ACNE

Acne is one of the most common of all skin problems.It affects most teenagers to some degree and even many adults. Acne presents in the form of whiteheads, blackheads, pimples, and in some people, deep painful bumps that look and feel like boils. Acne most commonly occurs on the face but can also appear on the back, chest, shoulders, and neck.

Acne usually begins around puberty, when members of both sexes experience an increase in the production of sex hormones called androgens. These hormones regulate the activity and size of the oil-producing, or sebaceous glands that reside in the pores or hair follicles of the skin. The increased production of these hormones causes the oil glands to get bigger in the areas where acne occurs.

The sebaceous glands make an oily substance called sebum. Sebum travels from the hair follicles to the surface of the skin. The lining of the wall of the hair follicle sheds skin cells, which then stick together with the sebum. The follicle gets clogged, plugging up the opening in the surface of the skin. Whiteheads and blackheads are the result of clogging of the pores. The sebum and cell debris together contribute to the growth of bacteria that live in your pores.

The body will naturally attempt to clear the clogged pores by sending in certain specialized cells that invade the follicle to help clean it up.   However, in the process, the wall of the follicle may weaken and rupture, emptying the contents of the follicle into the surrounding tissue.   When this occurs, swelling or redness can develop around the affected follicle, resulting in the larger bumps or pimples characteristic of acne.   These are known as papules and pustules and can sometimes cause scarring.   From the beginning until its disappearance, the life cycle of a pimple can take 8 weeks to run its course.   And it can take even longer for the darkened spots left by some acne pimples to fade completely.

Who gets acne?

It is estimated that as many as 70 million people in the U.S. suffer from acne. In most people, acne clears up after a few years. But at its worst, acne can cause permanent scarring of the skin. And even when there are few physical marks left, the emotional ones can be devastating.

Treatment

There are numerous treatment options for people who suffer from acne.   How you and your dermatologist decide to treat your acne will depend on the severity of your acne.  

Several lotions and creams are available without a prescription that are helpful in mild cases of acne. For more severe cases of acne, there are prescription creams and lotions. Some contain antibiotics to help get rid of the bacteria that contribute to the formation of acne pimples.   In some cases, oral antibiotics may be given. In many cases, a dermatologist will recommend a combination of two or more treatments for their patients with acne.

Other medications work to get rid of the pimples and help the skin to stay clear. A dermatologist can physically extract some kinds of acne pimples, especially blackheads. This kind of procedure should only be performed by a dermatologist or other skilled professional. Squeezing or picking at acne and pimples can result in infection and permanent scarring.

Some options for acne treatment are listed below:

• Oral Antibiotics. Four to eight weeks of antibiotic therapy are required before improvement is seen in acne, however, treatment can be effective for many acne patients. There are a variety of oral antibiotics prescribedby physicians to treat acne. These include Minocycline*, Septra** and Doxycycline***.

With any antibiotic: If you develop signs of a yeast infection, i.e. vaginal discharge and itching, call our office. If you have had yeast infections before and are having similar symptoms, Monistat and GyneLotrimin are now available over the counter without a prescription.

Recently a large well designed study has shown that antibiotics do not decrease the effectiveness of the birth control pill if the two medications are given at the same time.   If you are on the “pill” or have it prescribed while you are taking antibiotics, please discuss this with your dermatologist.

• Topical medications and topical antibiotics such as Differin, Duac, Benzaclin, Benzac AC Wash, Tazorac and Retin-A.

Retin-A, technically known as tretinoin or retinoic acid, is a prescription cream that began its life as an acne medication. This derivative of vitamin A fights acne by exfoliating the skin and unclogging pores, properties that make it useful for treating other skin problems as well. For instance, by increasing the shedding rate, it makes skin cells multiply faster, which helps pigmentation problems (like age spots) fade. Beyond that most dermatologist believe that tretinoin promotes collagen formation and thickens the epidermis (the top layer of skin) to lend a more youthful look to skin. New applications include preparing the skin for chemical peels and treating certain precancerous conditions.

• Accutane (click here for Accutane products). This oral medication is used to treat severe acne (nodular acne) which has not responded to other treatments, including topical medications and oral antibiotics. This synthetic oral form of vitamin A (Accutane) works by decreasing formation of oily plugs of sebum (the oil substance produced by sebaceous glands), reducing the formation of keratin (the tough outer layer of skin), and by shrinking the sebaceous glands. Isotretinoin cures or greatly reduces severe disfiguring acne in up to 80% of patients. The course of treatment usually runs four or five months, after which the condition may continue to improve at least two more months to a year. Sebum production then gradually returns to its pretreatment levels, but fewer than one-third of patients require a second course of the drug.

The physicians at the Cheyenne Skin Clinic have seen Accutane produce good results for the majority of their patients on the medication. However, Accutane is a serious medication and should be used only if other medications have failed. It is important to discuss the benefits and drawbacks of Accutane with your dermatologist if you think you are a good candidate for this treatment and before starting therapy.

• AcneLight. The FDA has recently approved the use of high intensity "blue light" to destroy Propionibacterium acnes, the bacteria that is the primary cause of acne. The treatment does not require patients to take or apply any medication, and is free of side effects. Patients visit the Cheyenne Skin Clinic twice per week for four weeks to sit in front of our special blue light for 15 minutes. It is best suited for patients with mild to moderate acne with whom other treatments have failed or for those patients who don't like to take medication. For more information, please contact the Cheyenne Skin Clinic at (307) 635-0226 to speak with a dermatology nurse.

Can I prevent my acne from coming back?

A dermatologist can prescribe a regimen that will help get rid of active acne and pimples and also prevent new ones from appearing.   By using medications correctly and consistently, patients can prevent   new acne pimples from forming. Stopping medication or “spot treating” visible pimples may allow new pimples to grow and take weeks to clear again.   Medication should be applied in the same way every day as recommended by a dermatologist.

Can acne be cured?

There is no instant or immediate cure for acne, but it can be controlled.   Scarring may be prevented with proper care and treatment.   Again, correct and consistent use of acne medication and following a dermatologist’s instruction is the best bet.

*The most common side effect seen with Minocycline is dizziness which occurs two to three hours after taking the medicine. One can usually avoid this problem if you take your capsule at bedtime for the first two weeks.  A very few people will have continued dizziness on awakening and must discontinue the medication. Other reported side effects with Minocycline include: yeast infections, diarrhea, increased skin pigmentation, and allergic skin rashes. Rarely liver problems and lupus have been seen with Minocycline. People with decreased kidney function, women who are pregnant or breast feeding, and children less than eight years old should not take Minocycline. If there is a chance you may be pregnant, discontinue the medication. Although minocycline has been reported to increase sun sensitivity, although it is rare. If you think that you sunburn more easily while on Minocycline, apply a sunscreen with an SPF of 15 or higher.

**Septra should be taken with a large glass of water with or without food.  It may rarely cause stomach upset with nausea and vomiting. This is a sulfa medication and should not be taken by those who are allergic to Sulfa. A few people develop serious allergic reactions including severe skin rashes and hives. If you develop a rash while on Septra DS, stop the medication immediately and notify our office. Rarely, Septra DS may cause a decrease in the white blood cells, red blood cells, or platelet count.   We routinely do a blood test at the first office visit after starting the medication and every six months thereafter. Septra DS may cause an increased sensitivity to the sun. If you notice this, use a sunscreen with SPF 15 or higher. Septra DS may interact with other medications including: phenytoin (Dilantin), diuretics (thiazides), Coumadin, and Methotrexate. If you are prescribed any of these, please discuss this with your physician or call our office.

***Doxycycline is an oral antibiotic that is effective in the treatment of acne. Take your capsules with a large glass of water on an empty stomach at least one hour before a meal or two to three hours after you eat. Do not take within one hour of milk, dairy products, antacids, iron, or calcium containing preparations. If the Doxycycline is taken with food or milk, it is poorly absorbed and is much less effective. Reported side effects with Doxycycline include: stomach upset, heartburn, yeast infections, and increased sensitivity to the sun.   If you experience heartburn, take the tablet with a cracker or cookie and a large of water.   It is very important that the capsule or tablet not lodge in the esophagus.   If you have the feeling the Doxycycline is “stuck” in your throat or esophagus, discontinue the medication or and take an antacid.   People with decreased kidney nction, women who are pregnant or breast feeding, and children less than eight years old should not take Doxycycline.  If there is a chance that you may be pregnant, discontinue the medication. Doxycycline may cause increased sensitivity to the sun with severe sunburn developing from relatively short sun exposure. Sunscreen with SPF 15 or higher should be used on all sun exposed skin.

ROSACEA

Rosacea is a condition that affects the skin of the face, mostly the area where people blush. A number of symptoms accompany this condition and range from mild to more severe. Some characteristics include:

• Redness. This can look like nothing more than a blush or a sunburn. It is caused by flushing when a large amount of blood vessels expand to handle the flow. If this continues to happen, over time, the redness becomes more noticeable and does not go away.

• Pimples. As a result of continual flushing, the skin eventually becomes irritated and inflamed and pimples may appear on the face. These pimples may be papules (small, red, and solid) or pustules (pus-filled, like teenage acne). This is why rosacea is often referred to as “adult acne” or “acne rosacea.” But people with rosacea don’t have the comedones (blackheads or whiteheads) usually seen in teenage acne.

• Broken or enlarged blood vessels. Doctors call this telangictasia. When people with rosacea flush, the small blood vessels of the face get larger-eventually showing through the skin. They may appear as spots or as thin wavy lines. Flushing, blushing, or redness may hide them, but they may become more visible as the underlying redness is cleared up by treatment.

• Enlarged, bumpy nose. This condition is called rhinophyma, and is present in the more advanced stages of rosacea, especially in men. When rosacea isn’t treated early, small, knobby bumps may gradually appear on the nose, giving it a swollen appearance. This is the symptom that gives rise to the myth that rosacea sufferers are actually problem drinkers, which can substantially contribute to the emotional upset experienced by many patients.

How does it start, and how does it progress?

The first sign of rosacea is usually rosy cheeks. As it progresses, the face may get red in patches and stay red for hours or days at a time. Eventually, the redness doesn’t go away at all. At this stage, some or all of the symptoms mentioned previously may also appear. Rosacea is a chronic condition, and that means the symptoms may come and go in cycles and fluctuate in their degree of severity. Because of this, many people mistake their rosacea for things like sunburn, windburn, a complexion change, or acne and they don’t bother to see a doctor. However, in most cases, the earlier they see a dermatologist, the quicker their rosacea can be brought under control.

Who gets rosacea?

Rosacea is usually seen in adults. It can affect those in their 30s, all the way up to and including people in their 70s and 80s. While rosacea is most common in persons with fair complexions, it can affect people of all skin colors and skin types. Most people who get rosacea seem to flush or blush more often than the average person and may have parents or grandparents who have the same symptoms. Because they think it is just something that “runs in the family,” they often don’t seek help from a dermatologist.

Treatment

Rosacea can’t be cured, but the right treatment, used faithfully, can create much clearer skin and actually helps keep symptoms from coming back. A person shouldn’t treat rosacea themselves. Nonprescription acne medications may irritate dry, sensitive skin, and may contain ingredients that appropriate for rosacea.

A dermatologist can recommend the right care for your symptoms. In most cases, this would include oral antibiotics to control the papules and pustules and/or topical metronidazole like MetroGel topical gel, MetroCream topical cream, or MetroLotion topical lotion applied directly to the skin.

• Oral antibiotics. Capsules or tablets can be taken by mouth, usually once or twice a day. Some of these such a Tetracycline, should be taken on an empty stomach. Patients should ask their pharmacist about milk and other foods that may keep the medication from being absorbed by the body.

• Topical Steroids. Prescription and non prescription topical corticosteroid cream or gel is sometimes prescribed initially to get redness under control quickly. Steroids are not generally used as a long term treatment for rosacea because they can sometimes cause a flare up of symptoms.

Since rosacea cannot be cured, once the symptoms have cleared up patients need to continue using their medications. Without this regular (maintenance) therapy, the symptoms may return or get worse over time.

• Laser therapy. Once blood vessels are visible, many people elect to have them removed with laser therapy. Surgery can also be used to correct a nose enlarged by rhinophyma.

ADORA DAY SPA offers threatment with two lasers to help decrease redness and the appearance of blood vessels. The Rosacea Treatment package is recommended by Dr. Surbrugg, director of the Cheyenne Skin Clinic. The package includes an AURORA FotoFacial treatment, followed by a V-Beam treatment in two weeks. This process is repeated every two weeks for a total of four FotoFacial sessions and three V-Beam sessions. The total time commitment for this package is 12 weeks. For more information, please call ADORA DAY SPA at (307) 773-8520.

Skin Care

Following a regular cleansing and medication routine-twice a day or as prescribed by a doctor-will make treatment easier and more successful. How and what is used to cleanse and moisturize the face is also important. Here are some simple steps to follow:

• Cleanse gently with a very mild cleanser. Avoid products that contain alcohol or other irritants. Dermatologists frequently recommend Cetaphil Gentle Skin Cleanser, a gentle soapless product available at most drugstores, that does an excellent job of cleaning without irritating.

• Medicate according to the instructions of a dermatologist.

• Protect with a sunscreen of SPF 15 or higher, even on cloudy days. Look for a non-comedogenic product that does not contain alcohol. Cetaphil Daily Facial Moisturizer with SPF 15 is an excellent choice, as well as Neutrogena or PreSun.

• Moisturize with a good quality moisturizer as needed. If the treatment therapy includes a topical medication, the moisturizer should be applied after the medication has dried. The moisturizer should say “noncomedogenic,” meaning it won’t clog pores. The Cetaphil product line also includes a moisturizer, available in both lotion and cream forms that are specially formulated for sensitive skin.

• Makeup can help hide rosacea while patients are in the process of getting their symptoms under control and afterward. Oil-free foundations with yellow (not pink) undertones are recommended, as are special green-tone products specifically designed to be worn under foundation to disguise facial redness. ADORA DAY SPA offers Jane Iredale Skin Care Makeup, which is recommended by dermatologists and plastic surgeons for its excellent coverage of redness caused by rosacea. Call or visit ADORA DAY SPA at (307) 773-8520 or www.adoradayspa.com.

Avoid rosacea triggers

Below is a list of things that can aggravate your rosacea symptoms. It is unlikely that a patient will react to everything on this list, but by being observant they can discover which ones apply to them to avoid flare ups in the future.

• Weather (sun, strong winds, cold humidity)

• Emotional influences (stress, anxiety)

• Temperature-related (sauna, hot tubs, over-bathing, excessively warm environments)

• Physical exertion (exercise, “lift and load” jobs)

• Beverages (alcohol, especially red wine, beer, bourbon, gin, vodka, or champagne and hot drinks including hot cider, hot chocolate, coffee, or tea)

• Foods (liver, dairy products, including yogurt, sour cream, and some cheeses, chocolate and vanilla, soy sauce and vinegar, vegetables including eggplant, tomatoes, spinach, lima beans, navy beans and peas, fruits including bananas, red plums, raisins, figs and citrus fruit, and hot and spicy foods.

• Skin care products (some cosmetics and hair sprays, especially those containing alcohol, witch hazel, or fragrances, topical steroids, any substance that causes redness or stinging.)

Patients need to experiment to determine their own personal triggers. They may find it helpful to keep a daily diary of food consumption and activities to get a better idea of what causes their episodes of flushing. Once their own triggers have been identified, they should avoid them for a few days. If the patient notices a reduction in the frequency and severity of their flare-ups, they have probably identified what should be avoided to help keep their rosacea under control.

A conversation with all of the patient’s doctors, in addition to their dermatologist, may also be in order, especially if they have medications prescribed to them for other medical conditions.