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Acne Basics – Part 2

Monday, May 20th, 2013

In the last posting, we introduced some of the basic causes of acne.　 Today I will present some of the available acne treatments.

lmost all cases of acne can be effectively treated. The goal of acne treatment is to heal existing lesions, stop new lesions from forming, and prevent acne scars.

Different acne medications are available that control one or more of the underlying causes of acne. 　Common classes of acne medications include the following:
  • Topical retinoids (Differin, Epiduo, Retin A Micro, Tazorac, or tretinoin) help unclog sebaceous glands and keep skin pores open.
  • Antibiotics, such as doxycycline and minocycline (Solodyn), may be used to fight the P. acnes bacteria.
  • Isotretinoin (Amnesteem, Sotret) remain a mainstay of treatment for severe acne by reducing sebum (oil) production.

  • Hormonal agents

  • , such as birth control pills, may be used by women to reduce sebum (oil) production .
Your doctor will prescribe acne medications based on the following 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 isotretinoin (Amnesteem, Sotret).

  • Results of previous treatments

  • . 　Medications may be added in a step-wise fashion, if previous acne treatments are found to be ineffective.

  • Degree of scarring

  • . 　More aggressive therapies may be started earlier if there already signs of acne scars.

  • Gender

  • . 　Some treatments are available only for women, such as birth control pills.
Non-prescription acne medications may provide sufficient results for some people with mild acne. 　However, most people with moderate acne and all with severe acne will need to use prescription acne medications for effective treatment.

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 retinoids 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 not promote acne).

For ongoing acne skin 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-based.” 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
Feel free to call our office if you have any questions or need more information on how to address your acne.

Reviewed and recommended by: Dr. Alia S. Brown

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Acne Basics – Part 1

Monday, May 13th, 2013

Acne

is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. 　Acne 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 acne scars..

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 layers of the skin.

What are the different types of acne?

Acne can be categorized by its severity:

 

    Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).

    Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).

    Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.

    Who gets acne? 

     

    Anyone at any age can get acne.　 Acne in teenagers is very common because the surging hormone levels (androgens) associated with puberty create more active sebaceous glands.　 Acne in adults is also very common, especially among women.

    Acne is more likely to afflict people whose parents had acne.

    What factors make acne worse?

    Acne lesions can come and go. These factors can cause acne to worsen:

      • 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

      Reviewed and recommended by: Dr. Alia S. Brown

       

       

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      Clinical Research

      Thursday, May 9th, 2013

      Clinical research leads to better medical care. 　New ideas often start in the laboratory, but eventually must be tested in the real world. 　A “clinical trial” is the name given to research that involves people as the subject of research. 　Our ability to diagnose, treat and prevent disease comes from the knowledge gained from these clinical trials.
      Who can participate in a clinical trial?
      All clinical trials have criteria about who can participate. 　These criteria are important for producing reliable results. For instance, people need to have a particular medical condition to be included in a clinical trial that evaluates a new treatment for that condition. 　Similarly, people may be excluded from a trial if they are too young or have other medical problems.
      People who meet the criteria, are willing and able to participate, and provide informed consent can participate in a trial that is accepting new patients.
      There are a variety of clinical trials recruiting patients to help study new treatments for major skin conditions.
      What happens during a clinical trial?
      The clinical trial process depends on the kind of trial being conducted.
      What are the different types of clinical trials?
      • Treatment trials look for new treatment options. These might include new medications, new dosages or combinations of medications, or new medical procedures.
      • Prevention trials look for ways to prevent disease, including the use of medications, vaccines, vitamins, minerals, or lifestyle changes.
      • Diagnostic trials look for better ways to diagnose illnesses.
      • Screening trials are performed to detect certain diseases or health conditions.
      • Quality of Life trials (or Supportive Care trials) explore ways to improve comfort and the quality of life for individuals with a chronic illness.
      Should I consider participating in a clinical trial?
      Participants in clinical trials help others by advancing medical science and may gain access to new treatment opions before they are widely available. 　Participants also benefit by playing an active role in their medical care. 　Choosing to participate in a clinical trial is an important personal decision. 　It is often helpful to talk to your physician, family member or friends about deciding to join a trial. 　After identifying some trial options, the next step is to contact our study research staff and ask questions about specific trials.
      You should try to get answers to the following questions?
      • What is the purpose of the study?
      • Who is going to be in the study?
      • Why do researchers believe the experimental treatment being tested may be effective? Has it been tested before?
      • What kinds of tests and experimental treatments are involved?
      • How do the possible risks, side effects, and benefits in the study compare with my current treatment?
      • How might this trial affect my daily life?
      • How long will the trial last?
      • Will hospitalization be required?
      • Who will pay for the experimental treatment?
      • Will I be reimbursed for other expenses?
      • What type of long-term follow up care is part of this study?
      • How will I know that the experimental treatment is working? Will results of the trials be provided to me?
      • Who will be in charge of my care?
      Please be sure to contact us if you have questions or need more information about current trials being conducted in our Gwinnett Clinical Research Center. (770) 972-4845 ext. 132
      BY: Joel S. Shavin, M.D.

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      Skin Care Overview

      Monday, May 6th, 2013

      A simple skin regimen, practiced every day, can help keep your skin healthy and more youthful in appearance.
      Some basic steps include:
        • Wash your skin twice a day with a gentle non-soap cleanser.　 Use a soft cloth and do not scrub vigorously.
        • Use a moisturizer twice a day. 　This helps your skin appear more youthful and can protect your skin. 　As much as two handfuls of moisturizer may be required to cover your body. It’s most useful when applied immediately after taking bathing (within three minutes).
        • Use a sunscreen every day. 　Choose one that protects against both UVA and UVB rays, with a sun protection factor (SPF) of 30 or higher. 　Use a sunscreen even if you will only see the sun through windows (UVA that penetrates glass does not burn your skin like UVB, but it can lead to premature aging).
        • Choose makeup that is oil-free and non-comedogenic (this means it does not block pores and is unlikely to cause pimples).
        • Protect your lips with lip block or lipsticks with sunscreen.
        • Avoid long hot showers or baths. 　Hot water extracts natural oils from your skin, leaving it dry. 　Instead, use lukewarm water for a shorter period of time.
        • Keep your regimen simple so that you are more likely to stick with it.
        • Follow your dermatologist’s recommendation and choose products compatible with your skin type. If you don’t tolerate the product, or don’t see any benefits after six to eight weeks, try a different product.
        • The American Academy of Dermatology (AAD) recommends that people perform a skin self exam once each month.
      By: Cathy Hedrick

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      Five Sun Defenses – Part 3

      Tuesday, April 23rd, 2013

      As we have mentioned in a previous blogs, the five basic sun defenses that you should keep in mind when you go outdoors should include:

      • Avoiding peak hours of sunlight
      • Using sunscreen and/or sunblock
      • Selecting appropriate clothing
      • Keeping sunglasses handy
      • Seeking shade

       

      In the last post we dealt with avoiding sunlight and sunscreen.  Today we will continue with using sunblock and selecting clothing.

      Sunblocks

      “Physical” sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful for people who are sensitive or allergic to the ingredients found in other sunscreens.  Sunblocks often contain one or more of these ingredients:

      • Zinc oxide
      • Titanium dioxide
      • Iron oxide

       

      Although past formulations were unsightly (often leaving a white film on the skin), newer “microfine” formulations are invisible after being applied.

      Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.

      Water resistance – Sunscreens are classified as “water-resistant” if they maintain their protection after two 20-minute immersions in water. They are classified as “waterproof” if they maintain their protection after four 20-minute immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as swimming or water skiing, or will be actively sweating.

      However, independent testing has shown many products do not perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently if you are actively sweating.

      Formulation – The formulation of a sunscreen or sunblock is important in that can determine if and when an individual actually applies the sunscreen.  Thick lotions that leave a film on the skin are not likely to be used repeatedly, so they may not be as effective as lotions, sprays or gels that dry quickly.  Choosing a formulation that is cosmetically acceptable to the individual using a sunscreen is paramount to successful use of the product.

      Using a Sunscreen

      Sunscreen should be applied evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect. (Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming or sweating to ensure effective sun protection. Apply sunscreen generously and reapply frequently at least every two hours.

      The chemicals may lose effectiveness over time, so it is important to throw away sunscreen that is past its expiration date or is over two years old.  No sunscreen is 100% effective; take additional measures to avoid the damaging effects of the sun’s rays.

      In the next blog entry we will address using sunglasses and seeking shade…

      Author: Jonathan S. Weiss, M.D.

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      Five Sun Defenses – Part 2

      Thursday, April 18th, 2013

      We have mentioned previously the five basic sun defenses that you should keep in mind when you go outdoors:

      • Avoiding peak hours of sunlight
      • Using sunscreen
      • Selecting appropriate clothing
      • Keeping sunglasses handy
      • Seeking shade

       

      Having dealt with avoiding the sun, using sunscreen and clothing selection…today, we will discuss the last two defenses.

      Sunglasses

      Overexposure to sunlight can cause cataracts and macular degeneration, a major cause of blindness. Sunglasses can provide effective sun protection for your eyes. However, not all sunglasses are of value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection. Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking 99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

      Shade

      If possible, remain in the shade when outdoors. Keep in mind that shade does not provide full sun protection because UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics used as shade devices, such as parasols or umbrellas, may not provide sufficient sun protection. If you seek shade under a cloth, look for a fabric that is thick, tightly woven, and dark-colored.

      Clear window glass provides protection from UVC and UVB, but not UVA rays.

      If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use of additional window shade devices for sun protection. Drivers in some states may be able to use darkly-tinted glass in the side windows, but this is illegal in some states.

      Sun Protection Summary

      • Avoid the sun when its UV rays are strongest, between 10 a.m. and 4 p.m.
      • Use a broad-spectrum sunscreen with SPF 30 or greater. Apply it 30 minutes prior to being exposed to the sun and reapply every two hours.
      • Consider using a water-resistant sunscreen if you will be active (sweating) or in the water.
      • Use a sunblock on your lips.
      • Wear a broad-brimmed hat when outdoors.
      • Wear sunglasses.
      • Wear tightly woven, dark clothing to cover your arms, legs, and feet.
      • Stay in the shade when possible.
      • Avoid reflective surfaces, such as water or snow.
      • Avoid sunbathing.
      • Don’t be fooled by cloudy days since damaging rays can penetrate clouds.

       

      Author: Jonathan S. Weiss, M.D.

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      Five Sun Defenses – Part One

      Tuesday, April 9th, 2013

      As Dr. Shavin mentioned in a previous blog entry, the five basic sun defenses that you should keep in mind when you go outdoors should include: 

      • Avoiding peak hours of sunlight
      • Using sunscreen and/or sunblock
      • Selecting appropriate clothing
      • Keeping sunglasses handy
      • Seeking shade

       The next few posts will address each of these in a little more detail beginning with avoiding sunlight. 

      In general, UV rays are the greatest between 10 a.m. and 4 p.m. It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and shade. 

      You can obtain an accurate measure of the amount of UV rays in your area by looking up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day to day according to time of year, cloud cover, atmospheric ozone, and other factors. 

      The following table is a breakdown of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater. 

      • 0 to 2 = Minimal
      • 3 to 4 = Low
      • 5 to 6 = Moderate
      • 7 to 9 = High
      • 10 or more = Very high

       The UV Index can be found on our Website or in local papers, usually in the weather section. 

      Sunscreen 

      There are several factors to consider when selecting the appropriate sunscreen for proper sun protection. These include:

      • Sun Protection Factor (SPF)
      • Spectrum of Protection (UVB vs. UVA vs. Both)
      • Sensitivity/Allergy to ingredients
      • Water Resistance
      • Formulation

      SPF – Sunscreens are rated by the amount of protection they provide from UVB, measured as the “sun protection factor” or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens that offer a minimum SPF of 30.

       Broad-spectrum sunscreens – It is best to use a sunscreen that can protect you from both UVA and UVB rays. These are called “broad-spectrum” sunscreens.

       Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has led to the development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product with greater protection.

      Common sunscreen ingredients that provide protection from UVB rays:

      • Cinnamates
      • Octocrylene
      • PABA (para-aminobenzoic acid)
      • Padimate O and Padimate A (Octyl Dimethyl PABA)
      • Salicylates

      Common sunscreen ingredients that provide protection from UVA rays:

       Avobenzone (Parsol 1789)

      • Benzophenones (oxybenzone, dioxybenzone, sulisobenzone)

       More to follow…

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      Sun Protection

      Friday, April 5th, 2013

      The damaging UV radiation in sunlight can lead to many skin problems, including sunburn, age spots, wrinkles, melasma, freckles, allergic rashes, and precancerous lesions called actinic keratoses.  Most importantly, overexposure to sunlight is the major cause of skin cancer, including melanoma.  It is important for everyone to be aware of the damaging effects of sunlight and take measures to avoid overexposure.

       

      Although many people enjoy the appearance of tanned skin and think it looks “healthy,” tanned skin is damaged skin. The ultraviolet radiation in sunlight penetrates the deepest layers of the skin where it harms the cells.

       

      The body responds by making more pigment (melanin) to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun, the more likely you are to develop skin problems later in life

       

      Sun Protection 

      The first and most effective way to avoid sun damage is to stay out of the sun as much as possible.  If you cannot avoid being exposed to sunlight, there are five basic sun defenses that you should keep in mind when you go outdoors: 

      • Avoid peak hours of sunlight (10AM to 3PM )
      • Sunscreen ( Apply liberally and reapply every few hours )
      • Clothing
      • Sunglasses
      • Shade 

      Enjoy the outdoors, but with intentions to protect your skin.  We will discuss each of these protection strategies in more detail in the days to follow as we continue the Gwinnett Dermatology blog.

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      Procedures Performed by Dermatologists

      Tuesday, April 2nd, 2013

      Dermatologists are physicians who diagnose and treat skin disease, as well as help patients maintain the health and appearance of their skin.  Procedures are an integral part of dermatology.  This article will outline the most commonly performed procedures by dermatologists, many of which will be discussed in further detail in future postings.

      Most all dermatologists, especially those focusing on medical dermatology perform the following procedures:

      • Skin Biopsies – removal of a small sample of skin under local anesthesia to help diagnose a skin condition.  The specimen is then sent to a pathologist for examination under a microscope.
      • Cryotherapy – treatment of various types of skin lesions with liquid nitrogen, including warts, pre-cancers and other benign lesions.
      • Simple Excisions – removal of moles, cysts or other lesions via simple skin surgery.
      • Skin Cancer removals – discussed further below. 

      Procedures that utilize mechanical devices to treat dermatologic conditions include:

      • Phototherapy – use of ultraviolet light (UV) with or without medications to treat various skin conditions such as psoriasis, eczema, intractable itching or other more rare skin conditions.
      • Laser Treatments – use of specialized devices to treat various types of skin conditions or lesions.
      • Photodynamic Therapy – use of topical compounds that are activated by a special light source to treat pre-cancers, photodamage, acne or other conditions. 

      Skin cancers can be removed by one of several procedures:

      • Electrodessication and Curretage
      • Excision
      • Mohs Surgery
      • Chemotherapy with Prescription Creams 

      Many dermatologists also perform cosmetic procedures to enhance the appearance of the skin, including:

      • Injectable Toxins – including Botox, Dysport and Xeomin.
      • Fillers and Volumizers – including Restylane, Juvederm, Belotero, Radiesse, Sculptra and others
      • Chemical Peels – including Glycolic Acid, Salicylic Acid, Trichloracetic Acid and Phenol
      • Resurfacing – using microdermabrasion, dermabrasion or lasers 

      Future posting will discuss many of these procedures in greater detail.  Stay tuned!

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      What is a Dermatologist?

      Thursday, March 28th, 2013

      A dermatologist is a medical doctor (M.D. or D.O.) who specializes in the diagnosis and treatment of medical conditions that affect the skin, hair, and nails. 

      A dermatologist completes at least three years of specialized dermatology training after graduating from medical school and completing a medical internship. This focused study, research, and training makes a dermatologist the most qualified medical professional for treating and managing skin conditions. 

      Skin conditions commonly treated by dermatologists include:

      • Acne that affects both teenagers and adults
      • Atopic dermatitis (eczema) that leads to dry, itching, and inflamed skin.
      • Psoriasis and its various manifestations including plaque psoriasis and psoriatic arthritis.
      • Rosacea, a common skin condition that can lead to redness and swelling.
      • Skin cancer, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma, and precancerous lesions, such as actinic keratoses (AKs) 

      Dermatologists also treat skin conditions arising from systemic and infectious diseases, as well as cosmetic issues that affect a person’s appearance. These commonly include the following:

      • Hair loss
      • Wounds and scars, including acne scars.
      • Aging skin and other natural changes, including fine lines, wrinkles, and age spots.

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