If you feel like your acne is getting out of control, it’s human nature to want to break out the big guns (or prescriptions, as the case may be). But before you go Googling how to get your hands on some Accutane, let’s back up a minute and talk about ways you can manage breakouts before making a doctor’s appointment.

According to our founder Dr. Sandra Lee (aka Dr. Pimple Popper), there are a few key active ingredients available over the counter that are highly effective in treating and preventing acne. Here, we break down her best advice: what to try first, and when it’s time to call a professional.

4 signs you should see a dermatologist for your acne

#1 You’ve tried a combination of over the counter acne treatments

Breakouts might seem sudden, but they’re not: behind the scenes, pores first need to fill with sebum and dead skin to become comedones. It may stop there, with blackheads and whiteheads, or it may progress to inflammation as C. acnes bacteria moves in to cause full-fledged pimples.

When you’re experiencing active acne, it’s important to address every stage of this process, to stop the cycle. Dr. Lee suggests trying a combination of dermatological acne-fighting ingredients:

• Beta hydroxy acid: start using a product like SLMD Salicylic Acid Cleanser, along with regular use of AHA/BHA Swipes. This will help keep pores clear and minimize existing non-inflammatory acne.
• Retinol: add this acne-fighting essential to your nighttime routine to reduce the likelihood of pore-clogging skin cell buildup. It also helps calm skin’s immune response (and has well-aging properties, to boot). Try Retinol Resurfacing Serum, with a gentle, time-released formula.
• Antimicrobials: If you’ve got inflamed, red pimples — papules, pustules, nodules and/or cysts — then you need to add an antibacterial, like benzoyl peroxide. SLMD Benzoyl Peroxide Acne Lotion kills C. acnes bacteria, helping to calm your skin’s immune response and reduce breakouts. If you’re sensitive to benzoyl peroxide, try mineral-based Sulfur Lotion instead.

Finding the right combination of ingredients and formulas can be intimidating, which is a main reason why Dr. Lee created her Acne System — so there’s no guesswork involved. It’s three steps, including a moisturizer, to make sure the skin barrier stays healthy during treatment. 

#2 You’ve stuck with your acne regimen for at least 3 months

Yes, you read that right: it can take about twelve weeks to see the impact of dermatological acne treatments. In fact, some research indicates that the full results of using retinoids can take up to a year. While we don’t suggest you wait that long if your condition isn’t improving, it does illustrate that patience is key.

So why does it take so long? Because of the process we detailed above — we know that pimples have a life cycle which begins long before you experience any noticeable symptoms. Pores that are turning into comedones, and eventually, inflammatory pimples, take time to resolve.

Another possible factor to consider is skin purgingg: the temporary surge in acne that can occur as deeper layers of skin quickly come to the surface. Using retinoids or alpha and beta hydroxy acids helps shed older skin cells to reveal the skin beneath, which may be harboring comedones or early stage inflammatory acne. Sometimes referred to as acne flaring, the phenomenon typically begins a couple of weeks into a new routine, and should subside around the one month mark.

#3 Your acne is creating scars

There are basically two ways that pimples can leave a permanent mark:

• If they’re inflamed and/or deep in the dermis. Nodular and cystic acne occur when bacteria breaches the wall of the pore, inciting an immune response. Damage to the surrounding skin structure can lead to scarring.
• If you pick your pimples, regardless of the type. Squeezing, picking and popping comedones and/or inflammatory pimples can create a more serious wound and spread bacteria — both of which can generate a scar.

If you’re experiencing inflammatory acne, it’s important to start a comprehensive regimen (like SLMD Acne System) and to spot treat with benzoyl peroxide (like BP Acne Spot Treatment), to minimize the chances of scarring. If you have a tendency to pick, covering pimples with Salicylic Acid Pimple Patches will help heal while keeping your fingers away.

While your pimples are healing, you may also experience a condition that Dr. Lee sees all the time, known as post-inflammatory hyperpigmentation (PIH). This happens when your skin deposits excess melanin pigment in response to trauma. The good news is that PIH typically heals well on its own, without the need for a dermatologist visit. Certain ingredients like retinol and kojic acid can help minimize the look of breakout-related dark marks. Use sunscreen to prevent further damage.

#4 Your self esteem is suffering

Studies show that a significant percentage of acne patients experience some form of mental health decline — anxiety, depression, and the like — as a direct result of their condition. And unfortunately, stress can trigger more breakouts, resulting in a self-perpetuating cycle.

But thanks in part to social media and figures like Dr. Pimple Popper, we’re finally beginning to normalize common skin conditions like acne. Even still, breakouts can affect our self-confidence. Taking control of your acne, by educating yourself and following a consistent routine, can help bolster your emotional well-being as you begin your skincare journey.

What to do if you don’t have access to a dermatologist

So you’ve tried all the right ingredients, given them enough of a chance, and your acne still hasn’t cleared? Time to make that appointment with the dermatologist. But what happens when they’re booking months in advance, or if your medical plan makes things difficult? Don’t despair, says Dr. Lee — there are still some things you can try:

• Channel your inner Dr. Pimple Popper. A good dermatologist will take the time to get to know you: your family and medical history, as well as any lifestyle choices that may be impacting your skin health. Becoming your own dermatological detective — examining things like stress, sleep, even your cosmetics — may lead you to a skin health breakthrough.
• Pay a visit to your primary care doctor instead. Your general practitioner can help rule out any underlying medical conditions that may be causing your breakouts, such as perimenopause, or polycystic ovary syndrome (PCOS). From there, a physician can prescribe the best course of action — including some topical or oral medications if necessary.
• Find a healthy skin support community. One of the beautiful things about social technologies is the ability to connect with people who are experiencing similar challenges. Seeking out a group on social media can be a source of information, support and encouragement along your journey.