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The Clear-Skin Makeover

GENTLER AT-HOME REGIMENS continued...

What you did then: Slathered 10 percent–benzoyl peroxide (BP) creams on zits
What you should do now: Keep on slathering — but with a 2.5 percent cream. BP is the best fast-acting acne healer, says Boston dermatologist Jeffrey Dover, M.D. Higher strengths can irritate dry skin, but studies have shown that the milder version works just as well. Try Skin Effects Acne Spot Treatment ($10, CVS) or Proactiv Repairing Lotion ($22, 800-950-4695). Apply in the morning, just to problem areas. If you suffer from stress or period pimples, use BP on known breakout spots for a week or two prior, as a preventive measure. And since adult acne tends to manifest as deeper, inflamed pimples, Doris Day, M.D., a New York City dermatologist, also recommends applying a 1 percent cortisone cream like Cortaid ($9, drugstores) after BP twice a day to calm redness.

What you did then: Swore off all moisturizers
What you should do now: Use oil-free lotions to smooth skin and reduce the look of lines. Apply one with sunscreen over your BP treatment in the morning — Olay Complete All Day Moisture Lotion with SPF 15 ($7, drugstores) is a good choice. At night, choose retinol to exfoliate skin and soften lines. Try Neutrogena Healthy Skin Anti-Wrinkle Anti-Blemish Cream ($13, drugstores). Since alpha hydroxy acids and benzoyl peroxide can reduce the efficacy of retinols (and their prescription cousins, the retinoids), make retinol your only P.M. treatment — or wait 10 minutes before layering on top of it.

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If you haven’t seen results from your OTC regimen after three months, it’s time to see a dermatologist. “Aging skin doesn’t heal as well and scars more quickly if you don’t get breakouts under control,” warns Dr. Graf. Most doctors will start you off with a retinoid to clear pores of dead skin cells. (Retinoids help build collagen, too, which fights lines.) Be sure to apply the treatment at night — retinoids break down in the sun. (You also must use sunscreen religiously.) The doctor may also prescribe a topical antibiotic such as clindamycin to destroy acne-causing bacteria.

If six to eight weeks of prescription topicals don’t clear up skin, oral antibiotics may be next, along with continued use of a retinoid. Since hormone fluctuations can bring on breakouts, low-dose birth control pills are another option. “They work to improve the skin in about one-third of women,” says Dr. Fried. (He often recommends a hormone test to women who suddenly start breaking out as adults.) If you’re still seeing severe outbreaks after several months, talk to your doctor about oral isotretinoin (common brand: Accutane). “It’s a magnificent medicine; it clears up almost everyone,” says Dr. Fried. Side effects, however, can be significant, ranging from dry skin to, more rarely, depression. And the link to serious birth defects means that you have to use two forms of contraception during treatment and take monthly pregnancy tests.

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