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How to Treat Stubborn Acne ASAP, According to Dermatologists

Clear skin right this way.


by Jessica Toscano Jan 20, 2022

Woman with tiny stickers on face
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If you’ve ever battled zits that are inflamed, tender to the touch, and nearly impossible to pop, then you know a little something about stubborn acne. Especially if a series of OTC treatments, trips to the dermatologist, and DIY remedies have cleared your wallet, but not your skin. Sound familiar? Then, you might be suffering from nodular acne, cystic acne, or a combination of the two.


Although both are characterized by deep, painful bumps under the skin that can lead to hyperpigmentation (dark spots) and atrophic scarring (indents in the skin), nodular acne or nodules are harder to the touch, whereas cystic acne or cysts contain fluid, so they tend to be on the gushier side, according to Cleveland Clinic. Either can appear on the face, shoulders, chest, or back and heighten from hormone fluctuations, eating habits, and lifestyle, which makes pinpointing the exact cause seem impossible.


Luckily, ditching these acne woes doesn't have to be. Here, dermatologists uncover everything you need to know about stubborn acne, including the steps you can take to (finally) clear it.


What causes stubborn acne?


“One of the first things that lead to acne formation is the trapping of dry skin cells in micro-cysts called comedones,” Syril Keena Que, MD, MPH, an assistant professor of clinical dermatology and the director of dermatologic surgery and cutaneous oncology at Indiana University School of Medicine in Carmel, tells Intrigue. “As more oil, bacteria, and dry skin accumulate, and as inflammation increases, this can lead to the formation of larger cysts.” Ultimately, build-up is dependent on genetics — whether your skin is naturally dry, oily, or combination — but can happen for a number of reasons.


One main culprit during this time of year is climate. Between frigid temps and indoor heat, skin tends to be drier in the winter, which prompts your sebaceous glands to produce more oil than usual to compensate, per the American Academy of Dermatology Association (AAD). Likewise, holiday stressors can trigger your adrenal glands to secrete cortisol and ultimately, increase sebum. Combine that with some of the 30,000 to 40,000 skin cells humans shed daily and bacteria, namely P. acnes, normally present on the skin’s surface, and you’ve got yourself inflamed — and probably painful — nodular or cystic acne.


You may also notice an increase in flare-ups when you eat certain foods, says Joshua Zeichner, MD, a board-certified dermatologist and associate professor of dermatology at Mount Sinai Medical Center in New York City. “Dairy (particularly cow’s milk), foods with a high glycemic index, whey protein, and vitamin B12 supplements have all been associated with worsening acne.” That means all the cookies, doughnuts, and pastrie