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Reader question: "Whenever I break out, it always leaves behind a red mark after it clears up. Why does this happen and how can I get rid of it?" —Cady Griffin
Facial redness can happen for many reasons, but if you're turning red in the wake of acne, you're suffering from something called post-inflammatory erythema, often referred to as PIE. And it's usually just as aggravating and stubborn to treat as the original acne itself.
Unfortunately, PIE doesn't discriminate by location—it can impact the face and anywhere else that acne occurs, including the neck, chest, and back. As for the "why" of it all, it's important to know that not all acne is created equal. In fact, there are many different types of acne that have different symptoms and aftereffects. "Acne is either comedonal, the term used for whiteheads and blackheads, or inflammatory, the term used for pimples, pustules, cysts and all red acne lesions," says Loretta Ciraldo MD, FAAD, a board-certified dermatologist in Miami, Fla. and founder of Dr. Loretta skincare.
The latter is what is causing the redness you see after a breakout. "The reddened skin in inflammatory acne is the result of blood moving into the skin of an acne lesion," says Dr. Ciraldo. "It is mostly white blood cells that are responding to trapped dead skin cells, bacteria, debris, and excess oils in the acne lesions as if they were foreign matter, and the blood moves into the area to start a healing process." In other words, that redness is proof of your skin regenerating.
However, this redness is often worsened by acne treatments, and in some cases, product irritation might be the true culprit. "Overworking skin with acne products is often a major contributing factor to pimple redness," says Dr. Ciraldo. "Certain ingredients, including benzoyl peroxide, retinoids, glycolic acid, and other AHAs, can all dry out the skin and promote redness. Products with these actives should not be applied onto skin that is already red, dry, or peeling." If you aren't sure if your redness is natural or the aftermath of product irritation, she recommends dialing down the frequency of application, or trying a lower concentration to see if redness improves.
And whatever you do, don't pick or pop your pimples, which will significantly increase the risk of PIE and trigger more inflammation. It could even take a turn for the worse and lead to post-inflammatory hyperpigmentation (PIH), the brown or dark spots that result from skin trauma. If you struggle with the picking urge (those with excoriation disorder will understand), try slapping on a pimple patch.
Once you've ruled out picking and product irritation from the equation, there are some ways to make the redness less visible.
How to Treat Post-Inflammatory Erythema
Use an ice compress
"If you have a lot of redness, you can apply an ice cube or ice compress to the affected area for 10 minutes," says Dr. Ciraldo. The cold will help to reduce both redness and swelling caused by a blemish. "Follow up the ice facial with a thin film of 1% hydrocortisone cream, which acts by lessening blood flow to inflamed skin," she adds.
Apply soothing, anti-inflammatory ingredients
The right anti-inflammatory ingredients work by inhibiting the body's negative response and blocking the effects of certain enzymes that contribute to inflammation. So, what ingredients should you be using to combat irritation? Dr. Ciraldo recommends aloe vera, green tea, and other healing ingredients like witch hazel and tiger grass. CBD skincare products might also help—studies found that it interacts with skin receptors to turn down its inflammatory response.
Incorporate a niacinamide serum into your routine
Niacinamide, also known as Vitamin B3, is an anti-inflammatory ingredient that reduces redness. "It can also be beneficial if you're battling PIH since it's a choice brightening ingredient, combating hyperpigmentation by blocking the transfer of pigment from the pigment-producing cells (melanocytes) to the skin cells on the surface where discoloration is visible," says Kenneth Howe, MD, board-certified dermatologist at UnionDerm in New York City. To reap the maximum benefit of the ingredient, look for a high-potency niacinamide serum, like Paula's Choice Clinical Niacinamide 20% Treatment ($50; sephora.com).
Invest in an LED face mask
LED face masks help treat a variety of different skin concerns, such as firming the skin, combating wrinkles, reducing inflammation, preventing breakouts, and regulating oil production. In the case of acne redness, a combination of blue and red LED light can help. "Because red light has also been shown to reduce the production of cytokines, which cause inflammation, it is commonly used in combination with blue light to manage inflammatory conditions like acne and rosacea," says Rachel Maiman, MD, board-certified dermatologist at Marmur Medical.
Talk to your doctor about prescription medication
If you have very severe cystic acne that is causing widespread redness, you can talk to your doctor about tretinoin (i.e., Retin-A Micro, Refissa, or Retin-A). This is an effective treatment for reducing bacteria on the skin and soothing inflammation (it works by exfoliating and stimulating cell turnover), but it is stronger than your standard medication and requires a conversation and prescription from a specialist.
Look into a laser treatment
Although it's a pricier treatment, lasers (specifically PDL, IPL, and KTP lasers) can be used to expedite the clearing of redness by targeting blood vessels. While you may see improvement from one session, take into account that it could take several sessions to achieve desired results.