Your skin is a reflection of your inner health, so the first step is to act in a way that is consistent with health. Eating, exercising and avoiding excessive sunlight go a long ways too.  We are past the point of doing what our parents instructed us to do for our own good and have progressed to the point of actually doing what is good for ourselves. Instead of asking yourself, "what sounds good for dinner?"  Ask, "What would be something healthy that I could eat for dinner?'  Modifying your perception that you will be healthy, that you are healthy,  will encourage more responsible choices. Dr. Hogan's answer for this is to write down everything that goes into your mouth.  No matter what.  At the end of the day, look up how many calories are in what you have eaten.  Body weight equals calories eaten minus calories used.  It is really simple math,  just like your bank account.  We just do not realize how many high calorie decisions we make during the day.  This will break you of that habit.

Speak to someone who is much older,  they will attest to the fact that 'if you don't use it, you will lose it.'  That is why when you see a healthy elderly person,  excercise is always part of their life style.  Don't forget to excercise your skin as well with some light exfolation.   Expose your skin to sunlight responsibly. That means don't ever put yourself in a situation that will make your skin turn red from ultraviolet light.  In the same vein, extremely hot showers directly to the skin are dehydrating and promote skin congestion dur to the dilatation of the skin, physically forcing the pores closed.  Avoid cigarette smoke. Avoid caffiene. Increase organic fruits and vegetables.  Read about health.  The knowledge will bring power to your resonsible decisions that you make as a healthy person. Be a healthy person.

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There is a common misconception that wrinkles around the mouth are caused from slurping through a straw or caused by smoking.  I have counciled many female patients that are saddened by these vertical wrinkles around their mouth, and they will exclaim," its not fair, I don't even smoke."  Lets look into how this phenomenon occurs.  The muscles of the mouth are named Orbicularis Oris.  Orbicularis means "sphincter around an orifice".  Oris is latin for mouth.  Like other sphincter muscles of the body, the muscle encircles the opening, in this case your mouth.  It functions much the same way as a purse string does. Its job is to hold materials in the mouth and functions especially well with fluids. When you are younger there is plenty of tissue and fat between this muscle and the outer layer of skin.  As you age and are exposed to ultraviolet light and an oxidating lifestyle the tissue previously surrounding the muscle begins to thin and the purse string effect of the muscle becomes obvious in the skin. To picture this think of the skin as being analogous to curtain fabric.Imagine how much easier it is to wrinkle a thin material verses a thicker one.

Premature aging due to ultra violet light will happen to lighter eyed persons before darker eyed persons.  This is because melanin in the pigment cells is proportional to ones eye color. Blue eyed people have the least and brown eyed people have the most. This is why blue eyed people seem to age faster.  They have less natural defense against ultraviolet radiation.  Women are affected more than men because men have thicker beards.  Much like Rebarb reinforcing concrete, the thicker hair follicle in a male serves as a foundational support to keep the skins turgor. Smoking will also cause premature aging but for different reasons thatt we will discuss in the future.

Fortunately, these wrinkles are remedied by recent innovations in cosmetic dermatology called injectable fillers. There are many filler materials available but the ones most preferred by patients and Dermatologists for this area are hyaluronic acid fillers. In the past we used collagen injections for this purpose but it was an inferior product and not well suited for filling longevity. To put this science into an everyday perspective, imagine your skin as a swimming pool filled with water and people swimming with in it.  For comparison purposes, collagen fibrils are represented by the people in the pool and hyaluronic acid is the water. There is 90% more hyaluronic acid than collagen in the skin and both will decrease as your skin is aging. Since collagen is a complex protein, the body would often attack any filler that had collagen in it, thus reducing its longevity.  Hyaluronic acid however is a simple molecule whose job it is to attract water to itself. It is also one of the most common substances found in the body. An initial obstacle to using hyaluronic acid as a filler was that it had a short lifespan and needed to be recreated daily. To combat this short existance scientists cross-linked the molecules. That is to say they figured out a way for all the molecules to hold hands and thus resist degradation.  The hyaluronic acids used today are formed through recombinant DNA technology, meaning it is an exact duplicate of what is in your body and then they are cross-linked so there is little to no chance of a reaction from your body.  The result is a safe filler that lasts up to a year and is ideal for filling this area of the face. The injections are considered off label for this indication. The most popular fillers go by the Brand name Restylane(R) and JuvedermR). There is some skill and talent involved in injecting this material so be cautious of who you choose to perform this procedure. Think this might be for you?  Come see us to find out.

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My license plates on my car are personalized, the say WEAR SPF.  I thought it was an amusing plate for a dermatologist.   Today, at the end of my day , I am walking to my car to go home and notice a business card on the window.  It is a card for a free 15 minute session at a tanning salon. Well, it gives me the topic of today’s blog.   The reason that we dermatologists know so much about the effects of tanning is that we used to use tanning booths quite extensively in the 50’s and 60’s for certain skin conditions.  They were quite effective because ultraviolet light has the effect of depressing the immune system.  That is why you are so tired after a day of sun exposure, your immune system is telling you to sleep so that it can recover.  There are immune cells in the skin whose job it is control what it perceives to be an invader. The inflammation caused by doing their job sometimes causes a problem in certain skin diseases.  So for years we effectively irradiated these conditions with ultraviolet light and noticed that 20 years later the exposed areas would have premature aging and skin cancers greater than the rest of the population. A case of we did not know for sure, what we did not know.  So this is proven in dermatologists minds and in application.  So much so we are typically very vocal about it. Apparently our message was getting through so the indoor tanning association launched an aggressive counter marketing campaign called "tanning causes melanoma HYPE." Reminiscent of conspiracy theory in application, its information is meant to promote tanning.

Even if not mentioned, like in my last post, they will introduce information that there is no solid evidence linking malignant melanoma to ultra violet radiation. This is true, there is no solid evidence for a melanoma link.  Anyone want to volunteer for this study?  It will not happen because it would be unethical.  Regardless of that point, it is a fact, that ultraviolet radiation will induce other disfiguring types of skin cancer like Basal Cell and Squamous cell cancers, usually on your face.  Another front is that of Sunlight induction of Vitamin D production. This is difficult to determine what is true, because we don't really know yet. Dermatologist will all agree Vitamin D is essential and necessary vitamin.  Most physician's agree that this vitamin can be obtained through increasing dietary fish products and supplementation.  My feeling is that between diet and what is coming through the sunscreen is probably sufficient. The osteoporosis prevalent in today’s society is not from people applying too much sunscreen.  The only people I know who apply sunscreen and practice sun avoidance to that degree would be dermatologists.  Most people barely apply enough to work. Osteoporosis etiology is probably more of a lifestyle, hormone, diuretic origin. The bone softening from vitamin D deficiency is a disease called Rickets, that was prevalent in the days before the advent sun screen and is the reason that milk now comes fortified with vitamin D.

Another point of contention is the The base tan argument. True, a base tan provides about an SPF of 4.  That may be helpful to you while starting your vacation or it may be an unneeded extra dose of concentrated radiation.  If you practice this behavior, be cautious not to burn yourself as there is general agreement that burning the skin increases your risk of neoplasm growth. We also know that ultraviolet light does cause premature aging and loss of elastic tissue cells within the skin.  

Consequently, the scientific method requires that we argue both sides until the preponderance of evidence shows that someone wins. In most medical arenas this is done in medical journals and at annual meetings.  Since tanning is good media copy and since it is an industry whom some peoples livelihood depends upon, the conflicting information is played out back and forth on the news and defended vehemently on the Internet.  What happens is there is too much information and there is no certainty in the public's minds.

For me as a dermatologist, it is glaringly obvious.  For you, it may be a bit more challenging. This is all your own personal decision to make.   A good rule of thumb that Dr. Hogan taught me,  if you are trying to evaluate your chances for success, Look at what similar people in similar situations did and see what their results were. Odds are yours will be the same. The bottom line for me in helping to make your skin more beautiful is to ask yourself,  what will the cumulative effects of my habits have on my skin?  When you start thinking that in ten years you will not care what your habits bring you, remember what George Burns said.

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Today was interesting,  I had a 22 year old female patient come see me and she incidentally mentioned that she was using a tanning bed.  Now this is a little of a bit of dilemma to a dermatologist.  At this age group, if I give unrequested information about the risks of tanning; the patient will typically look at me while dazedly nodding their head in agreement.  Inside they are really thinking that this information does not apply to them and why is he lecturing me. .  If I say nothing then I lose the chance to plant the seed of realization of the most important skin fact of her life.  Of course by age 40, they will listen but the damage is already been done by then.  

So, the conversation began.  Lets hypothetically say her name is Tammy.   “How often do you tan?,” I asked.   Tammy  grudgingly replied, knowing what was probably coming, “Once or twice a week at my tanning salon.”   I pondered how I could get through to her and then said, “I would rather you tan at the beach.”  She looked at me in disbelief, “you would rather I tan at the beach?”  “Yes,” I replied.  She asked, “Why?”  “Because in the tanning booth you will get a weeks worth of sunlight in 6 minutes, if you go to the beach you may only get a day in.”  I discussed that only cream proven to prevent wrinkles is sunscreen.  She said, “Oh I use that on my face,  I just tan my body.” 

My explanation to that was to look at women in their 40’s who have followed that idea.  They look like someone pasted their younger looking heads on an older person’s body because the color difference is so dramatic.  To go further,” of course you look good with a tan. You have young skin.  Young skin is the most beautiful thing you will ever see.”  I continued, “ look at a babies skin sometime, no freckles, smooth, perfect.”  Kids will often begin their life long enamoration  with sunlight because association with independence they experience at the beach for the first time in their lives.  Their friends are running around in bikini’s, the boys all have muscles.  Compliments are given for perhaps the first time. Romance is in the air.  Remember most of your hangups and beliefs about ourselves are created during early teens and adolescence.  So is the desire for a tan/compliments/freedom.  Well, at least she was wearing sunscreen on her face.  I said to her, “I understand why you like to tan, you feel your skin looks better with a tan now, but what about later?”   I explained that there is a major change in the body and brain from age 12 to age 22.   Not so big of change in the brain from age 22 to 32 but a slight change in the body.  Even less change of the brain from age 32 to 42 and a major change in the body.  Your brain with all the desires that you have today will be in a 42 year old body someday and you will wish that you did not do the damage that you are doing right now.  Please eliminate the tanning bed.

She actually looked at me and honestly thanked me and said she would do her best to not tan.  Doctors can often tell when patients are lying, or saying something that they will not do.  We learn this through daily experience of advising people and following up with them.  I think that I honestly got through to her.  This is a rarity for this type of interaction.  Usually the patient will never come back because at this age it sounds too much like unasked for parental advice. Of course at some point in their life, they remember that dermatologist that said....

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Certain rays of light called UVB will tan or sometimes burn your skin.  Other rays of light will penetrate more deeply and do no tan you, but will disfigure the skin DNA setting you up for cancer at a later date.  These rays are called UVA. These are the same rays that come in though glass windows.  They penetrate so deeply that they will actually dissolve skin and fat along the way.  This becomes apparent when one reaches their 30’s and looks in the mirror to see the "crows- feet" like wrinkles by the eyes. because of the 90-degree angle of the sun and our face, the cheekbones and nose absorb the greatest amount of energy. Light energy will not bounce off as much as it would if it were a different angle.  This is why as we approach our 40’s we will see the fat dissolved around our eye socket and the deeper fat that protects the eyeball will sometimes pooch out.  This is commonly referred to “bags,” or “dark circles under the eyes.”  It looks like a dark circle because typically the light source in a room is from above and the brow casts a shadow on the upper cheek/eye area.  You can prove this to yourself by looking in the mirror and tipping your head upwards as you watch the bags disappear.   Compare your profile to a child’s; you will see a marked difference in the way the fat is accumulated in this area.

This is the first phase of the physical appearance of aging.  Traditionally the treatment for this would be the plastic surgical removal of fat from around the eye so that the fat would not bulge any more.  This works if done in moderation.  Care must be taken to avoid a hollowed out appearance.  In this same way, other areas of the face become affected as well. The analogy that I like to give is as a child your face is like an overstuffed couch.  As you age more and more stuffing is removed until it looks like fabric on a frame.  This is why plastic surgery will make you look different rather than better. Surgery does not do anything to address the volume loss of the lower face.

What can you do about it?  Acid Creams and lotions will help about 10% for the wrinkles around the eyes by generating younger fatter cells in this area.  Botox® can be used off label in this area and will help the wrinkles about 75%.  It is off-label because when Botox® came out as a wrinkle reducer, the company could not conceive of all of the areas that it would be useful, so they did not go through the FDA application process for each area of the body that it is now being used for.  Nor do they need to because the government assumes that each physician will do what is right concerning the evolution of a drug and each physician is liable for the repercussions of their actions.  It has been used off label in this way for many years but is considered an advanced technique so make sure your Dermatologist is comfortable performing this procedure.

As far as the actual shadows beneath the eyes, if it is mild it can sometimes be corrected with the use of filler.  Filler is a category of materials that when injected in the skin will provide volume in that area.  The most versatile fillers are those composed hyaluronic acid because of their longevity, flexibility and ability to dissolve over time. They are useful for many wrinkles around the face and over the last year have evolved to be beneficial for this area we call “tear troughs.”   Again, it is an off-label use of filler that has been FDA approved for use in other areas of the face.  I have seen this be successful many times for mild to moderate situations. Severe cases typically will need some sort of plastic surgical intervention.  Again, it is considered an advanced technique, so be sure your dermatologist is comfortable doing this procedure. The fillers typically last around a year and initial swelling or bruising is common.  Beware of permanent options offered as the face changes as you age and the option that benefited you in your 40’s may curse you in your 50’s.

There are many fillers avaialble.  While many are safe, they are best used under the advisement and experience of your Dermatologist.  This guide is for informational use only.  It is not meant to take the place of your health care provider recommendation and no doctor patient relationship is implied.  If you are curious if these types of treatments are for you, please come see us for an appointment.

making your skin more beautiful

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George Burns once said, "If I knew that I was going to live this long, I would have taken better care of my self"  As those of us who have aches and pains can attest, he was right.  I have noticed  that my 30's were when I  started to realize I was aging. My 40's are when I started to experience the feeling of aging.  If you are not 40 yet,  you will notice too, when your vision changes. I will let you know about the 50's when I get there, but I am trying to stave off the aging process.

Since  your skin is a reflection of your inner health both mental and physical. Here are a few ideas that I can share  with you.  All tings you have heard before. Eat more fruits and vegetables. Really. There are vitamins and minerals in raw fruits and vegetables that we have yet to discover, so don't rely on your vitamin bottle to get them.  Avoid canned foods as many of their nutrients are lost in the process.  Try the organic fruits, they are utterly delicious and will remind you of your youth. Afternoon snack? Ever try red grapes and cheese?  Delicious combination. Humans were meant to consume 90% fruits and vegetables and 10% meat and fish, not the other way around.  It is obvious by looking at our teeth and comparing them to actual carnivores.We were only meant to be happenstance carnivores. Don't worry about protein. Its over rated.  Look at a gorilla, he  doesn't eat meat and yet finds enough protein to be one of the strongest mammals.   Try eating more fish. Rather than asking yourself  'what would taste good for dinner?' Instead ask 'what can I eat that will be healthy for me?'  You wouldn't let your child make decisions that way,  you shouldn't either.  Now, granted, eating healthy is not as much fun during the eating process.  It is more fun to eat a big steak coated in butter,  but the real fun about eating healthy is how you feel before you eat and after.  You will not feel like collapsing into a coma, like you do with a big meaty meal.  You will have more energy to do the things in life that really matter. What I do is eat healthy 6 days a week.  One day a week, I will eat what I want.  Usually it is a dessert or wine indiscretion. Recently I watched my friend eating french fries when his much older father walked by and said. " I remember what those tasted like... they were quite good"  and then the father walked away. Your elders know, they just don't like to tell you.  At some point, eating healthy will become a life or death decision. Start your healthy eating habits early before your cardiologist forces you. 

Here's another idea, reduce and eliminate anything in your diet that has ingredients that you cannot pronounce.  They may have not yet been proven to be harmful,  but remember in life and science "we don't know what we don't know." And just in case,  reduce plastic in your life where possible.  Exercise. Don't like formal exercise? Create your own by not parking  your car at the closest parking spot.  Park in the back of the lot.  Not only will you get less car dings,  but you just built in some easy exercise. When entering a building, if it is only a few floors, skip the elevator.  Too hard?  Take the stairs down instead. Drying your self after a shower?  Use the towel to perform some isometric exercises.        .  Floss your teeth it will stop you from losing them. Wear sunscreen, it really does prevent skin cancer and premature aging.  These are all  things your mom hoped to teach you. Some of it is effort.  Consider it an investment.  As I tell my adolescent acne patents when they do not want to wash their face, 'welcome to becoming an adult.'
 
One of the most delicious habits that I have found recently is starting the day with fresh squeezed organic orange juice. I bought the Breville citrus press. Cutting, juicing and cleanup takes a total of 3 minutes.  It has to be, hands down, the best tasting liquid ever. Here is a way to ensure your healthy success.  Feel how good it is to be healthy.  See yourself make healthy decisions.  Hear your friends asking you 'what is it your doing to keep that healthy glow?' Truly picture yourself as healthy and bad habits will become inconsistent with your identity and thus eliminated. Spend time imagining your  body in a healthy state. You can do this while driving.  Consider using the  morning drive to think about your day and what you want to do or be.  Leave the radio off.  It is kind of a meditation for  people who don't  have time to meditate.  Having healthy skin starts from the inside.

What are some of your healthy habits that you think others would benefit from?

making your skin more beautiful

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There are 2 types of exfoliation, chemical and physical. Today we will discuss chemical exfoliaters and how they impact acne and anti-aging.  There are several different types and are composed of acids.  The way acids exfoliate the skin will depend on their affinity for different aspects of the skin. To better understand this, we need to look at a skin cell with microscopic eyes.  The individual skin cells start at the bottom of the epidermis at a place called the basement cell layer.  They will then mature and ascend upwards over the next 90 to 120 days to eventually be shed.  The cells are all attached to each other as if each cell is holding multiple hands with the other skin cells.  These tiny hand holding attachments are called desmosomes. Interspersed throughout the epidermis are tiny tubes composed of modified hair follicles that have evolved to produce oil rather than grow hair. That is what your skin looks like with microscopic eyes. 

As they age, skin cells will clump together and adhere to the oil glands.  Acids help weaken this clumping action through various ways. The weakest acids used in dermatology are Vitamin C acids.  This acid has anti-inflammatory and anti-oxidant properties and is useful for Rosacia or sensitive skin states.  The next strongest acid is Salicylic acid.  This is the same acid that aspirin is made of.   Its mechanism of action is similar to vitamin C acid in that it weakens certain hand holding desmosomes between the skin cells and the cells will fall off.  This property makes it useful in anti-aging applications and acne to a lesser extent.  Glycolic acids are made from fruit acid and are the next strongest strength.  They will have an affinity for the pore itself and as such are ideal for acne situations.  The next strength moves to the vitamin A acids, many of which are prescriptions. These are unique in that they detach desmosomes, clear the pore and send a unique signal to the cell to operate more efficiently.  Oil production is decreased, skin cells fall off at about 45 days and the remaining cells function to their capacity.  These acids are most ideal for acne and anti-aging.  Prescription Retin A is the prototype of this vitamin, although there are several chemical modifications of this drug that are weaker or stronger depending on what your Dermatologist recommends. Chemical exfoliation is most effective when combined with physical exfoliation. The acids will loosen the old cells attachment and the physical exfoliation will sweep them away!

These acids are in a great deal of products for acne and anti-aging uses.  Any label that says anti-aging on a creme probably has an acid in it. Important to know, if you have sensitive skin.  Knowing the mechanism of action may help you decide which over the counter product may be useful to you.  Some caveats are in order.  Salicylic acid strengths are regulated as medications and should not be used during pregnancy.  Glycolic acids are considered foods and are not regulated.  They are often sold in different strengths.  People have the erroneous perception that larger numbers are stronger and perhaps better.  Higher strengths may have deeper penetration but the manufacturer does not wish to incur additional liability for possible burns so they will “buffer” the acid.  Meaning they will add a base to the acid resulting in a higher pH that reduces the efficacy of the product.  Be aware when comparing different product lines based on concentration and be sure to ask if it is buffered.  Un-buffered glycolic acids over 20% are unpredictable, so use with caution.  Any of these acids will assist in keeping fresher more rounded cells at the bodies surface. These are useful for acne and for combating fine lines and wrinkles.  

Acids can be unpredictable and can result in burns if used indiscriminately or too often.  While many are safe, they are best used under the direction of your Dermatologist.  This guide is for informational use only.  It is not meant to take the place of your health care provider recommendation and no doctor patient relationship is implied.  If you are curious if these types of cremes are for you, please come see us for an appointment.

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Microdermabrasion and acne

Treatment of acne needs to be based at the three causes. 1) Hyper-hormonal states 2) Unplugging the pores so the bodies’ oil can flow 3) Reduce opportunistic bacteria, those bacteria that take advantage of the blocked pores by consuming the trapped oils.  The only effective methods of combating hormonal states are prescription medications.  Unplugging the pores is performed by exfoliation.  If the pore is not plugged, the bacteria do not matter as much because there is no food for them to proliferate.   Exfoliation is divided into physical and chemical.  Today we will discuss physical, or things you do, rather than acids that you apply.  The simplest method of chemical exfoliation is simply adding a washcloth to your cleansing routine.  Once daily would be a good start.  Eventually after 6-8 weeks your skin will acclimate to this and you can move to twice daily.  This is more important for women and adolescents than adult men because we exfoliate daily while shaving with razors.   No-laundry alternatives to washcloths are 4x4 gauze pads that are sold in the drug store for wound care.  They can be thrown away after cleansing the face. The next layer of exfoliation would be adding a scrubbing cleanser made with micro beads. 

The final level of exfoliation includes microdermabrasion and Laser. Laser is more important for eliminating discolored spots of the face. More about lasers in a future article.  Microdermabrasion made a splash onto the cosmetic scene when it was first introduced to the United States from France in the late 1990’s.  Dermatologists were initially skeptical, but after witnessing the positive effects that exfoliation provided, many have adopted the technology.  Microdermabrasion is not to be confused with dermabrasion.  Dermabrasion is a surgical procedure for acne scars where a spinning wire brush abrades the top to middle layers of skin away. It has a several week recovery time and is considered surgery.

 Microdermabrasion by contrast is where fine grains of sterilized sand are gently forced onto the skin and sucked away in the same instance.  The sand and dead skin cells are whisked away by a suction wand the size of a pencil that also vacuums the pores.  One would think that repeated applications of this level of sanding would result in a thinner dermis.  Luckily, the skin is a living entity and views this type of activity as exercise.  Indeed the first day, the epidermis becomes a little thinner, but what happens next is that the younger cells that were waiting for the older ones to drop off suddenly spring to life to take the old cells place.  After 7 days the skin has actually thickened and has become more functional.  I liken it to imagining a room full of 90 year old people, verses a room full of 30 year olds.  Which would you rather have?  The analogy is surprisingly accurate; rather the cells are more like 90 days and 30 days.  The younger cells are more rounded than their shriveled predecessors. Your skin care expert may take advantage of the initial epidermal thinning to apply topical nutrients or mild acids to the skin, as they will now penetrate much better.  The initial result is that of smoother skin to the touch, a healthier glow, and free flowing pores.  Very similar to the results Dermatologists would get with Retin A acid, but without the irritation.   An initial downside was that the procedure was a little messy in that there was a need to protect the nose and eyes from potential particles. As the years progressed, most physicians have gotten away from the actual sand and have replaced it with a diamond tipped suction wand that offers the same levels of microexfoliation without using sand particles.  Treatments can be done monthly or biweekly and will help reduce fine lines and wrinkles as well as reducing acne through exfoliation and regeneration of new skin cells.   Interested? Call today for an appointment to see if this innovation can help you.

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Now that we have covered the conventional treatments of acne it is time to consider alternative options for those who can not tolerate topical and oral antibiotics.  There are a lot of topical acne programs out there.  Many designed by dermatologists.  The most popular one is Procactive.  This one is mild for an over the counter strength system.  Its success lies in that it is a system, founded on many of the principles that we have discussed previously.  Obagi is another system that is stronger, but is still a system.  These alternatives are useful because most adolescents are not patient enough to allow medications to work.  They are complex enough to keep the patient entertained until they do work.  But now, armed with the knowledge of how these systems work, you can create one of your own. 

Lasers are very space age and by their very essence ooze the possibility for success.  Lasers have been used for acne and many are FDA approved for this indication.  So that means that the FDA has stamped that it works, right?  Nope.  FDA approves devices for safety, not efficacy.  Prescription drugs, however, are approved for efficacy and safety.  That’s why your dermatologist’s medication recommendations usually work.  In any case, some laser lights have been shown to reduce the population of acne causing bacteria.  There is probably some other heat induced change that we do not understand that helps reduce acne, but it will not take the place keeping the pores open and skin exfoliated. Lasers in general are expensive to purchase and operate and are not a very cost productive way to reduce acne as their effects last a few short weeks and the acne will return without further treatment.  Although they have show success in treating acne scars after acne has resolved, but more on that later.

There are blue light based systems that have been proven to work and will treat acne in a similar manner but without the large price tag.  This is achieved with a machine called a Clearlight.  Rather than a laser which is a very concentrated beam of light, the light based systems are more of a light bulb that emit a special wavelength of 405-420 nanometers which has shown to be absorbed by Propionibacterium acnes bacteria responsible for eating the skin's oil and clogging the pores.  As it turns out, P. acnes bacteria have the unfortunate luck to be a microscopic bluish color that will absorbs the light and destroy them.   The treatment regime consists of 15 minute bi-weekly treatments for a month to achieve this result. In conjunction with an exfoliation routine, these light treatments will result in an 80% reduction of acne over an 8 month period. It offers a wonderful option to those who wish to avoid antibiotics.

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Since acne is caused by plugged  pores the best way to combat it is to keep the pores open.  First off do not use products that are non comedogenic.  This means they either have ingredients shown not to plug pores or they have been tested to not cause blockage.  Avoid products with Dimethecone and isopropyl myristate  Stage make-ups like Mac are common offenders.  Moreover, keep your face out of the shower stream.  The pounding water acts as a massager bringing the blood to the surface squeezing the pore closed.  Avoid extreme water temperature's for the same reasons.  Don’t squeeze.  If you feel you must, remember you have only one shot at it, so time it appropriately.  The deeper cysts will eventually come to the surface so you may have to wait a week for those, but you can put an ice cube on them.  Ice is natures anti-inflammatory.  To a point, the less the inflammation the smaller the lesion will be.  Mild exfoliation is good because the overactive oil glands will mix with dead skin cells make a microscopic sludge that further plugs the pore. Exfoliation reduces this.  Be sure to exfoliate but not irritate.  You can tell if your skin is irritated because the skin will turn mildly red. So be gentle.  I recommend using a wash cloth or a gauze pad if you don’t like doing frequent laundry.  Scrubbing cleansers are nice as well, but avoid the pulverized apricot versions since they have sharp edges.

Physical exfoliation is best accompanied by chemical exfoliation.  This can be done in may ways. A salicylic acid cleanser like Neutragena Oil Free Acne Wash is a good choice . This will chemically disengage any dead skin cells that are about to fall off and the physical exfoliation will sweep them away.  During the day, this can be followed by a benzoyl peroxide lotion at a strength of 2.5-10%. This will reduce the bacterial population and minimize the chances of bacterial invasion.  If you are young, you may apply this to your entire face, if older then use the lower strengths  and only apply to the lesions as peroxide can result in oxidization of the skin (READ WRINKLES.)  At night time, cleanse again and it is time to use another chemical exfoliator in an attempt to keep the pores open.  Glycolic acids are suitable for this purpose.  They are also known as alpha hydroxyl acids or AHA’s.   Glycolic acids have a special affinity for pores.  A stronger acid is vitamin A acids,  Retin A being the most popular prescription version.   A dermatologist will prescribe a similar regime, but typically with both prescription strength topical antibiotic creams and acids.  There is a stepwise approach to acne and each step needs to be tried for a period of 3 months before moving up.  This seems forever to a teenager ,but if done this way, the acne will not become worse before it becomes better. 

If topical treatment is not working, then oral therapy may be warranted. This may include oral antibiotics to reduce inflammation and bacteria.  In a female,  water pills or birth control pills may help stabilize hormonal swings. Last line efforts include Accutane which is effective in 95% of the cases. Accutane is a modified vitamin A.  As such it is incorporated into developing fetal tissue, so extreme care is made to assure that the consumer avoids pregnancy for the course of therapy and 3 months after.  The oil in the skin will flow into the blood stream and triglycerides and cholesterol need to be monitored monthly.  There are other non traditional approaches to acne like blue light therapy, lasers and photodynamic therapy that are typically useful for people that cannot tolerate the classic approaches.

 Reading cannot take the place of a physical exam and evaluation by a Dermatologist.  This information is not personal medical advice nor does it infer a doctor patient relationship.  If any adverse reactions occur from using any topical or medication, cease using the product and see your Physician. Or better yet, come see me for an appointment and acne program tailored to your needs.

making your skin more beautiful

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