This blog discusses the spectrum between benign nevi, atypical nevi, and melanomas.
Acne and the Pimple Popper Experts
While there is a TV show by the name of Dr. Pimple Popper, this moniker has been used to describe all dermatologists. Dermatologists are the experts when it comes to managing acne. We understand the causes of acne. We can distinguish between the different types of acne. Most importantly, we know the best treatments for acne.
What Does Acne Look Like?
Classical acne starts with blackheads. Blackheads, also known as comedones, occur when the skin cells over the follicles become sticky and block the flow of oil (sebum) onto the skin. The oil on our skin is important for moisturizing our skin. The dead skin cells that block the follicles are exposed to the air and gradually become black due to a process known as oxidation. Whether we like knowing this or not, we all have bacteria that live on our skin. The bacteria see this blocked pore as yummy food. The bacteria enter into the follicle, but our body’s immune system does not appreciate bacteria in our follicles. The immune system signals for white blood cells to attack the bacteria. This creates the familiar red acne papules and pustules. Sometimes there is so much inflammation that the skin becomes especially irritated. The follicle can start to grown into the skin which creates a cyst – a skin-lined sac under the skin. Since it is lined with skin, dead skin cells – or keratin – accumulate in the sac which can make the cyst grow larger over time.
Causes of Acne
Acne typically rears its ugly head in adolescence. This coincides with puberty and the hormonal changes that occur to transform from a child’s body to an adult. The hormones that signal the transformation of puberty are very important and beneficial, yet there is a down side, too. The steroid hormones of adolescence – primarily estrogen for females and testosterone for males – can manifest themselves in blemishes on the skin. Teenage acne focuses primarily on the T zone which includes the forehead, nose and chin. Teens can have acne on the cheeks, but the T zone is typically most impacted. Acne on the chest and back also occurs. This is sometimes related to sports and sweating.
Adults may continue to struggle with the same acne battle they did as teens. Some people escape adolescence without acne only to face it in their 30’s, 40’s and beyond. Adult acne is classified into three forms: female pattern hormonal acne, adult onset acne and acne rosacea. Female pattern hormonal acne is caused by – wait for it – yes, hormones! While women produce predominantly estrogen, women also have progesterone and trace amounts of testosterone, too. Much like during adolescence, these hormones can create a mixture of skin problems. Interestingly, female pattern acne tends to focus on the chin and jawline. Adult onset acne plagues both men and women and looks and acts the same as teenage acne. Acne rosacea is a whole other category. This presents typically in the 30’s but can occur earlier or later. It focuses on the central face: nose and cheeks. Rosacea has a few components to it. It may include scaly, red patches and sensitive skin as well as pimples. Unlike the teenage style of acne with blackheads, rosacea pimples tend to be more often tender, pink bumps under the skin.
Beginning with teenage acne, treatment is aimed at the root causes. The first thing dermatologists target is the blocked pores. There are several ways to accomplish this. First, not surprisingly, hygiene is important. Washing the face twice daily with a gentle non-soap cleanser (we love Elta’s foaming face wash) keeps the skin clean. Avoid harsh scrubs and toners; these often irritate the skin. Second, there are two primary medications that can help prevent the pores from getting blocked: benzoyl peroxide treatments and retinoids. Benzoyl peroxide is available as gels, creams, and cleansers. This can be an easy first step to help prevent the blocked pores. These medications can be drying. For people with oily skin, this can be beneficial, while individuals with dry or combination skin will need to use a moisturizer. If benzoyl peroxide isn’t enough, then the gold standard for comedonal (blackhead) acne is retinoids. Retinoids are a class of medications that are related to Vitamin A. Applied topically as gels or creams, retinoid medications prevent the skin cells from getting sticky and blocking the follicles. Retinoids are really aimed at the root cause of acne. Some of the common brands of retinoids include Differin (adapalene), Retin-A (tretinoin), and Tazorac (tazorotene). Differin is available over-the-counter, while the others require a prescription.
The second lesion of acne after the blackhead is the papule or pustule. For this, targeting the bacteria on the skin decreases the number of red bumps and pustules. Decreasing bacteria can be accomplished by washing the face regularly. Often, this is not enough. Topical medications on the skin for reducing bacteria include topical antibiotics lotions, creams, or gels and benzoyl peroxide agents. While the benzoyl peroxide medications are available over-the-counter, the topical antibiotics require a prescription. In addition to antibiotics, there are other more novel medications for acne such as Aczone (topical dapsone) which works on the bacteria and may affect the inflammation, too.
Sometimes the inflammatory component of acne includes too many pustules and deep-seated red, painful, bumps. For this, topical antibiotics and retinoids are not enough. This is the time that dermatologists add oral antibiotics. While the antibiotic pills no doubt decrease the bacteria on the skin, they also work from the inside out to lessen the inflammation and swelling in the skin. This decreases the number of the so called “underground” pimples and the pus bumps.
There are other oral medication options for treating hormonal acne. For females whose acne seems to flare with menses or is tied to their monthly cycle, managing the hormones can help get the acne in balance. This can be done using oral contraceptive pills to even the hormone levels. This can also be done using spironolactone. This medication is classically used for blood pressure. In lower doses, though, it works to block the steroid hormones that are promoting acne.
For individuals that struggle with scarring, deep cystic acne unresponsive to the topicals and oral antibiotics, isotretinoin can be a game changer. This medication is commonly known by the brand name, Accutane. This medication is an oral retinoid, which means it is derived from Vitamin A. It is much stronger than the topical retinoids. A typical course of Accutane is five months in duration. Because this medication has potential side effects – most importantly it can cause birth defects if females are or become pregnant while taking it – it must be monitored carefully. Patients on Accutane must have blood work done every month and are seen in clinic monthly. This medication is not for everyone, but it is an amazing game changer for the patients that need it.
While medications play a major role in our battle against acne, we find that working with our aestheticians also helps acne to improve faster. Our aestheticians offer an Acne Membership Program with special treatments including facials – especially Hyrdafacial MD; Laser Genesis treatments to decrease the redness and the bacteria on the skin; Clear and Brilliant laser treatments to allow medications to penetrate better; chemical peels with dermalplaning to exfoliate; and physical extractions to express difficult blackheads/comedones.
What Will thedermgirls Do for Your Acne?
When you come to see thedermgirls board-certified dermatologists at Associated Skin Care Specialists, we will examine your skin carefully. This helps us to determine exactly what types of acne lesions you have. We also will take a complete medical history, because sometimes other medical problems or medications can cause acne. We will ask questions such as how do you care for your skin; what medications or treatments have you already tried; what has worked and what hasn’t worked. It is important for us to know about your activities, too. What sports do you play? What kind of work do you perform? Once we gather all the information, we will create a personalized plan to treat your acne, including skincare products, medications, and coordinating with our medically trained aestheticians.
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