The Best Tips for Clear Skin
Top dermatologists weigh in on what really works to get a flawless complexion.
Historically, the premier hormonal mediator has always been the birth control pill, which works by replacing the hormones your ovaries are producing with synthetic varieties that won't stimulate those pesky sebaceous glands as much. But this doesn't have to be your first line of defense. Marmur points out that while the Pill may clear up acne, it can also provoke another unsightly reaction: melasma, a noticeable discoloration of the skin that she says is on par with acne in her practice as a top complexion complaint.
If you do opt for the Pill, figure out an exit strategy first. "Birth control pills can be very effective. But eight or nine times out of ten, when you stop them you are right back where you started," says Bank, who's a big fan of the controversial Accutane, the prescription-only vitamin A–derived pill, because it continues to work after you stop using it. "Accutane is still, hands-down, our most effective, lasting antipimple medication," he says. "My Accutane-treated patients are among the happiest and most grateful patients." Although an Accutane prescription comes with significant FDA regulation (because of possible birth defects, patients have to agree to use two forms of birth control and undergo regular pregnancy tests during treatment and for one month after), most of the derms we interviewed believe it to be worth the trouble. Downie calls Accutane "the be-all end-all for really bad cystic acne," and Mariwalla says it is phenomenal: "After you stop the medication, many people have a durable response for many, many years."
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Gold-standard topical acne fighters such as retinoids, benzoyl peroxide, and salicylic acid remain the solutions most frequently name-checked by our dermatologists; what's new are the streamlined formulas, delivery systems, and accompanying ingredients. "Old medications are being revived by novel combinations," says North Carolina dermatologist Zoe Draelos, MD. She cites prescriptions like Ziana, a blend of the antibiotic clindamycin and the retinoid tretinoin, and Epiduo, which contains another retinoid, adapalene, plus benzoyl peroxide.