Acne

Q. How can I get retinols or benzoyl peroxides to get rid of my blackheads?

A. Blackheads sometimes are "stuck" in the skin. I explain that many times this is analogous to a cork in a bottle. Acne medications will loosen up the blackheads and hopefully help them come out. Sometimes the blackheads need a little help. Outside of using the medicines divided with one in the morning and one in the evening, glycolic acid peels and a comedone (blackhead) extractor are very helpful. Controlling blackheads is very difficult and diligence is the key word here.


Q. Hello, my situation is very complex. I started to develop mild-moderate acne at the age of 12. From the ages 12-17 I broke out but was able to control my breakouts with oxy and clearasil. In the past year or so, my acne has become out of hand. I get breakouts on my back, chest and neck occasionally, but my face has been really bad. I do get cystic pimples sometimes, but lots of red small ones and puss filled ones pop up nonstop. I tried retinal a micro and it did not work. I have been using Proactiv for about 2 months and while it does help my acne somewhat, I wake up one morning with a clear face, but pimples develop by 12-1 o clock in the afternoon out of no where. I just started Ortho Tri Cyclin about a week ago and I'm hoping it helps. Acne runs in my family. My mother is against me using Accutane and I took Minocycline but may have had an allergic reaction to it. Any ideas? And do you know why I wake up with clear skin in the morning and develop like 10 pimples in the middle of the day?

A. Acne is the nemesis for young people and adults. Acne can change from small pimples to large cysts without warning. The causes of acne are unclear. Most of the time acne is genetic in origin; however, acne may also be from medications or oil containing cosmetics. We do know that the pore is blocked, oil production is abundant and bacteria is present. Treatments are almost always individualized depending on skin type and degree of involvement. For many women, birth control pills are wonderful and control the acne (it takes three months to see improvement). There are also some great over-the -counter products to try. If conservative measures don't work, it's time to see a dermatologist.

Q. I am looking to get rid of my blackheads and was told that beta would solve the problem. Would the alpha work as well?

A. Basically, Alpha hydroxy acids are glycolic acids and beta hydroxy acids are salicylic acids. They both will work for acne (black heads). Salicylic acids tend to penetrate down the follicle: however, glycolic acids are very effective for exfoliation. It is important to use a comedone extractor with both acids after application. Also, remember that glycolic acids must be washed off. These acid peels should be used at most 1-2 times a week. Acne treatment requires daily maintenance so have patience.)


Q. I frequently have acne on my chest and I have several scars that I would like to get rid of. Would it be safe to try acid peels or microdermabrasion on my chest?

A. Acne scars involve the deeper layers of skin. Improvement is seen with procedures that reach the deeper layers. Microdermabrasion and acid peels address the upper layers of the skin. Scarring on the chest is precarious in that it is not predictable and varies from person to person. Traditionally, theses areas have been treated with conventional methods such as cortisone injections and topical scar medications such as Mederma. Your goal should be scar improvement and not disappearance.

I would like to add that you should work on controlling the acne and scarring shouldn't be a problem.

Q. I'm 18 years old, and I have a lot of acne and pigment problems on my upper back. I've tried everything from gels and creams, to oral medications and benzoyl peroxide washes. Nothing seems to work. I've heard of acid peels, are they something that could help me?

A. Acne is from skin irritation, blocked pores, bacteria and oil secretion in the skin. If your outbreak is sudden, go back and look at any predisposing factors such as oil containing skin products, a new exercise regimen with excessive sweating, or even a new hair style with hair rubbing on your skin. The answer may be simple elimination of an irritation.

Sometimes acne will present with no apparent reason. The treatment is then daily maintenance. Face washing 2-3 times a day is a must. Use of over-the-counter topical acid products and benzoyl peroxides are very helpful. It takes six weeks for acne treatments to start working. As acne is improving, it will leave a temporary "dark area" in the skin. This "dark area" is not scar and will disappear with time - usually many months. If you continue to get new acne despite daily maintenance, you should consult your dermatologist.


Q. I have very large clogged pores on my nose and cheeks. I believe this may be hereditary as I remember my Mom having the same problem. I cleanse twice daily and have tried several different products but nothing seems to help. Do you have any suggestions?

A. "Clogged pores" are called comedones. This is a type of acne that can be controlled with daily maintenance. Hydroxy acids and retinols are a good place to start. Many people benefit from facials. The cosmetologist will extract all the debris. Have the cosmetologist teach you how to clean the pores at home.

Q. I have been going Microdermabrasion for my acne scars but got very minimal results. I recently went to a well-known dermatologist here in Orange County who recommended Saline solution injection on my scars and I went through the first treatment already. I didn't do a research on this thing and I know that doctors now use saline solution for Sclerotherapy. My question is, does this have any side effects if this is used on the face?

A. Acne scarring consists of depressions in the skin. Discoloration in the skin from acne does not represent scarring. The medical term for the dark areas is called post-inflammatory hyperpigmentation. This discoloration takes many months to clear. If the acne outbreaks are controlled, there are fewer dark areas and the skin clears in time.

Microdermabrasions exfoliate and stimulate the skin. This procedure helps improve fine wrinkles, sun damage and uneven pigmentation - essentially dull lifeless skin. Unfortunately, this procedure does little for acne scarring.

Sclerotherapy, is a procedure where a salt solution is injected into vessels. This is effective for spider and varicose veins on the lower extremities. Possible complications include scarring, post-inflammatory hyperpigmentation and possibly ulceration. It is not a common procedure used on the face.

Acne scarring is commonly treated with surgery or resurfacing with lasers or dermabrasions. For severe scarring usually more than one procedure is necessary.

Q. I started taking the medication erythromycin for my acne about a week ago and it seems to be getting worse. How long does it take for the medication to kick in and is it suppose to get worst before it gets better?

A. In some people, acne will get worse before it gets better. As a rule of thumb, it takes six to eight weeks before significant improvement is seen. If after two months, the acne is as bad or worse, then it is time to switch treatment programs. Remember, most acne treatment is designed to suppress acne and not cure it. You must continue with your medications until your physician prescribes otherwise.

Q. I have acne on my face and I would like to know what I can use to lighten the marks. I am trying to have a baby and I read that products that contain hydroquinone are not recommended.

A. Dark areas from acne usually will go away in time. It may take many months but they usually all go away. You are correct. If you treat the dark areas early, you can hasten their disappearance. Hydroquinones really shouldn't be used during pregnancy. Options are topical vitamin C and topical glycolic acid peels (sunscreen/block is a must). Remember, try and control the acne before it leaves a mark.

Finally, women can get dark areas in the skin from pregnancy. This is called melasma or pregnancy mask. This is treated the same as described above. Good luck with your little one.

Q. I have dark pores on my legs, and I was just wondering if there was anything I can do to clear them up, I have very light skin so they are very noticeable. Any help would be greatly appreciated!

A. Assuming that you are referring to "dark pores" as the hair follicles, this may represent a condition called keratosis pilaris. This is a benign follicular plugging condition that seems to run in families. It has a predilection for the outer arms, thighs and buttocks. Most of the time, this condition can be controlled but not cured. Treatments vary from retinoic acid preparations to alpha hydroxy creams.

Q. My face is broken out, dry, and oily at the same time. I never know how to fit in putting on lotion and putting on my acne medication (Retin-A tretinoin 0.05%) and when to put on which in my daily basis. My skin gets very shiny and gets in the way when I'm trying to go out and feel confident. The lotions I've used (Keri, Eucerin, Aveeno) cause my skin to get even more shiny or more broken out or they just don't moisturize my skin very well. Am I using the wrong lotions or cream and how and when should I put each on? I'm also using an oil-free cream cleanser with 2% salicylic acid by Neutrogena which seems to dry out my skin further, but my dermatologist recommended it. Is this not good and can I just switch to something else despite my dermatologist's advice?

A. Your problem is very common and not really complicated. Combination skin is always a challenge. It is important that the basics are covered as far as washing and make-up. If the wash is drying you out, then it's time to switch. Gentle cleansing or glycerin bars are always a nice start. Use your hands and no wash rag or buff puff. Make sure that all your make-up is oil free. It cannot say water based. Also, do your hair styling first before you wash your face. This is so the hair care products do not get on your face. The term non-comedogenic is also acceptable. Retinols (Retin - A) is excellent for acne. Sometimes people will breakout before they get better and I encourage them to stick with it (good or bad) for six weeks. That is the time required to see if the acne is going to clear. In the oily areas we encourage the retinol to be applied a little more liberal. Conversely, in the dry areas, the retinol is applied sparingly. A moisturizer can also be applied to the dry areas as long as it is oil free. Moisturizers are most effective when used twice a day. Before you start adding new products, see how you do with what you have.