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233 Broad Street
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Milford, CT 06460
(203) 878-3435
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761 Main Avenue
Suite 102
Norwalk, CT 06851
(203) 810-4151
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1250 Summer Street
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Stamford, CT 06905
(203) 975-1112
Greenwich Office
600 W. Putnam Ave
Greenwich, CT 06830 203-810-4151

Defining the Future of Dermatology

Acne

  • Acne One
    Comedones that stay closed at the surface of the skin are called whiteheads. This happens when oil and skin cells prevent a clogged hair follicle from opening. Many of the same over-the-counter medicines that treat blackheads are also effective against whiteheads.
  • PAPULES:
    Papules are comedones that become inflamed, forming small red or pink bumps on the skin. This type of pimple may be sensitive to the touch. Picking or squeezing can make the inflammation worse and may lead to scarring. A large number of papules may indicate moderate to severe acne.
  • PUSTULE:
    Pustules are another kind of inflamed pimple. They resemble a whitehead with a red ring around the bump. The bump is typically filled with white or yellow pus. Avoid picking or squeezing pustules. Picking can cause scars or dark spots to develop on the skin.

About

Acne

Acne is a common skin condition that occurs when oil and dead skin cells clog the skin’s pores. Acne primarily affects teens; more than 85% experience at least a mild form of this condition. It most commonly occurs on the face, chest, back, shoulders, and neck. Acne affects young men and young women about equally, but there are differences. Men are more likely than women to have more severe, longer lasting forms of acne. In contrast, women are more likely to have intermittent acne due to hormonal changes associated with their menstrual cycle and acne caused by cosmetics.

More Women Are Getting Acne

A growing number of women in their 30s, 40s, 50s, and beyond have acne. Dermatologists are not sure why this is happening, but dermatologists understand that adult acne can be particularly frustrating.

Causes

During puberty, elevated hormone levels stimulate sebaceous glands to produce more oil, also called sebum, which is normally released through the hair shaft to lubricate and protect the skin. Sebum combines with dead cells, forming a plug in the skin pore called a comedone. These comedones or plugged follicles may eventually rupture and sebum may seep into the surrounding skin causing inflammation. There are harmless bacteria present in the sebaceous glands. These bacteria can break down the fatty parts of the sebum into fatty acid substances which leak into the surrounding skin and may also cause inflammation. The result can be a small or large solid bump or a pustule on the surface of the skin or cysts underneath the surface of the skin.

Stress or illness may aggravate acne. Women may also have flares prior to their menstrual periods. Oily cosmetics may alter the opening of the sebaceous gland making the cells more likely to stick together and form comedones.

Foods do not cause acne, but for some individuals, certain foods may aggravate the condition. While dietary modification is not part of standard acne therapy, avoiding milk products and foods with a high glycemic index (ie., processed foods, carbohydrates, and sweets) may be helpful in some people.

Treatment

HOW IS ACNE TREATED?

Treatment for acne depends upon its severity. The goal of treatment is to reduce or eliminate outbreaks and to prevent scarring.

One common myth is that you have to let acne run its course.
Dermatologists know that letting acne runs its course is not always the best advice. Here's why:

  • Without treatment, dark spots and permanent scars can appear on the skin as acne clears
  • Treating acne often boosts a person's self-esteem
  • Many effective treatments are available

TOPICAL MEDICATIONS:

  • Benzoyl peroxide is available by prescription and in lesser strengths over the counter. It is usually applied once or twice a day to work best against pustules. It can be irritating if used around the eyes and mouth. It should be used carefully since it can bleach skin and clothing. If used excessively, benzoyl peroxide can cause drying and redness.
  • Salicylic acid is effective in treating non-inflammatory acne lesions. Salicylic acid helps correct the abnormal shedding of skin cells and unclogs pores to resolve and prevent lesions. It has no effect on oil production or bacteria. Like benzoyl peroxide, salicylic acid must be used continuously. Salicylic acid is found in many over-the-counter acne products, including lotions, creams and pads. It may be irritating to the skin.
  • Retinoids are derivatives of vitamin A and have been a mainstay in acne treatment for 25 years. They decrease the stickiness of plugged sebaceous glands. They work best against blackheads and reduce papules and non-inflamed pimples. Use a small-pea sized amount to the entire face as overuse can cause dryness, irritation, and redness. Retinoids can make skin more sun sensitive so sunscreen is recommended. Common names are Tretinoin (Retin-A, Atralin), Adapelene (Differin), or Tazarotene (Tazorac).
  • Topical antibiotics come in solution, gel, or cream form. They help reduce the amount of bacteria on the surface of the skin thereby preventing inflammation and the formation of new pimples. They are to be applied to the skin once to twice a day.
  • Azelaic acid (Finacea) is used to treat mild to moderate acne. It is believed that azelaic acid clears acne by reducing the populations of bacteria, decreasing the abnormal shedding of skin cells and reducing inflammation. Side effects may include skin dryness and lightening of the skin where applied.

How to use topical medicines: To decrease the chance of skin irritation, start applying acne medications every 2-3 days and work-up to every day as tolerated. Apply medicine to all areas of your face (not spot-treatment). It’s fine to apply multiple topical medicines at the same time.

SYSTEMIC MEDICATIONS

  • Antibiotics are used for mild-to-moderate and moderate-to-severe acne. They work to reduce bacteria thereby reducing inflammation. A typical course of treatment can be six months or longer. Tetracycline, doxycycline, erythromycin, and minocycline are commonly used antibiotics. These medications should not be taken with milk, milk products, or antacids because these products decrease absorption. They also should not be taken within 30 minutes of lying down as they can cause a gastritis. These medications can cause sun sensitivity so it is recommended that you wear daily sunscreen and avoid exposure to the sun. Pregnancy is also contraindicated with these medications.
  • Oral contraceptives and hormonal medications (spironolactone, flutamide) have been shown to effectively clear acne in women by decreasing circulating male hormones called androgens, thereby decreasing sebum (oil) production.
  • Isotretinoin (accutane) is a potent oral medication that is used for cystic, refractory acne that does not respond to any of the other medication. Used over a four to six month period, it works to decrease inflammation as well as formation of comedones. Because of some potentially serious side effects, patients undergoing isotretinoin are enrolled in the iPledge system, monitored with monthly appointments and laboratory examination. Fifty percent of patients will experience complete clearance of their acne after one course of isotretinoin.
  • Other oral medications such as niacinamide, zinc, copper are being used for acne as they have been shown to have anti-inflammatory properties.

OTHER THERAPEUTIC MODALITIES:
Light therapies (blue and red light), chemical peels (glycolic acid), and less traditional therapies are also used for treating acne in the appropriate patient. Intralesional steroid injections are commonly used for stubborn cystic acneiform lesions.

ACNE Patient Treatment Handout

  1. Wash your face in the morning and evening using lukewarm water.
  2. Cleanse gently with a cleanser applied with your hands. Do not use rough cloths, scrubbers or brushes. Recommended cleansers: Cetaphil cleanser, CeraVe cleanser, SkinCeuticals Clarifying Cleanser, Neutrogena acne wash, Purpose cleanser
    AM Face cleanser: ________________________
    PM Face cleanser: ________________________
  3. Apply the topical medications to dry skin all over the areas that tend to develop pimples. Do NOT spot treat pimples.
    AM Topical medication:________________________
    PM Topical medication:________________________
  4. If an oral medication was prescribed, take as directed. Remember that antibiotics for acne are used for their anti-inflammatory properties and are treating inflammation, not an infection.
    Oral medication:________________________
  5. Use a moisturizer with sunscreen on a daily basis as many of these acne medications are drying and photosensitizing. Some recommended moisturizers are CeraVe AM, Aveeno Positively Radiant, SkinCeuticals Daily Moisturizer, Neutrogena Daily Moisturizer with SPF
  6. If you are using a retinoid at night and your skin is getting irritated, red, or flaky, add a nighttime moisturizer, such as CeraVe PM to your regimen after you apply your retinoid.
  7. Apply makeup products after applying the acne medications. Only use non-comedogenic (won’t clog pores) and oil-free products.

USING TOPICAL RETINOID CONTAINING MEDICATIONS
Tretinoin (retin-A, ziana), Adapelene (differin, epiduo) Tazarotene (tazorac, fabior)

  • Use the medication every other night for the first two weeks. If after two weeks there is no redness or irritation, increase application to every night. If you are becoming too irritated by the medication, wait 15-20 minutes after cleansing your face at night before applying the medication.
  • Apply a “pea-sized” amount of medication to your index finger.
  • Gently rub a quarter of the medication into each quadrant of your face.
  • The medication should disappear into your skin quickly. If the medication doesn’t easily disappear, you may be using too much medication.

Benzoyl Peroxide 10% Wash CDG, Clean & Clear, CVS, Walgreens
1. Use this product daily in the shower to acne-prone areas (face, chest, and/or back). If your skin becomes too dry, use it every other day. This product bleaches clothing and linens if not washed off completely.

Acne will often get worse before better when a new treatment is started. Treat through this and results will be seen. Treat the whole face NOT spot-treatment. A realistic expectation is 60% improvement at 6 weeks and maximum effect at 8-12 weeks. Thus, we usually wait at least 8 weeks before changing a regimen to allow maximal efficacy to be reached. These treatments are not magic; they take time and effort to work. COMPLIANCE IS ESSENTIAL.


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  1. Elta MD UV Clear SPF 46
     

    EltaMD® UV Clear Broad Spectrum SPF 46 Non-Tinted

    Facial sunscreen for skin types prone to acne, rosacea and hyperpigmentation. Learn More
  2. SkinMedica Rejuvenize Peel
     

    Rejuvenize Peel

    Chemical exfoliation treatment to reduce the primary signs of aging. Learn More
  3. SkinMedica Vitalize Peel
     

    Vitalize Peel

    This peel helps fight the effects of sun damage and environmental assaults. Learn More

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FAQs

CAN I PREVENT ACNE BY WASHING MY FACE MORE?

No. Dirt does not cause acne. It is the overproduction of oil (sebum) from within the skin rather than the surface oil/dirt that leads to acne.

WHAT IS THE BEST WAY TO CLEAN MY FACE?

Wash your face twice daily with mild soap and water. Don’t be too rough while washing and avoid astringents and abrasives as they can cause skin irritation and in general don't help improve acne. Use products that are non-comedogenic and oil-free to minimize acne breakouts.

WILL SQUEEZING PIMPLES CAUSE SCARS?

Yes, squeezing a pimple may cause the contents of the follicle to rupture into the tissue rather than being expressed to the surface of the skin. This can cause tissue damage and scarring. Sometimes a medical provider will open a pimple or cyst with a special instrument designed not to damage the tissue, but you should avoid squeezing or picking pimples.

WILL ACNE GO AWAY?

Yes, eventually. However, while the condition is still active, there may be episodic flares and improvements. With the exception of isotretinoin, there is no cure for acne but there are treatments and medications that help keep acne under control until it clears with time. These medications can be used alone or in combinations. Sometimes acne worsens for the first several weeks after treatment is initiated and then gradually improves. Often improvement will not be noted for 6-8 weeks and maximum efficacy is not seen until 8-12 weeks after therapy initiation. Once acne significantly improves or clears, continued treatment is needed to keep acne from reappearing. The care of your skin may require teamwork between you and your clinician. Be prepared to see your clinician several times, as medications may be added or deleted based on how your skin responds to treatment.

Videos

Acne Videos

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