regulations on cosmetic labeling (especially in the U.S.) are relatively loose and companies can label their products "non-comedogenic" whether it is true or not.  Acne sufferers in particular tend to get caught up in marketing traps by purchasing products with meaningless labels like "oil-free" that end up making their condition worse.  Just like choosing food at the grocery store, the only way to really know what a product is about is by reading the back where the ingredients are, not the front where the label is.  In our e-course The 8 Steps To Clear Skin, we have an entire lesson on eliminating pore-clogging products that includes tips on oils, fragrances, and an entire checklist of products you should be checking.  To get started, check all of your skincare products, household products, and personal care products for you or anyone you come in contact with against this list.  I also recommend taking a screenshot of this list so next time you go to purchase a new product, you can check it against the ingredient list first.

 

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