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NYC Acne Treatment Center
NYC Dermatology Board
Certified Dermatologist
Dr. Gary Rothfeld Manhattan, New York 
Acne Implicated
in a wide range of conditions and illnesses, hormones also play a role in the development of acne. Androgens, male hormones
that are secreted in different amounts by both men and women, play an important role in most cases of acne. Androgens stimulate
the hormone-sensitive sebaceous glands, which produce oil, known as sebum. Sebum, in turn, has been called "the fuel
that feeds the flame of acne."
Genetics also seem to play a role. There are some families in which severe
acne is inherited. Unfortunately, the exact genetic component is not known yet.
If the acne does not respond to home and over-the-counter treatments
after two months, it is a good idea to see a dermatologist before the condition produces scarring and/or takes an emotional
toll. Dermatologists have numerous prescription medications and procedures available. Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. These 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
scarring. 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.
 
Mild acne with comedones on the forehead Moderate acne with
pustules Who Gets Acne? Anyone can get acne, but it appears
most often in teenagers, whose surging levels of androgen (a type of hormone) create larger and more active sebaceous glands.
Acne may continue for people in their twenties and thirties, and even women over forty. Acne also appears more commonly in
people whose parents had acne. What Factors Make Acne Worse? Acne
lesions can come and go. These factors can cause acne to flare: - 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
What Are The Treatment Options for Acne?
Almost all cases of acne can be effectively treated. Treatment goals are to heal existing lesions, stop
new lesions from forming, and prevent scarring.
Acne treatments aim to control one or more of the underlying causes
of acne. For instance, topical retinoids, such as Differin or Retin A Micro, may help unclog sebaceous glands and keep pores
open. Antibiotics may be used to fight the P. acnes bacteria. Accutane or hormonal agents, such as birth control pills, may
be used to reduce sebum (oil) production.
Before Treatment
After Treatment 
A. Topical medications (applied to the skin) Over the counter - Benzoyl
peroxide—This is found in many products including Clearasil and Proactiv. It is a mild antibiotic that kills
the P. acnes bacteria. It is available in different concentrations. Higher concentrations are more likely to irritate
the skin. It does not unclog blocked pores so is not as helpful for reducing whiteheads and blackheads.
- Sulfur
and salicylic acid—These have some mild ability to break down whiteheads and blackheads.
Prescription
- Topical retinoids (Differin, Retin A Micro, Tazorac, tretinoin)—These are among
the most effective and commonly used acne medications. Topical retinoids are unique in their ability to unclog swollen pores.
They may be used alone for mild acne or combined with other medications for moderate-to-severe acne. They may also be recommended
for long-term use, even after the acne is under control, to keep the skin clear.
- Topical antibiotics—Antibiotics
applied to the skin, such as clindamycin (Clindagel) and erythromycin, kill the P. acnes bacteria that leads to inflammation.
B. Oral medications (taken by mouth) - Oral antibiotics—These medications, which include
tetracycline, doxycycline (Adoxa, Doryx), and minocycline (Dynacin, Solodyn), act systemically and can reach bacteria in the
deep layers of the dermis. They are also used for their anti-inflammatory effects.
- Oral contraceptives
(Ortho Tri-Cyclen, Yaz)—For women who experience hormonally triggered acne, birth control pills may be prescribed to
reduce sebum production.
- Anti-androgen drugs—Some drugs used for other medical conditions are
known to reduce androgen levels, such as spironolactone (Aldactone). These may be used in some cases of acne.
- Isotretinoin (Accutane, Sotret)—Isotretinoin remains the most effective treatment for severe acne or acne that does not respond to other treatments.
Isotretinoin treats all causes of acne: excess sebum, clogged pores, bacterial overgrowth, and inflammation. Most patients
take the medicine for 15-to-20-week periods that may be repeated if necessary. Treatment requires monthly office visits, monthly
lab tests, and strict contraception. It is critical that women of child-bearing age do not get pregnant while taking isotretinoin
because of the serious risk of birth defects. The iPledge program was developed to reduce the likelihood of birth defects and other side effects.
Many of these medications have
side effects, such as burning, redness, and irritation. With some medicines, such as topical retinoids, these side effects
usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away,
tell your doctor. C. Procedures For persistent lesions that are inflamed or unresponsive to medications, some
doctors recommend additional methods, including extraction, light therapy, or corticosteroid injections. How Will
I Choose a Treatment Plan? Your doctor will recommend a treatment based on these 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 an oral retinoid
(Accutane, Sotret).
- Results of previous treatments. Medications may be added in a step-wise fashion,
only if previous treatments are found to be ineffective.
- Degree of scarring. More aggressive therapies
may be started earlier if acne scars have already started developing.
- Gender. Some treatments are
available only for females, such as birth control pills.
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 retinoid 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)
What About Self Care and Prevention? For ongoing self-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.
Cleansing
Acne has nothing to do with not washing your face. However,
it is best to wash your face with a mild cleanser and warm water daily. Washing too often or too vigorously may actually make
your acne worse. . Cosmetics Wear
as little cosmetics as possible. Oil-free, water-based moisturizers and make-up should be used. Choose products that are "non-comedogenic"
(should not cause whiteheads or blackheads) or "non-acnegenic" (should not cause acne). Remove your cosmetics every
night with mild soap or gentle cleanser and water. A flesh-tinted
acne lotion containing acne medications can safely hide blemishes. Loose powder in combination with an oil-free foundation
is also good for cover-up.
. Treatment Control of acne is an ongoing process. All
acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement
takes time. If your acne has not improved within two to three months, your treatment may need to be changed. The treatment
your dermatologist recommends will vary according to the type of acne. Occasionally,
an acne-like rash can be due to another cause such as make-up or lotions, or from oral medication. It is important to help
your dermatologist by providing an updated history of what you are using on your skin or taking internally.
Many non-prescription
acne lotions and creams help mild cases of acne. However, many will also make your skin dry. Follow instructions carefully.
Topicals - Your dermatologist may prescribe topical creams,
gels, or lotions with vitamin A acid-like drugs, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria.
These products may cause some drying and peeling. Your dermatologist will advise you about correct usage and how to handle
side effects.
- Before starting any medication, even topical medications, inform your doctor if
you are pregnant or nursing, or if you are trying to get pregnant.
Special Treatments - Acne surgery may be used by your dermatologist to remove blackheads and whiteheads.
Do not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation,
and scarring may result.
- Microdermabrasion may be used to remove the upper layers of the skin
improving irregularities in the surface, contour, and generating new skin.
- Light chemical peels
with salicylic acid or glycolic acid help to unblock the pores, open the blackheads and whiteheads, and stimulate new skin
growth.
- Injections of corticosteroids may be used for treating large red bumps (nodules). This may help them go away quickly.
Oral - Antibiotics taken by mouth such as tetracycline, doxycycline,
minocycline, or erythromycin are often prescribed.
Birth Control Pills
- Birth control pills may significantly improve acne, and may be
used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness
of birth control pills. This is uncommon, but possible, especially if you notice break-through bleeding. As a precautionary
measure use a second form of birth control.
Other Treatments - In cases of unresponsive or severe acne, isotretinoin may be used. Patients using isotretinoin must understand the side effects of this drug. Monitoring with frequent follow-up
visits is necessary. Pregnancy must be prevented while taking the medication, since the drug causes birth defects.
- Women may also use female hormones or medications that
decrease the effects of male hormones to help their acne.
- Photodynamic therapy using the blue wavelength of light can be helpful in treating acne as well.
Your dermatologist will evaluate you and suggest the appropriate treatment
regimes considering your age, sex, and the type of acne you have. Treatment
of Acne Scarring The dermatologist can treat acne scars by a variety
of methods. Skin resurfacing with laser, dermabrasion, chemical peels, or electrosurgery can flatten depressed scars. Soft
tissue elevation with collagen or fat-filling products can elevate scars. Scar revision with a microexcision and the punch
grafting technique can correct pitted scars, and combinations of these dermatologic surgical treatments can make noticeable
differences in appearance. Proper Care is Necessary No
matter what special treatments your dermatologist may use, remember that you must continue proper skin care. Acne is not curable,
but it is controllable; proper treatment helps you to feel and look better and may prevent scars.
To learn more
about acne and acne treatments please consult with Dr. Rothfeld at NYC Acne Treatment Center of New York, NY.
Retinoic
acids.
Available as creams and lotions, these vitamin A acids can help unblock pores
and reduce the skin's bacteria. Topical antibacterials
or antibiotics.
These creams and lotions can help reduce
acne inflammation and skin bacteria. Oral antibiotics.
Though not usually
the first course of treatment, oral antibiotics such as tetracycline are often used to help reduce the inflammation of acne.
Birth control pills.
Women who use oral contraceptives may notice that their acne improves significantly.
In fact, the FDA has approved one birth control pill specifically for acne treatment. Isotretinoin.
For severe acne that does not respond to other treatments, your dermatologist
may prescribe isotretinoin. This medication must be used with care, however, since it can cause birth defects. Surgery.
It is never a good idea to remove blackheads or whiteheads (both called comedones) or pimples on your own. A dermatologist
has the proper equipment to extract them without leaving scars. Millions
of people suffer the ravages of acne scars long after adolescence has passed and the acne condition has faded. Acne in its
most severe form can leave sufferers with deep permanent scars. Acne typically results in two types of scars - "icepick,"
or pitting scars, and "depressed," crater-like scars. Treating Scars
Thanks to the refinement of a
number of dermatologic surgical techniques, acne scars can be treated with a variety of safe, effective procedures that improve
the appearance of a patient's skin and boost the patient's self-esteem. Dr. Rothfeld, a dermatologic surgeon will
choose the technique or combination of treatment approaches based upon the nature of the scarring. The following are common
techniques and procedures used to improve acne scarring:
Dermabrasion The dermatologic surgeon
freezes the patient's skin or uses tumescent anesthesia and then removes or "abrades" the skin with a rotary
instrument. The skin undergoes a "remodeling" process as it heals, resulting in a smoother and fresher appearance.
Excision
and Punch Replacement Graft A depressed acne scar is surgically removed, and
a patch of skin from elsewhere on the patient's body. Soft
Tissue Fillers Bovine collagen, collagen-related fillers, polymer implants or a patient's own fat (taken from
another part of the body) is injected in small quantities below the surface of the skin to elevate depressed scars. Laser Therapy By delivering
short pulses of the laser beam, the dermatologic surgeon can smooth, sculpt and normalize the appearance of acne scars. The
ultrapulsed carbon dioxide laser, the erbium YAG laser and the pulsed dye yellow light laser are most commonly used for treating
acne scarring. Chemical
Peeling By applying a chemical solution to the skin, mild scarring and certain types of acne may be treated. The
procedure enables new, regenerated skin to appear, improving the appearance of the condition. Chemical Chemical peels have
been a mainstay of Dermatology for decades. Chemical peels work by ungluing the top layer of damaged skin and discolored skin
so it can peel away and reveal the fresh new skin beneath. Come into Dr. Rothfelds' office to discuss
the different type of chemical peels that would be appropriate for you. Chemical peeling uses a chemical solution to improve the skin's appearance. It can reduce or eliminate fine
lines under the eyes and around the mouth, correct uneven skin pigmentation, remove precancerous skin growths, and soften
acne or treat scars caused by acne. The procedure can also treat wrinkles caused by sun damage and scarring, as well as skin
blemishes common with age and heredity. Chemical peels can be performed on the face, neck, chest, hands, arms, and legs. Possible
complications associated with chemical peels may include but are not limited to the following: - change
in skin tone color
For certain skin types, there is a risk of developing a temporary or permanent skin color
change. Taking birth control pills, being pregnant, or having a family history of brownish discoloration on the face may increase
the possibility of developing the abnormal pigmentation.
- scarring
Chemical peels
can cause scarring. However, if scarring occurs, it can usually be treated effectively.
- cold
sores and fever blisters
Those who are susceptible to cold sores, or herpes
simplex infections, may have a reactivation of cold sores or fever blisters following a chemical peel.
A chemical
peel is most commonly performed for cosmetic reasons to enhance appearance and self-confidence and may be performed in conjunction
with a facelift. However, a chemical peel is not a substitute for a facelift and does not prevent or slow the aging process.
Chemical PeelsPhenol, trichloroacetic
acid (TCA), and alphahydroxy acids (AHAs) are used for chemical peels. The precise formula used may be adjusted for each patient.
- alphahydroxy acids (AHAs)
Alphahydroxy acids (AHAs) such as glycolic, lactic, or fruit acids
are the mildest of the peel formulas and produce light peels that can often provide smoother, brighter-looking skin. AHA peels
may be used to accomplish the following:
- reduce fine wrinkling
- treat
areas of dryness
- reduce uneven pigmentation
- aid in control of acne
- smooth
rough, dry skin
- improve texture of sun-damaged skin
AHA peels may cause the following:
- stinging
- redness
- irritation
- crusting, flaking, or scaling
- dryness
Generally,
no anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application. Protecting
skin from the sun is important following AHA peels.
- trichloracetic
acid (TCA)
Trichloroacetic acid (TCA) can be used in many concentrations and is used to accomplish the following:
- smooth fine surface wrinkles
- remove superficial blemishes
- correct
pigment problems
TCA can be used on the neck or other body areas, and may require pretreatment
with Retin-A or AHA creams. This procedure is preferable for darker-skinned patients. Anesthesia is not usually required
for TCA peels because the chemical solution acts as an anesthetic. Although, sedation may be used before and during the procedure
to help the patient relax. Two or more TCA peels may be needed over several months to obtain the desired result, although
mild TCA peels may be repeated more frequently. The results of a TCA peel are usually less dramatic than and not as
long-lasting as those of a phenol peel. More than one TCA peel may be needed to achieve the desired result. TCA-peel
patients are advised to avoid sun exposure for several months. The procedure also may produce some unintended color changes
in the skin.
- phenol
Phenol is the strongest of the chemical solutions
and produces a deep peel. A phenol peel is mainly used to accomplish the following:
- correct blotches caused
by sun exposure, birth control pills, or aging
- smooth out coarse wrinkles
- remove
precancerous growths
Phenol:
- should be used on the face only, as scarring may result
if used on the neck or other body areas.
- is not recommended for darker-skinned
individuals.
- may pose risk for patients with heart problems.
- may
permanently remove facial freckles.
- may cause permanent skin lightening.
- may leave lines of demarcation.
Recovery may be slow and
complete healing may take several months. After a phenol peel, new skin may lose its ability to produce pigment. The
skin will be lighter and will always have to be protected from the sun.
About
the procedure:The procedure involves a chemical solution that is applied to the skin. The solution causes
a layer of skin to separate and peel off. The new, regenerated skin underneath is usually smoother, less wrinkled, and more
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