There is probably no single disease which causes more psychic
trauma, more maladjustment between parents and children,
more general insecurity and feeling of inferiority and greater
sums of psychic suffering than does acne vulgaris." (Sulzberger)
The words of Marion Sulzberger, one of the great dermatologists of the past, expresses my feelings about acne. I feel that it is the most important disease that I treat and I particularly enjoy treating now because I know that I can clear up a patient’s face 99.9% of the time.
There is nothing more gratifying than to see the emotional changes of an adolescent as their face begins to clear. Teens come to my office on their first visit, sullen, with there eyes on the floor. As their acne improves I see animation in their expressions, I see smiles on their faces and a bright self-confident look in their eyes.
Acne is a common skin condition that afflicts most people, to a varying degree, during the teen years. However, the disease is by no means restricted to this age group; adults in their 20’s to 40’s may have acne. Do not think that because acne is common, treatment is unnecessary. Waiting to “outgrow” acne can be a serious mistake. Medical treatment can improve your appearance and self esteem, and prevent the development of lifelong
scars.
Acne Patients also suffer from the “conspiracy of silence” Because of elegant makeup most patients do not seeother proples acne. They feel they are the only ones with acne.
Rising hormone levels during adolescence, cause enlargement and over activity of the oil glands in the skin. The canals that bring this oil to the surface become blocked with keratin (a protein that is part of the skin). When these oil glands are overactive and the canals are blocked, the bacteria that normally live on the skin and in the oil become trapped. They subsequently multiply, and cause inflammation and irritation.
Cleansing and Cosmetics. Even though you may be told to wash frequently, acne is not a disease caused by improper cleansing. For example, the blackness of a blackhead is not dirt, but is due to the accumulation of the normal skin pigment in the oil glad ducts.
We will recommend a cleanser, or you can wash your face with a mild antibacterial soap twice a day. If one’s skin is very oily, it may be washed more often. Over washing or scrubbing tends to irritate the skin and will make acne worse. Therefore, do not use any abrasive cleaners or cleansing pads.
Shampooing is also important in acne therapy. The oilier your hair is, the more often you should shampoo it. Also, it is best to keep hair off the face as much as possible. Often using a dandruff shampoo is helpful, particularly if you have fine bumps on the forehead. For covering blemishes, many preparations may have been formulated to match skin color. These cosmetics should be water based. Most cosmetics and skin products that are safe to use on acne-
prone skin will say “non-comedogenic”, “oil free”, or “won’t clog pores”. Look for these labels on your facial products. Greasy applications such as Vaseline, cocoa butter, cold cream and vitamin E oil should be avoided. If the face is dry, we can recommend a moisturizer for your skin type.
After your appointment with me, you will be escorted to our Medical Spa where someone there can discuss different skin care lines and makeup that would best suit your skin type. The Spa carries many different pharmaceutical brands that are very popular.
The idea that acne can be brought on by an unhealthy diet has been
debated for years. For the last 30 years the conventional wisdom
has been that diet plays no role in most cases of acne. While
many dermatologist still believe this to be true, another view is
emerging.
Could something in the modern diet be the culprit?
Doctors were surprised to learn that acne is virtually unknown in some remote jungle tribes. Some say yes, because eating the wrong things can cause the release of certain hormones, which can activate the oil glands in your face. High levels of hormones are present in cows milk. The idea that milk is an essential part of everyone’s diet is probably wrong. You can easily get your calcium, vitamin D and protein from other foods, or from supplements. It may take 6 months off all dairy products before significant improvement can be seen, but many patients benefit from a dairy free diet. Another theory blames sugar and excess carbohydrates. These push your body to pump out insulin, which can throw off other hormones as a result. Some over-weight women with acne have hormone imbalances and excess insulin. In these women bringing the insulin level down corrects the hormone levels and acne
While there is no proof sugar and carbohydrates are important in most cases of acne, there is also no doubt sugar and excessive carbohydrates are not good for you. Eating healthy foods is a good idea for acne sufferers.
There are still others who blame particular foods for their acne. Chocolate and nuts are commonly mentioned, but these do not seem to play a role in most people’s acne. The importance of diet may vary between individuals, but the idea that diet plays no role in acne is probably on the way out.
Treating Acne
Acne need not be feared as something untreatable. In recent years many effective forms of therapy have been developed. I want to prevent scars. Years of untreated acne can leave a lifelong imprint on a person’s face causing irreversible emotional trauma. While acne may not be curable, it is usually controllable.
Since acne is affected by many things, I will design an individual approach for each patient. Thus, the course of therapy will vary according to such factors as age, sex, type of acne, its severity and extent, and the patient’s day-to-day activities.
Mild acne is treated with one or a combination of topical medications. The purpose of these is not only to treat existing acne lesions, but to prevent new blemishes from forming. Therefore, these are applied to acne prone areas, not just directly on the present pimples.
In addition, in some people these creams may cause the face to become a little dry, pink or feel taught. This is normal. If your face becomes too irritated or “raw” feeling, do not stop the creams, just decrease the frequency of application (i.e. apply every second of the third day).
Moderate and severe acne is usually treated by topical medicines with the addition of oral antibiotics. Since different combinations work better for some patients than others, you are usually evaluated every four to six weeks until the acne is well controlled. In addition to this conventional therapy, I may recommend one or more of these treatments to speed healing and clearing of your acne.
Acne surgery - This procedure greatly speeds acne clearing and appearance by manually removing blackheads and whiteheads. A round loop extractor is used to apply uniform smooth pressure to dislodge the material. Inserting a pointed instrument to carefully expose the contents loosens lesions that offer resistance. This may be combined with microdermabrasion, which helps to remove dead skin on the face and open up smaller blocked pores. These proc-
edures are performed in our medical spa and are not covered by insurance.
Chemical Peel - Irregular pigmentation of the skin is treated with this technique. A very mild acid is applied to the skin, which caused the outer layer to be removed. Different chemical concentrations are used, depending on ones skin color. In general the desired result is very mild peeling. The goal is not to remove pigment in one treatment. A light peel is used in addition to bleaches, retinoids and sunscreens.
Intralesional Corticosteroid - We use Intralesional Corticosteriod Therapy If one or several painful acne cysts or large pimples develop, fast relief is available with this relatively painless procedure. Each cyst is given a single injection of a dilute cortisone solution, using a very tiny needle. This will give you overnight improvement in your appearance as well as decrease scarring and hyperpigmentaion.
Accutane - is a very safe and effective drug. It will clear up acne virtually 100% of the time and side effects are minimal, usually dry skin and dry lips.
Hormonal Treatments - Since hormones dramatically affect acne, I often use birth control pills to treat acne. There are some other birth control pills approved for acne treatment, like Yaz and Yazmin, but several birth control pills can improve acne. However, some oral contraceptives can worsen acne. If you are taking on of these pills, then a switch to a less androgenic pill usually improves acne.
Spironolactone - is a mild diuretic that blocks certain androgenic hormones that aggravate acne. I will often prescribe this to a woman with acne with or without an oral contraceptive. Unfortunately, males cannot take the hormonal treatments because of possible feminizing side effects.
Light Laser Treatments There is several light and laser based treatments for acne that can be used instead of or in addition to the previously mentioned treatments. Unfortunately, insurance will not cover these services.
Acne Scaring
Treatment of Acne Scaring Prior to correcting acne scaring, it is generally advisable to wait until acne activity has been low or absent for several months. Scars improve with time as the body softens their appearance. The color contrast is often the most troublesome aspect of resolving large acne blemishes. These lesions may leave a flat or depressed red scar that is so obvious, patients mistake the mark for an active lesion. The color will fade and approach normal skin tones in 4 to 12 months. Many patients are self-conscious about the pitted and crater like scars that do not
fade. These remain as a permanent record of previous severe acne. There are a variety of procedures available to you to remove or revise these marks;
Punch Excision and/or Grafting - Some narrow pitted scars are too deep to be removed by dermabrassion. These can be removed with a surgical instrument called a punch. The resulting defect is closed; primarily or with a tiny skin graft, with gratifying results. Sometimes chemical peel or laser resurfacing are used following this procedure.
Filler Injection- Patients with a few soft depressed scars with smooth edges respond well to injection of various fillers. There are fillers available and the choice of filler will be discussed with you.
Treatment of acne is a continuing process if the disorder is to be controlled successfully. You must follow our instructions, since youare the only one who can accomplish the necessary daily care.
If you are willing to spend the time and effort, you can expect a pleasing result.
