Common Skin Conditions and What to Do About Them

This is the chapter where we get specific.

In my office, most people aren't coming in with a general "I want better skin" complaint. They're coming in with something concrete. Acne that won't quit. Redness that flushes at every meal. Brown patches that appeared after pregnancy and never left. Skin that itches and flares for no clear reason. These are the conditions I treat all day, and they're where good information matters most.

I'm going to walk you through the conditions I see most often. For each one, I'll cover what's actually happening, what you can do at home, when to see a professional, and what's worth knowing about the deeper or more aggressive treatments.

A note before we start. If something on your skin is changing rapidly, painful, bleeding, asymmetric, growing, or just feels wrong to you, skip the home treatment and go see someone. A book is not a substitute for an in-person exam, and some of what looks like a "skin condition" is something more serious that needs an expert eye.

Acne

Acne happens when oil, dead skin cells, and bacteria combine inside a pore. The body sees the trapped contents as an invader and inflames the surrounding tissue. That's the pimple.

There are different types, and the type matters because the treatment differs.

Comedonal acne is the non-inflamed kind. Blackheads (open comedones) and whiteheads (closed comedones). Caused mostly by congestion and slow cell turnover. Responds well to retinoids and salicylic acid.

Inflammatory acne is the angry red bumps and pustules. Caused by bacteria triggering an inflammatory response inside a clogged pore. Responds to retinoids, benzoyl peroxide, and sometimes antibiotics.

Cystic or nodular acne is the deep, painful, often scarring kind. Often hormonal in adults. Topicals alone usually aren't enough. This category often needs prescription help.

Hormonal acne isn't a separate type by mechanism, but by trigger. It's typically inflammatory or cystic, located along the jawline, chin, and lower face, and flares cyclically with menstrual cycles. Common in women in their twenties through forties. Often resistant to topical treatments alone.

What to try at home, in order:

Start with a salicylic acid cleanser or treatment. Two percent salicylic acid two or three times a week to start, then daily as tolerated. If you can also tolerate it, add an adapalene gel at night. Adapalene (the over-the-counter retinoid I mentioned earlier) is genuinely transformative for many acne patients and costs about fifteen dollars at any drugstore. Give it three months before judging it.

If you're still breaking out after twelve weeks of consistent use, or if you have cystic or hormonal acne, see a provider. There are several escalations available.

Prescription topicals include stronger retinoids (tretinoin, tazarotene), topical antibiotics (clindamycin), benzoyl peroxide at higher strengths, and combination products.

Oral options include antibiotics like doxycycline (for inflammatory acne, short-term), spironolactone (for hormonal acne in women, often a meaningful shift), oral contraceptives (specific formulations help hormonal acne), and isotretinoin (Accutane, for severe or treatment-resistant acne, a powerful option with real side effects).

A common mistake I see is people fighting acne with harsh products that strip the skin and make everything worse. A wrecked barrier produces more oil, more inflammation, and more breakouts. If your skin is acneic and also tight, flaking, and irritated, the problem isn't that you need to be more aggressive. It's that you've been too aggressive. Back off, repair, and reintroduce slowly.

One more note: please stop picking. I know. I know. But every pimple you pop has a fifty-fifty chance of leaving either a scar or post-inflammatory hyperpigmentation that takes six to twelve months to fade. The picking is making the long-term problem worse than the short-term one.

Rosacea