Most acne scars are not true scars and aren't permanent. Post-pimple marks are pink, red or brown spots that will fade with time and can be covered by makeup. Pink or red marks should fade in 3 to 4 months.

Dark brown marks can last 6 months to a year or longer. These are caused by the melanin pigment in the dermis found in cells called melanophages. These scavenger-like cells remain behind to clean up the pus and mess caused by papules and pustules. The challenge in treating these medically is penetration to the depth of the upper dermis, where melanophages reside. The darker your skin, the darker the spots will be. They can be treated painlessly with skin lighteners containing hydroquinone, which does not affect the normal skin color.

Superficial scarring, such as small, shallow depressions, can be improved with topical retinoids, available over-the-counter and in prescription medications. If caught early, these depressed, shallow scars may respond to microdermabrasion, which helps stimulate collagen production. There are over-the-counter microdermabrasion products, or you can have it done professionally. At minimum, 6 to 8 treatments performed on a weekly basis is necessary to see any results.

Treatment of more serious acne scars

Shallow, sunken depressions in the skin with fairly smooth edges, and sunken depressions with ragged, uneven edges are known as Dell scars. Several treatments with microdermabrasion can soften the ragged-edge scars a bit. Laser resurfacing with a CO2 laser or radiofrequency treatments have shown promising results for long-term improvement of these scars. Areas of sunken depression may be filled with materials such as bovine (cow) or human collagen. For deep depressions, there are permanent fillers which serve as something like Bondo does on dents in a car. If you decide on this option, discuss it with the doctor and make sure you understand the pros and cons - if the filler fails, it can leave an even bigger depression and larger scar than you had originally.

The scars usually found on the cheeks are called ice-pick scars, because of their appearance - they look like someone has taken an ice pick to the skin. They're small, deep holes with jagged edges and steep sides. These can evolve over time into depressed fibrotic scars, which also have sharp edges and steep sides, but are larger and firmer at their base than ice-pick scars. These scars are difficult to treat, unfortunately. They require surgery, either cutting out the hole and sewing the sides together, or transplanting skin from behind the ear to fill in the hole, then lasering the entire area so it blends in with the surrounding skin.

Severe cystic acne scarring can result in sinus tracts, leaving spaghetti-like tunnels under the skin that connect one sebaceous gland to another. These pull down and tether the skin. Extensive surgery to remove these tracts may lead to further scarring and increase the likelihood that new cysts will form in these damaged areas. If you have this type of scarring, seek out an accomplished specialist with references for performing surgery on these types of scars.

You can see from the above that scarring can be difficult to remove, which is why the primary goal of most dermatologists is to prevent scarring. If your acne is progressing to the severe stage and home remedies and over-the-counter treatments aren't working for you, see a dermatologist immediately.

The clinical (medical) definition of sensitive skin is skin that has a noticeable reaction with product application. The product can be ANY product, including prescription and over-the-counter. If the skin turns red, itches, tingles or burns (any one, anycombination or all four), it is classified as clinically sensitive skin.

What causes sensitive skin?

There are two causes of sensitive skin: environment and genetics.

Environmental factors causing sensitive skin are usually product-based. Every product you use on your skin contains numerous ingredients. The more products you use, the more ingredients you're exposed to, and the more likely you are to create a sensitive skin response. Stripping your skin of its barrier function through multiple product use often results in irritated skin.

Genetic factors are more complex. One-fifth of babies develop eczema (atopic dermatitis) within the first 6 months. Other symptoms may include allergies, asthma and hayfever. By the age of 12, most children outgrow atopic dermatitis. However, their skin may remain somewhat immunologically compromise and their risk of developing skin sensitivities is greater. Adults with a history of childhood eczema are prone to eyelid dermatitis, hand eczema and tiny red bumps on the backs of their arms (known as keratosis pilaris). They may also be intolerant of some topical acne preparations.

About sensitive skin

"Sensitive skin" is a term often incorrectly applied by those who have experienced some sort of irritation from a skin care product. As a result, we find many cosmetic companies have product lines specifically for sensitive skin. These do not contain well-known irritating agents. While you may benefit from using these products, it doesn't necessarily follow that you meet the medical definition of sensitive skin.

The medical definition is more precise. There is a lot of variation in how sensitive skin reactions appear; there may be redness, tightness, dryness and blemishes. There may also be blotchiness, dry patches, itching and stinging. Sensitive skin has been classified into four general categories.

Type 1: Redness associated with diet, alcohol, stress, emotion and temperature changes. The medical term for this is rosacea, and it is believed to be a genetic condition.

Type 2: Redness, scaling and tightness associated with environmental factors, such as cold, wind, air conditioning and excessive heat.

Type 3: Redness, tightness, stinging and small papules associated with cosmetic use, soap and detergents, and hard water.

Type 4: Red patches associated with hormonal changes, such as the menstrual cycle.

How to care for sensitive skin

If you believe your skin is sensitive, read labels and use caution with new products. And remember that your skin covers your entire body - not just your face. Use fragrance-free and hypoallergenic products with the fewest number of ingredients.

If you have been able to identify an ingredient you know causes irritation, it makes sense (of course!) to avoid any product that contains that ingredient. Keep in mind that ingredients are listed in order of the quantity of that ingredient in the product; if the ingredient is at the top of the list, its volume is most likely sufficient to cause irritation. If it's at the bottom of the list, your skin may be able to tolerate it, but proceed with caution. Always do a patch test first.

The texture, pore size and oiliness/dryness of your skin is largely determined by genes, and regulated by hormones. There's nothing you can do about your body's natural inclination to be oily or dry; all you can do is recognize the skin type you possess and do whatever is necessary to regulate nature.

Your skin also changes as you age. While you might have oily skin as a teenager, you may have dry skin as an adult. As these changes take place, you need to recognize them and alter your skin care regimen accordingly. The routine that serves well during teen years may actually be damaging in someone past their 30s.

What if my skin is mostly dry?

You can still have dry skin, even if it's covered with acne. It's a common notion that the best form of treatment is to strip all oil from the skin, or that acne is caused by an excess of oil. That is not the case, however. Acne has its causes in several factors and stripping the skin of what is perceived as excessive oil causing acne can produce nothing more than skin that is parched, irritated and more susceptible to infection. Don't indiscriminately strip your skin of excess oil until you understand the types of acne, which type you are and what treatment plan is best.

If your skin is mostly dry, humectant agents, or moisturizers, can help relieve dryness. A humidifier in the bedroom at night can also help, especially if you live where the weather is very dry, or you have an air conditioning or forced air heating system that zaps the moisture out of your skin. Some medications also dry out the skin; if you just started taking a new medication and notice a change in your skin, ask the prescribing physician if the medication is known to have dry skin as a side effect.

What if my skin is mostly oily?

Most of us have probably experienced those teenager years when we were quite certain we could've provided all the oil necessary for the french fryer at the local hangout. Women are especially susceptible, due the skin's sensitivity to changes in hormones. Oil production constantly changes; again, it isn't the root cause of acne. You can have oily skin and terrible acne, or oily skin and acne.

Living in a hot, humid climate will stimulate oil gland production, Exercise, stress and hormones such as testosterone and DHEA-S will also increase oil flow. Loose,k oil-free powders and medicated clay-based masks will help. Remember that excessive stripping of lubrication may actually increase production of oil, as your glands respond to perceived dryness.

Combination Skin and the T Zone

In reality, almost everyone has combination skin. The greatest density of oil glands is in what is known as the "T zone," so called because it comprises a "T" shape of the forehead, down the nose, and ending at the chin. Even if you have oily skin in the T zone, you are likely to have dry skin elsewhere.

Once you've made yourself aware of the different types of skin, it makes it easier to work out a plan to get rid of your acne.

Skin has an almost magical ability to repair itself, which we seem to take for granted. It constantly replenishes itself. It covers an amazing 20 square feet and is 15% of our total body weight. In the three layers of one square inch of skin, you'll find 19 yards of blood vessels, 65 hairs, 78 yards of nerves, 100 sebaceous glands, 650 sweat glands, 1300 nerve endings, 20,000 sensory cells, 129,040 pores and 9.5 million pores.

Your skin's top layer - the epidermis

This microscopically thin layer of your skin is a mere 7 to 10 cells thick; in a young adult, it completely renews itself every 28 days. Almost 95% of this layer is composed of new cells called keratinocytes. The rest (5%) is made up of cells that product melanin, which gives your skin color, and Langerhan cells, which work with the immune system to help fight infections. The renewal rate of the epidermis diminishes with age. As a result, the pores pack up with dead skin cells, which makes them look larger. This slowing down with age is also the reason for the epidermis being less resiliant and bright as we get older.

Your skin's middle layer - the dermis

Most of the skin's volume is found in the middle layer. The dermis is composed of collagen and elastin fibers; nerve endings that sense temperature and pressure; blood vessels that supply nutrients to keep everything replenished and renewed; sweat glands, which function to cool you down; muscles that contract and cause you to "shiver" and make your hand "stand up;" hair follicles, and oil glands. However pesky you may find them when you're having an outbreak of acne, you can't live without oil glands. They produce the sebum that keeps your skin soft, pliable and waterproof.

Your skin's bottom layer - the subcutaneous layer

In this layer there are lots of fat cells. These provide insulation and protection for your fragile organs. Rooted in these fat cells are most of your hair follicles. The hair follicle and attached sebaceous, or oil, gland share space in what is known as the pilosebaceous gland. The pore is the passage from the base of the hair follicle to the surface of the skin (the epidermis). Sebum is an oily substance composed of free fatty acids, cholesterol, triglycerides and wax. It is released from the gland, into the pore and travels to the skin's surface to keep it pliable and protected. Without sebum, your skin would be dry and itchy.

Understanding this vital organ

It's important to understand how your skin works and what can go wrong with it, just as it's important to understand how any other organ in your body works. We tend to take our skin for granted, not realizing that it is an organ performing functions just as vital to our health as our hearts, lungs and other organs. Knowing how skin works is the first step to understanding the causes of acne and how to reduce or prevent outbreaks of acne.

Adult Acne Treatment

• Pay attention to the amount of water you drink every day. You only get to count water! Coffee, tea, soft drinks, flavored drinks – don’t count. There’s nothing better for you than just plain water. Add some lemon to it for a little flavor, but try and drink more water. If you are taking diuretic medication, talk with the prescribing physician, but in most cases you are still expected to take in plenty of water, even when taking diuretics.
• Watch what you eat. Avoid caffeine, sugar and refined carbohydrates, as well as processed foods. Eat more fresh fruits and vegetables. Vegetables are best for you when they are raw or just lightly steamed.
• Do your best to banish blackheads before they become inflamed and break out as full-blown acne. In addition to thorough daily cleansing, two to three times a week, use an exfoliating scrub in the shower, such as a loofah, and a salicylic acid cleanser or alpha-hydroxy acid exfoliant. Don’t go crazy – gentle scrubbing is all you need, and consistent application. These chemical products work better to clean out pores than most scrubs. Ask for someone in your home to assist you if you have back acne that you can’t reach with a long-handle scrubbie.
• Moisturizer is not bad for acne, but be careful what kind you use. Try non-acnegenic or oil-free moisturizers and apply after bathing or showering.
• If you are experiencing severe back and chest acne, consider changing your laundry routine. Your skin may be irritated by the soap you use, or by inadequate rinsing. Try a gentler laundry soap and run an extra rinse cycle.
• Speaking of clothing – if you work out, try buying workout clothes that have a wicking effect and draw the moisture away from your skin as you work out. This may help reduce breakouts. Wash after every workout and wash all your other clothes frequently, as well. You want what touches your skin to be clean, and as dry as possible.

Four skin factors that lead to acne

1. Clogged pores: Normally, skin cells are in a constant state of gradual renewal. As old cells die, they mix with your skin's natural oils and are sloughed off, making room for fresh, new skin every 30 days. However, this process of shedding dead cells doesn't always happen as it should. Sometimes, the skin cells don't shed evenly or the cell turnover slows down. When that happens, skin cells become "sticky." When they combine with the natural oils of your skin, they clog your pores. A plug called a comedo is formed inside the hair follicle and acts like a cork on a bottle. This plug traps oil and bacteria in the follicle.
2. Overproduction of oil (sebum): Hormones stimulate oil production in the sebaceous glands, which are attached to hair follicles. Normally, the oil flows freely to the surface of your skin. If your hormones tell your sebaceous glands to pick up production, they'll churn out sticky oil, which results in potentially clogged pores that then create an environment for the growth of bacteria.
3. Bacterial attack: Once your pores are clogged, bacteria that is normally growing on your skin starts feeding on the trapped oil. Like all bacteria, it feeds on the oxygen-free atmosphere and moisture. It digests the entrapped sebum, breaking the oil molecules down into smaller particles. When these broken-down oil molecules leak outside the follicle, it generates a response in your body.
4. Inflammation: The body's response to  any proliferation of bacteria is to send an army of red and white blood cells to fight the infection. These cells attempt to wall off the follicle, with the result being the swelling, inflammation and pain that we call pimples.

The different types of acne, or comedones

Although all acne starts the same way, the lesions produced look different on your skin.

Whiteheads: If the plug stays below the surface of the skin, it's called a closed comedo, or a whitehead. The white debris is trapped sebum and dead white blood cells.

Blackheads: If a plug enlarges and widens the pore, it's called an open comedo, or blackhead. Blackheads are not caused by trapped dirt, even though that's what they look like, and you can't simply wash them away. The black spots are from a buildup of melanin, the pigment that colors your skin, and oxidized oil.

Papules: These types of acne are small, pink, domed bumps that are tender to the touch.

Pustules: These are small, round, pus-filled lesions. They appear swollen and red at the base, with a yellowish to whitish center.

Nodules and Cysts: These are large, deep and painful bumps filled initially with blood, then with pus. Persistent nodules can harden into deep cysts, and both may leave deep scars.

Genetic disposition to acne

There's absolutely nothing you can do about your genetic makeup. If you are wondering if you're genetically prone to develop acne, interview your blood relatives. If there is a family history of moderate-to-severe acne, you are at the greatest risk for having a genetic disposition for acne, with onset most often in the early teen years.

Your genetic makeup may make it is easier for the P. acnes bacteria to proliferate on your skin. Your body may be more inclined to produce a swelling response to the bacteria. You may produce more oil. Your pores may plug more easily. Your skin cells may turn over at a slower rate for your age. These contributing factors to acne are all determined by your genetic makeup. In addition, if both your parents have had significant acne, your risks for developing acne is also very high.

Acne and hormones

Hormones are another genetic factor affecting the development of acne. For women, hormones regulate changes throughout her lifetime. Fluctuations in estrogen levels (and androgen levels) can cause acne. As a result, many women experience outbreaks in conjunction with their menstrual cycles. The flood of hormones released by the body during and after pregnancy can also cause acne. And, just when you thought you were too old for acne, you find that the erratic estrogen levels during perimenopause and menopause can cause yet more acne, once again.

During puberty, everyone begins to produce androgenic hormones. One of the things these hormones do is cause the sebaceous glands to enlarge. The rate at which the body produces sebum, or oil, is affected by hormone levels. Too much oil stimulation, causing sticky oil and too little shedding of dead skin cells - and the next thing you know, your face is populated with a new acne outbreak. These hormones fluctuate during puberty, which is why almost all teens suffer from some form of acne.

Other factors that cause acne

One of the most important contributing factors to acne is stress. If I remember my years of puberty accurately, they were loaded with stress - some of it caused by the acne itself, an ironic catch-22. The reason for this is that stress hormones are released by the body to deal with stress, triggering increased oil production by the sebaceous glands. In addition, stress delays wound healing, so the breakouts last longer.

Environment is another factor in acne outbreaks. Pollution, exposure to oil or grease, dry air, and high humidity all have an effect on your skin and play a part in acne outbreaks. Put a teen in front of a fryer for a couple of hours after school every day and you can pretty much take bets on the next outbreak of acne.

A variety of over-the-counter and prescription medications may have side effects that affect your body's chemistry, leading to changes in hormones that instigate acne. These include any drugs regulating or stimulating androgenic hormones (which is why athletes using corticosteroids, legal of otherwise, typically have a lot of acne), phenobarbital and some other anti-epileptic drugs.

If your mother keeps telling you to keep your hands off your face, she has a good reason - excessive rubbing or irritation to the skin can lead to acne. Holding the telephone too close to your face, sweating in a football or bicycle helmet, a backwards baseball cap with the strap pressing on your forehead - all these can lead to acne outbreaks. If you hold a cell phone to one side of your face, you may notice you break out more on that side. Even the strap of a purse can cause an outbreak on your shoulder.

If you are having problems with acne, use cosmetics, sunscreens and moisturizers that are noncomedogenic. This means they have been specifically formulated so they don't contain ingredients known to cause acne. Otherwise, they may irritate your skin and clog your pores.

With careful attention to the causes of acne that you CAN control, you can reduce the problems caused by the factors you CANNOT control.