Acne Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. These usually appear on the face, neck, back, chest, and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent scarring. What Causes Acne? Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell. Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time. Bacteria called Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect the sebum. This causes the skin to become swollen, red, and painful. Infected sebaceous glands may burst, releasing sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts may form in the deeper _layer_s of the skin. What Are the Different Types of Acne? Acne can be categorized by its severity:    1. Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).    2. Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).    3. Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne can will likely lead to scarring if left untreated. Acne with comedones, foreheadModerate acne with pustules Mild acne with comedones on the forehead      Moderate acne with pustules Who Gets Acne? Anyone can get acne, but it appears most often in teenagers, whose surging levels of androgen (a type of hormone) create larger and more active sebaceous glands. Acne may continue for people in their twenties and thirties, and even women over forty. Acne also appears more commonly in people whose parents had acne. What Factors Make Acne Worse? Acne lesions can come and go. These factors can cause acne to flare:     * Changing hormone levels in women 2 to 7 days before their menstrual period, during pregnancy, or when starting or stopping birth control pills     * Oil from skin products (moisturizers or cosmetics) or grease in the workplace (for example, a kitchen with fry vats)     * Pressure from sports helmets or equipment, backpacks, tight collars, or tight uniforms     * Environmental irritants, such as pollution and high humidity     * Squeezing or picking at blemishes     * Hard scrubbing of the skin What Are The Treatment Options for Acne? Almost all cases of acne can be effectively treated. Treatment goals are to heal existing lesions, stop new lesions from forming, and prevent scarring. Acne treatments aim to control one or more of the underlying causes of acne. For instance, topical retinoids, such as Differin or Retin A Micro, may help unclog sebaceous glands and keep pores open. Antibiotics may be used to fight the P. acnes bacteria. Accutane or hormonal agents, such as birth control pills, may be used to reduce sebum (oil) production.            Before Treatment                           After Treatment Acne, before and after treatment A. Topical medications (applied to the skin) Over the counter     * Benzoyl peroxide—This is found in many products including Clearasil and Proactiv. It is a mild antibiotic that kills the P. acnes bacteria. It is available in different concentrations. Higher concentrations are more likely to irritate the skin. It does not unclog blocked pores so is not as helpful for reducing whiteheads and blackheads.     * Sulfur and salicylic acid—These have some mild ability to break down whiteheads and blackheads. Pre_script_ion     * Topical retinoids (Differin, Retin A Micro, Tazorac, tretinoin)— These are among the most effective and commonly used acne medications. Topical retinoids are unique in their ability to unclog swollen pores. They may be used alone for mild acne or combined with other medications for moderate-to-severe acne. They may also be recommended for long-term use, even after the acne is under control, to keep the skin clear.     * Topical antibiotics—Antibiotics applied to the skin, such as clindamycin (Clindagel) and erythromycin, kill the P. acnes bacteria that leads to inflammation. B. Oral medications (taken by mouth)     * Oral antibiotics—These medications, which include tetracycline, doxycycline (Adoxa, Doryx), and minocycline (Dynacin, Solodyn), act systemically and can reach bacteria in the deep _layer_s of the dermis. They are also used for their anti-inflammatory effects.     * Oral contraceptives (Ortho Tri-Cyclen, Yaz)—For women who experience hormonally triggered acne, birth control pills may be prescribed to reduce sebum production.     * Anti-androgen drugs—Some drugs used for other medical conditions are known to reduce androgen levels, such as spironolactone (Aldactone). These may be used in some cases of acne.     * Isotretinoin (Accutane, Sotret)—Isotretinoin remains the most effective treatment for severe acne or acne that does not respond to other treatments. Isotretinoin treats all causes of acne: excess sebum, clogged pores, bacterial overgrowth, and inflammation. Most patients take the medicine for 15-to-20-week periods that may be repeated if necessary. Treatment requires monthly office visits, monthly lab tests, and strict contraception. It is critical that women of child-bearing age do not get pregnant while taking isotretinoin because of the serious risk of birth defects. The iPledge program was developed to reduce the likelihood of birth defects and other side effects. Many of these medications have side effects, such as burning, redness, and irritation. With some medicines, such as topical retinoids, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away, tell your doctor. C. Procedures For persistent lesions that are inflamed or unresponsive to medications, some doctors recommend additional methods, including extraction, light therapy, or corticosteroid injections. How Will I Choose a Treatment Plan? Your doctor will recommend a treatment _base_d on these factors:     * Severity of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with an oral retinoid (Accutane, Sotret).     * Results of previous treatments. Medications may be added in a step-wise fashion, only if previous treatments are found to be ineffective.     * Degree of scarring. More aggressive therapies may be started earlier if acne scars have already started developing.     * Gender. Some treatments are available only for females, such as birth control pills. Whatever your treatment plan, it is important that you give it enough time to work. This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medication is hard at work keeping new lesions from forming. Staying on your medication is the most important step to getting acne under control. How Can I Keep My Acne Under Control? After your acne clears, your doctor may recommend that you continue therapy with a topical retinoid to keep it under control. It is always a good idea to maintain good skin care and use skin care products labeled as “non-comedogenic” (do promote acne) What About Self Care and Prevention? For ongoing self-care and prevention of acne, follow a few simple guidelines:     * Clean skin gently—Use a mild skin cleanser twice a day, and pat skin dry. Harsh cleansers and astringents can actually worsen acne.     * Do not pop, squeeze, or pick at acne lesions, as this can promote inflammation and infection. Keep hands away from your face and other acne-prone parts of the skin.     * Limit sun exposure—Tanning only masks acne at best. At worst, sun exposure can lead to skin damage, especially if you are using an acne treatment that makes your skin more sensitive to sunlight and UV rays (this includes tanning booths).     * Choose cosmetics with care—As mentioned above, choose non-greasy skin products, and look for words like “non-comedogenic”, “oil-free”, and “water-_base_d”. Some facial products contain active acne-fighting ingredients, such as benzoyl peroxide or salicylic acid, to help keep mild acne at bay.     * Be patient with your treatment—Find out how much time it should take for your acne treatment to work (generally 6-8 weeks) and then stick with it. Stopping treatment early may prevent you from seeing good results or even cause a relapse of symptoms. Your skin may look worse before it begins to improve. You may need to try more than one type of treatment. Images courtesy of DermAtlas, © 2001-08 ___________________________________________________________________ This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health- related questions or concerns. Be sure to follow
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Dr. Gary Rothfeld NYC Dermatology - Board Certified Dermatologist - New York, NY 30 E. 60th St. Ste. 805 Manhattan, New York 10022 212.644.9494 1.800.BLEMISH NYC Dermatology by Board Certified Dermatologist Dr. Gary Rothfeld at (212) - 644 - 9494 Welcome Dermatology NYC Dermatology Google Groups About Us Acanthosis Nigricans Acne Acne: Accutane Acne Aestivalis Acne: Antibiotics Acne: Blue Light for Acne Acne: Chloracne Acne: Comedones Acne Condition Acne Cosmetica Acne due to Medicines Acne Excorie Acne Facts Acne Fulminans Acne Glossary Acne in Pregnancy Acne in Teens Acne: Inflammatory Lesions Acne: Infantile Acne Inversa Acne: Isolaz Laser for Acne Acne Keloidalis Acne : Large Pores Acne Management Acne Medications Acne Message Board Acne Myths Acne Necrotica Acne Nodulocystic Acne Photo Library Acne: Pimples Acne Pomade Acne: Psychological Effects Acne Scars Acne Scars: Dermabrasion Acne Scar Treatments Acne: Solar Comedones Acne: Steroid Acne: Stress Acne Surgery Acne Treatments Acne: Trichostasis Spinulosa Acne Urticata Acne Vulgaris Acrochordons Actinic Keratosis Age Spots Aging Skin Allergic Reactions Alopecia Areata Alopecia Areata Treatment Angioma Anti-Aging Appointment Atopic Dermatitis Atopic Dermatitis: Complications Balding Beautiful Skin Board Certified Dermatologist Botox Botox Benefits Botox Brow Shaping Botox Injections Botox Therapy Botox Treatments Botox: Warnings Breast Augmentation Broken Blood Vessels Brown Spots Bullous Pemphigoid Camp Discovery Capillaries Cellulite Chemical Peels Chemical Peels: Before and After Chemical Peels: Sunspot Removal Chemical Peels : TCA and Phenol Chemical Peel Treatments Cherry Angiomas Chloasma Clean Skin: Three Steps Clear Light for Acne Cold Sores Collagen Collagen Injections Complexion Condyloma Accuminata Contact Dermatitis Contact Us Corticosteroids - 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The FDA approved narrow-band, high-intensity blue- light therapy for treating acne. Now widely advertised, this is probably the best-known light therapy for acne treatment. Blue light works by killing the acne-causing bacteria, P. acnes, and is being used to treat inflammatory acne vulgaris that has not responded to other acne therapies. The blue-light products of today do not contain ultraviolet (UV) light, which was a staple of former light therapy used to treat acne. UV light can damage skin and is no longer used to treat acne. Patients receive blue-light therapy in increments. Generally, eight sessions are given over a four-week period, and each session lasts about 15 minutes. Side effects tend to be mild and include temporary pigment changes, swelling of the treated areas, and dryness.  As the results from the following studies show, many patients — but not all — see noticeable improvement with about 55% clearance:     *       31 patients with symmetrical (same on both sides) facial acne received blue-light treatment on 1 side of their faces. Blue-light therapy was given twice a week for four consecutive weeks. The other side of each patient’s face did not receive any treatment so that researchers could judge the effectiveness of the blue-light therapy. The researchers concluded that blue-light therapy is an effective acne treatment unless the patient has nodulocystic acne lesions, which tend to worsen when treated with blue light. (     *       25 patients with inflammatory acne on their faces had half of their face treated with blue-light therapy (8 sessions over 4 weeks) and the other half with clindamycin (a topical antimicrobial shown successful in treating acne). Patients were instructed to apply the clindamycin twice a day for four weeks. After four weeks, the clindamycin side showed a 22.25% improvement, and the side treated with blue light improved by 39%. However, after eight weeks and without further treatment, the side treated with clindamycin was better able to maintain results. (United States)2     *       10, 13, and 25 patients were enrolled in three separate studies designed to learn more about the effects of blue-light therapy on papulo-pustular (inflammatory) acne. In all three studies, more than 80% of the patients treated with blue-light therapy responded to the treatment. The patients who responded saw a 59% to 67% reduction in inflammatory acne lesions. (Israel)3     *       30 patients with mild to moderate acne were treated twice a week with blue-light therapy for up to five weeks. After five weeks, acne lesions decreased by 64%. However, not all patients saw improvement; 20% remained unchanged or experienced a worsening of their acne. As you can see, the number of patients involved in these studies is small. Clinical trials conducted to test new drugs generally must enroll hundreds to thousands of participants before submitting the data to the FDA for consideration. With such small numbers, statistically valid conclusions cannot be drawn. Research also is needed to learn the long-term effects. At present, blue-light therapy appears to improve acne vulgaris in some individuals. This therapy appears most effective for inflammatory acne lesions and may not be suitable for patients with nodulocystic acne. Add to Google Google Groups Subscribe to NYC Dermatology Email: Visit this group powered by FreeFind  Dear Friends Our goal at NYC Dermatology is to be the Tiffanys of Skin Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I would seek for my own family. This is a very important point, since physicans often use the phrase Doctor's Doctor to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat
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