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FAQs and Answers

What is the most common type of acne that you see on DermCheck App?

There are several types of acne that an individual can present with. In some cases an individual will present with a combination of different types of acne. Comedones are essentially small round bumps that often occur on the chin and forehead of individuals with acne. When the comedone is open it is referred to as a blackhead because when the oil secreted is exposed to air, it turns black. When the comedone is closed, it is known as a whitehead. Most people are not aware that wearing a hat or bangs in females can block the pores and lead to development of comedones. For women who have long bangs, it is important to trim them to prevent comedones. Men should avoid wearing a hat or any type of head covering to prevent comedone formation.

One other type of acne that is also commonly seen on the face is reddish pimples which are also referred to as erythematous papules. In some cases, comedones, blackheads and whiteheads can also turn into reddish pimples. The reddish pimples are frequently tender to touch and may even contain pus. Overall, the reddish pimples can vary in size and intensity of color. Most of these reddish pimples have ongoing inflammation due to the presence of bacteria. The main treatment for such reddish pimples is a course of antibiotics, which not only kill the bacteria but also decrease the symptoms. Sometimes the red pimples can turn into cystic acne.

Besides red pimples, one can also develop cystic acne on the face. These cysts may occur on any part of the face and can affect facial cosmesis. If cystic acne is not treated promptly and aggressively it can leave unattractive residual scars, which are difficult to treat. Patients who present with cystic acne are usually treated with Accutane, which appears to be very effective. Because cystic acne can lead to depressed scars, patients should see a skin doctor as soon as possible. The earlier cystic acne is treated, the better are the results.

What are the most common treatments for whiteheads and blackheads?

Comedones are also referred to as blackheads and whiteheads. These lesions can occur anywhere on the face but tend to be more common around the forehead and chin area. If neglected, comedones can turn into red pimples. Comedones are best treated with the vitamin A derivatives like Retin-A (Tretinon) or Differin (Adapalene). These retinoids act as exfoliative agents, unplug the pores and decrease oil secretion from the glands.

Studies show that use of these topical retinoids can result in marked reduction in comedones over the face.

How does one apply Differin and Retin-A?

Both Differin and Retin-A are applied as a thin film on the acne lesion just before bedtime. It is important to avoid applying too much as this will result in irritation and dryness. More important, both Differin and Retin-A can sensitize your skin to the sun. So it is vital that you apply a moisturizer and liberally use a sunscreen every time you go out. To be on safe side, skin experts recommend that patients with acne should start slow with these agents and apply them on them on the face every other night. If within 5-10 days, there is no adverse reaction, then one can resume daily application.

What strength of Differin and Retin-A should I use?

Both the drugs are available in several strengths. The strength of the drug you use will depend on your skin sensitivity. In general, individuals with blue eyes, blond hair and fair skin tend to be more sensitive than individuals with dark colored eyes and dark skin. Thus, in sensitive patients, doctors usually start with Retin-A 0.04% microgel or Differin 0.1%. For those people with dark skin, the starting dose is usually Retin-A 0.1% or Differin 0.3%. For the first week, it is important for both groups of individuals to apply the medication every other night.

How are red pimples on the face treated?

Red pimples are usually treated with a combination of topical retinoids, topical antibiotics and oral antibiotics. Newer clinical studies reveal that the topical retinoids are effective for both comedones and red pimples on the face. The topical antibiotic that is frequently used to treat red pimples is clindamycin. Clindamycin is usually never applied alone on skin as it can lead to development of bacterial resistance. Hence, it is usually combined with topical benzoyl peroxide. This is the reason why medications like Duac and BenzaClin have been developed.

Once applied on the face, these topical antibiotics work rapidly and within no time will lead to resolution of your facial acne, without causing any development of bacterial resistance.

In individuals who have moderate to severe red pimples on the face, just applying a topical antibiotic may not work. Thus, addition of an oral antibiotic is needed. The antibiotic of choice for red pimples is doxycycline, which is a tetracycline. A dose of 100 mg of doxycycline (Doryx, Monodox) taken once or twice a day is the recommended treatment.

Even though there are generic brands of doxycycline available, the brand name drug should be used as it is associated with fewer adverse effects like stomach upset. To avoid the stomach upset, doxycycline should be taken with food and never on an empty stomach. In addition, all individuals who are prescribed doxycycline should wear a sunscreen when going out as the drug does sensitize the skin. For people who are not able to tolerate doxycycline for whatever reason, another option is minocycline which causes less skin sensitivity, but it may cause dizziness.

Minocycline is prescribed at 100 mg taken once a day. In patients with different types of acne present at the same time (ie comedones, blackhead, whiteheads and red pimples) it is important to use a combination of a topical retinoid, topic antibiotic like clindamycin with benzoyl peroxide and an oral antibiotic. In most cases, the duration of treatment is for 6-8 weeks. Once the acne starts to resolve, the dose of the oral antibiotic is decreased and the patient is maintained on the topical medications.

How is cystic acne treated?

Cystic acne is usually treated with the vitamin A derivative, Accutane. This prescription medication is generally used when the oral antibiotics and other topical medications have failed. While Accutane is a very effective medication for acne, it is not prescribed to everyone. Accutane (Isotretinoin) is usually consumed for 4-5 months. However, because the drug has the potential for causing harm to the fetus it is not prescribed for women of child bearing age or any female who is thinking about getting pregnant. In order to be prescribed Accutane, the individual must register under a government program known as iPLEDGE, which is done at the doctor’s office. The purpose of iPLEDGE program is to ensure that the female does not become pregnant while taking Accutane. Further when taking Accutane, the female must not be sexually active. If she is sexually active, some form of contraception is mandatory (ie condom, birth control pill). Accutane should never be taken without guidance from a healthcare provider. It is not recommended that one buy Accutane from outside the USA, as the potential for harm is much greater than its benefit.

Most physicians in the USA provide comprehensive education to all patients prior to prescribing Accutane. Once registered in the iPLEDGE program, the individuals are also closely followed.

Is benzoyl peroxide good for your skin?

Benzoyl peroxide is one of the oldest medication for treatment of acne. It is usually applied to the acne lesions and it acts by killing the bacteria that causes acne. For maximal benefit, benzoyl peroxide is combined with clindamycin. The reason for this is that recent studies show that if clindamycin is used alone, the bacteria rapidly develop resistance to the drug- hence the antibiotic is not effective for treatment of acne. By combining it with benzoyl peroxide, there is a less risk of developing bacterial resistance. The combined formula of benzoyl peroxide and clindamycin are sold as Duac and BenzaClin. While benzoyl peroxide is an effective acne medication, it’s one negative is that it can cause skin irritation.

There are several formulas of benzoyl peroxide available and they vary in strength from 2.5 to 10%. The 10% formula is usually not recommended because of the potential to develop side effects and hence the 5% formula is selected. In addition, some dermatologists also recommend use of PanOxyl, which is a topical benzoyl peroxide wash. The product should only be used once a day. Frequent usage can lead to skin irritation and dryness.

Does Proactiv work?

Proactiv is probably one of the most hyped up product for the treatment of acne,. Even though it does contain sulfur and benzoyl peroxide, it only works on mild acne. For some unknown reason Proactiv does not work in all people with acne and its benefits are neither reliable or consistent.

Proactiv usually does not work in people with reddish pimples and moderate to severe acne. This type of acne is usually treated by skin doctors and treated with topical and oral antibiotics.

Does Proactiv work on acne scars?

Acne scars are some of the most difficult skin lesions to treat. There are many types of acne scars and they vary in intensity, depth, length and appearance. Proactiv has almost no affect on scars. It has no ability to stimulate collagen synthesis which is needed to elevate the depressed scar. In general, acne scars are treated with a variety of lasers (CO2, Fraxel, SmartZide, Active FX) and peeling agents like trichloroacetic acid.

Does Proactiv work on blackheads?

Even though Proactiv is widely promoted as treatment for acne, it really does not do much. Proactiv does not have the ability to unplug the pore nor does it exfoliate the skin; two key factors needed to treat acne. Proactiv has neither of these activities.

Does exercise make acne worse?

It is important to understand that exercise by itself does not worsen acne. Even though many individuals claim that after heavy exercise the facial acne got worse, it is not the exercise but the sweat and humidity that are responsible, Sweat can plug up the pores on the face and that leads to development of acne. Hence after exercise it is important to shower and wash off the sweat. When exercising always have a towel handy so that you can wipe the sweat and prevent it from accumulating on your face. One can also buy pads that contain glycolic and salicylic acids that can be used to wipe off the sweat.

Is back acne hard to treat?

Unlike acne on the face, back acne is much more difficult to treat. In most cases, one needs to use oral antibiotics or even Accutane to treat back acne as most topical agents do not work. The antibiotic of choice for back acne is doxycycline 100 mg twice a day in combination with clindamycin lotion applied once a day. It is highly recommended that the patient also use a benzoyl peroxide (PanOxyl) wash once a day. This agent should not be used more than once a day as it can cause a moderate amount of skin irritation and dryness.

Do lasers work for acne?

There are several types of laser treatments of which one of them is called photodynamic light therapy (PDT). This type of laser contains both blue and red light and is quite effective for facial acne. Recently, newer agents (eg Metvixia, levulan) have been developed which are applied on the skin and get absorbed by the oil glands. Then the laser is applied and it selectively targets the acne lesions where these agents has accumulated. This leads to a rapid decrease in size of the acne lesions. This type of therapy also reduces the adverse effects of the laser on normal skin. In most cases, several treatments with the laser are required to obtain the maximal benefit.

The general protocol for use of photodynamic light therapy in combination with levulan for facial acne is as follows:

  1. The face is first cleaned with mild alcohol.
  2. The levulan is then applied on the face and allowed to sit for at least 30 minutes.
  3. Then the light is applied to the face for a specific duration of time.
  4. After the light treatment, the face is washed and a sunscreen is applied. The patient is asked to wear a hat before leaving the office.
  5. After treatment it is important to keep out of the sun for at least the next 48 hours because levulan makes the skin sun sensitive and cause a sun burn like effect.
  6. All patients are seen again the clinician in 14 days time for the next treatment session