Why do new breakouts keep interrupting my dark spot routine?

Why are new spots still appearing?

Acne starts when hair follicles become blocked with excess oil and dead skin cells. Bacteria can grow inside those blocked follicles and cause inflammation. Hormone changes, certain medicines, and skin or hair products that make skin greasy can contribute. A product aimed at discoloration does not necessarily address those causes.3

The flat dark marks left after inflammation are called postinflammatory hyperpigmentation: pigment deposited in skin that was recently inflamed. They are more common in darker skin tones and can take months or longer to improve. Flat color changes are different from indented or raised scars, which need a different treatment approach. Treat active acne before starting scar procedures.1

Choose treatment for the breakouts, not just the marks

For mild acne, match the active ingredient to the problem.

• Azelaic acid treats acne and can also fade the dark spots left after a breakout.
• Salicylic acid works best on blackheads and whiteheads because it unclogs pores.
• Adapalene is a retinoid that treats blackheads, whiteheads and pimples.
• Benzoyl peroxide is especially useful for mild pimples. Start with 2.5% to reduce irritation.

Choose an active ingredient for its job, not because the bottle has promoted itself to a complete solution. Use one acne product as directed for 6 to 8 weeks without adding another. Apply a thin layer across the whole acne prone area, not only visible pimples, to help prevent the next breakout.4

Keep the rest of the routine simple

• Wash gently twice a day and remove makeup at the end of the day.
• Choose skincare and makeup labeled noncomedogenic, meaning formulated not to clog pores.
• Do not scrub or squeeze spots. Scrubbing can worsen acne, and picking can cause scars.
• Wear SPF 30 or higher sunscreen every day, especially if your routine includes exfoliating acids.

More exfoliation is not the answer to every new bump. Too much acid exfoliation can irritate skin and strip structures that retain water and healthy fats. If you use glycolic acid, begin once or twice weekly at night and increase only if it is not irritating. A simpler routine is easier to keep using, even if it gives the bathroom shelf less to do.6

Could retinol be causing the early breakouts?

If you recently started retinol, pimples can continue during the first couple of months, and skin can initially look worse. Retinol helps prevent clogged pores, but visible improvement takes several weeks. Dryness, itching, burning and peeling are also possible side effects, so new bumps alone are not enough to identify a retinol purge.7

For retinol, patch test first and follow the package or prescriber's directions. General use is at bedtime after gentle cleansing and drying: apply a pea sized amount in a thin layer, avoiding eyes, mouth and nose, then moisturize. Start every other night for the first couple of weeks. Sensitive or allergy prone skin can need an alternative.7

When should you get help?

Effective acne treatment can produce fewer breakouts in 4 to 8 weeks, with clearing around 16 weeks. See a dermatologist for continuing dark marks, deep painful pimples, scarring, or no improvement after several weeks. If you are pregnant or trying to conceive, ask a dermatologist before treating acne yourself.4

Get medical advice for hot, swollen, red skin that could indicate infection, or if acne is affecting your mental health. Prescription treatments can address inflammation, oiliness, bacteria or hormone related acne when shop bought treatment is not enough.3