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Ask the Beauty Expert || Allure November 2021 Issue

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What can I do for bad breakouts that need regular maintenance but may not be right for medications, like isotretinoin?

—Andrea C. Hear that sound, Andrea? It’s the whispers of thousands of readers thanking you for asking this question. Acne is the most common skin condition in the United States, affecting up to 50 million people every year, according to the American Academy of Dermatology. (That’s about 10 million more than the entire population of California.)

Since acne can be triggered by factors ranging from hormones to stress to diet (or a combination thereof), there’s no one topical product that’s guaranteed to work for everyone. But there are certain ingredients that board-certified dermatologists typically recommend. Notice I said dermatologists, not Reddit users or your cousin’s godmother’s aunt. If your acne is persistent enough to warrant treatment, seeing a dermatologist, who can help identify the potential cause, should be step one.

Here are other steps, in no particular order: One tried-and-true ingredient for treating whiteheads and blackheads is salicylic acid, a type of beta hydroxy acid (BHA) that helps dissolve the pore-clogging oil and debris that can lead to breakouts. It’s also keratolytic, says Corey L. Hartman, a dermatologist in Birmingham, Alabama, which means it helps slough off dead skin cells, revealing the healthier ones underneath. You’ll often find salicylic acid in spot treatments and liquid exfoliants. Benzoyl peroxide can target and destroy acne-causing bacteria and takes about 12 weeks to clear up skin. But because it can be drying, this antimicrobial ingredient is commonly found in rinse-off products, like face wash.

Calling in the big guns for acne treatment means calling in retinoids. The vitamin-A derivative helps regulate cell turnover and oil production, explains Hartman. Prescription-strength retinoids—like Retin-A or tretinoin—can only be prescribed by a doctor. But you can get your hands on a retinol—which has a lower concentration of the same active ingredient—at just about any drugstore. Keep in mind that any type of retinoid can cause irritation, which is why it’s important to start slowly. Most dermatologists recommend using a retinoid a couple of times a week before building up to daily use, so your skin can acclimate to it.

That brings us to Accutane, which is a (now-defunct) brand name for isotretinoin—the medication you mentioned—an even more powerful vitamin-A derivative that’s taken orally. “If someone takes a full course [of isotretinoin], there’s an 80 percent chance of curing their acne for life,” says Amy Wechsler, a dermatologist in New York City, who notes that could take anywhere from nine months to a year, depending on one’s weight and the dosage. “There are other treatments, but then you stop them, and the acne comes back. But isotretinoin has the potential to be a cure,” Wechsler adds.

Of course, with great power comes great responsibility. If you’re pregnant or planning to become pregnant, isotretinoin is not for you—nor is retinol. Vitamin A in high doses can cause severe birth defects, says Wechsler. Before your doctor can even prescribe isotretinoin, those assigned female at birth must provide two negative pregnancy tests one month apart as well as monthly blood tests to make sure you’re not pregnant for as long as you are taking it.

Isotretinoin can also make skin dry (stock up on basic moisturizer, like Aquaphor). And there’s what Wechsler calls a “myth” that isotretinoin can cause depression, citing, among others, a 2012 study conducted at Albert Einstein School of Medicine that found rates of depression decreased while self-esteem increased among patients being successfully treated with isotretinoin. Wechsler has observed the same result in her New York City practice: “I have a stack of thank-you notes from patients telling me how much better they feel about themselves now that their acne has cleared up.”

But for every happy ending, there’s someone struggling to find the balance between all-guns-blazing treatment and simple, unbridled acceptance: “I still want to fix my acne, but instead of having it veiled under negativity or positivity, I’m working towards it in a healthy way,” says aesthetician and content creator Cassandra Bankson, who, in 2010, revealed her acne in a YouTube video that has garnered more than 29 million views. “Your appearance does not define things you can do for this world,” Bankson says. And as this month’s Beauty Expert, I couldn’t agree more.