The Ultimate Everything-You-Need-to-Know Guide to Acne




Dr. Neal Schultz is one of the most highly regarded dermatologists in the country. He has been repeatedly featured within the “Best Doctors” lists in New York Magazine, and he's the founder of, where he has posted over 500 videos covering pretty much every skin-related topic imaginable. A few months ago, we asked him to fill us in on the ins and outs of sun protection and now we turned to him once again to get an everything guide to acne.

theFashionSpot: What are some of the best things people can do to prevent acne?

Dr. Neal Shultz: Regular washing and toning with cleanser and toner for acne prone/oily skin and daily exfoliation with chemical exfoliants such as glycolic or salicylic acid; I believe glycolic works better. Also, while most foods don’t cause acne, avoiding foods high in iodine and any other food that has consistently caused breakouts. Make sure you're not sleeping with makeup on regularly, avoiding ALL oil-based products.

tFS: Is there a difference in teen versus adult acne?

NS: No.

tFS: What's the difference between salicylic acid, sulfur, and benzoyl peroxide — and can they work together?

NS: Salicylic acid is strictly an exfoliant to help unclog your pores. Sulfur reduces inflammation and helps heal inflammatory pimples (not blackhead or whiteheads), so it's often used as a spot treatment. Benzoyl peroxide is a combination antibiotic and exfoliant so it’s very effective and yes, they can all be used by the same patient, but not at the same time on the same pimples.

tFS: What's the deal with Accutane?  

NS: The original manufacturer stopped making it because of legal constraints in the U.S. Now other manufacturers have reintroduced it under other brand names.

tFS: Is it something you recommend given the dangers? 

NS: Definitely YES… It’s one of the miracle drugs of the 20th century; it not only cures acne but changes peoples lives! Accutane, like other potent medicine, has side effects. But there are really only two that are “dangerous.” They concern pregnancy and the alleged causation of depression. Any woman that becomes pregnant while on Accutane unfortunately must terminate that pregnancy because Accutane will cause a deformed baby, however, that risk goes away a month after finishing Acctuane. The controversy surrounding depression is much more difficult to conclude. Certainly anybody that is a candidate for Accutane and has a history of depression or is taking medicine for depression should consult with the physician who is treating that depression, but I know one thing for sure: Accutane stops acne. Bad acne causes depression, and as far as I’m concerned, Accutane relieves depression.

tFS: Are there textures that are more effective than others (pads versus lotion for example)?

NS: That’s a personal preference, but pads are great for treating large areas and have the added benefit of providing a small amount of physical exfoliation.

tFS: Can you talk to us a little bit about how to find acne-friendly products?

NS: By definition, if you have acne or are prone to acne breakouts, you have oily skin and if you have oily skin, then the last thing that you would want to do is to put oil-containing products on your skin. When you go to buy skincare products, look for "water based." Water based means that it is mostly water so there is very little or no oil in it. The second term you want to look for is the self-explanatory "oil free." Oil free is oil free, which is just what you want. The third term is "non-clogging." This means it has been shown to not clog pores and therefore it should not cause breakouts. The last term is the confusing one: it’s called "non-comedogenic." A comedone is a blackhead or a whitehead and something that is comedogenic causes them (conversely, something that is non-comedogenic has been tested and demonstrated to not clog pores). So the next time you go to buy products for your skin, if you are prone to acne, make sure they are labeled water based, oil free, non-clogging or non-comedogenic.

tFS: Sweating can often aggravate acne. What should we do when working out/sweating?

NS: You’ll probably be surprised to find out that washing your face before you exercise is what’s so very important in trying to prevent acne breakouts from sweating during exercise. Nobody would dispute that exercise is terrific for your body, your heart and your mind, but one thing’s for sure, the sweating that occurs is annoying. So what do we do? Of course, we wipe it away and when we wipe it away, that motion is fast and it’s not gentle and effectively what it does is grinds any makeup, dirt, debris or oil that’s on the skin into the pores. In doing that, you promote clogs and acne breakouts. The best way to prevent this is to make sure that before you exercise, you take off your makeup and wash your face thoroughly and then tone it thoroughly to make sure that you removed all of the makeup, oil, dirt and debris so that when you do wipe your perspiration away, you won’t clog your pores or cause acne breakouts.

tFS: What are the dietary and psychological factors that can affect acne?

NS: We’ve all heard about the traditional forbidden foods like chocolate, nuts, caffeine, colas, fried foods, pizza… The reality? When you do well-controlled, statistically valid studies, those foods don’t cause acne. Some people, however, come in and tell me "when I eat chocolate, I break out," and I tell that patient, of course, you obviously can’t eat chocolate. But at this point in your life, if you haven’t noticed a relationship between eating those foods and breaking out with pimples the next day, then there probably is no relationship. The only exception is iodine and iodine is contained in shellfish, lobster, shrimp, crabmeat and certain green vegetables that come out of the ocean like seaweed, spinach, kelp and certain medications like thyroid medications. Iodine will cause acne, but not the day after you eat it. It’s the accumulation of eating these foods day after day that suddenly causes acne.

In terms of psychological factors, anything that causes stress makes acne worse, more so in females than males. The stress organ, called the adrenal gland, secretes the hormones called cortisone, which helps your body fight stress. Each time your adrenal gland secretes cortisone, it also leaks out a little bit of male hormone, testosterone, which increases oil production and thereby increases acne. The reason women are affected by this much more than men is because women normally have such a small amount of male hormone in their blood that the small amount that leaks out with the cortisone represents a meaningful increase in women’s blood testosterone level.