Why You Have Acne
Your Hormones—male hormones, produced by both males and females, can cause acne and make it worse. Some females produce excess male hormones causing irregular menstrual cycles, acne, excess hair growth, and infertility.
Prescriptions: certain BCP's, Depo-Provera, Mirena IUD, Testosterone.
OTC: DHEA, anabolic steroids, and certain muscle building supplements.
Inherited Tendency—acne often runs in families
Some Things Can Make Acne Worse
Exercise, Heat, Sweat/Sports, Friction and Oil—football helmets, sweaty workout clothes, hands or cell phones on face.
Normal Skin Bacteria
Stress—causes increased male hormones, especially in women.
Waterproof Sunscreen—plugs pores, use non-waterproof.
Cosmetics—some foundations, concealers and powder brushes worsen acne.
Diet—caffeine in coffee, chocolate, caffeinated soft drinks, processed foods, or milk may aggravate acne in some people.
Choices for Acne Treatment
Skin Care—OTC or stronger physician skin care can control mild acne, help control moderate or severe acne, reduce marks from old acne blemishes, and restore moisture balance from drying prescription medications.
Surface Antibiotics—Clindamycin (Cleocin) and Erythromycin decrease bacteria.
Surface Retinoids—Retin-A / Differin / Tazorac unplug pores. They are drying but most patients are able to use them.
Oral Antibiotics—Minocycline or Doxycycline are taken by mouth when acne is more severe or there are deeper cysts. Minocycline is often more effective than Doxycycline.
Chemical Peels/Acne Surgery—Glycolic Acid peels help remove plugs from pores and both treat and prevent acne. Acne Surgery is the removal of acne plugs using sterile instruments.
SilkPeel— precision exfoliation with infusion of Salicylic Acid for adult patients with mild acne.
Isotretinoin (Accutane, Sortret, Claravis, Amnesteem)—strong oral medication for the most severe cases of acne that do not respond to other treatments. Dr. Cook will discuss with you if she feels it is indicated.
BCP's—prescribed by your Gynecologist or Family Physician. Certain birth control pills such as Yasmin, Yaz, Ortho Tri-Cyclen, Estrostep, Alesse, Mircette, Ortho-Cept, and Desogen lower free testosterone in the blood.
Spironolactone—a diuretic which lowers male hormone level. Only used if there is no chance of pregnancy and with monitoring of blood pressure and potassium.
Be Patient—It Takes Several Months for Acne to Get Better
Sometimes, acne worsens during early treatment. This is normal and means that treatment is working. As pores open, next month's pimple is brought out earlier. Judge the effectiveness of any acne treatment program after 2- 3 months, by the decrease in new acne pimples. Old pimples and brown or red discoloration may take months to fade. Treatment must be continued to maintain improvement. Do not stop your program because you are better.
Possible Side Effects of Acne Treatment
Oral Medication Side Effects—please note this is not a complete list of side effects. Discuss any medication with Dr. Cook or your physician.
Minocycline—may cause vertigo/dizziness, gastrointestinal upset, yeast infections or sun sensitivity. Rarely an allergic reaction with rash, fever, hepatitis or respiratory distress occurs. Over a long period of time (usually longer than one year), rarely patches of bluish color on the lower legs, gums, teeth, or in scars occur. If Minocycline is discontinued when pigmentation occurs, the color usually fades; therefore, patients need to be seen by Dr. Cook at regular intervals, and refills cannot be authorized without evaluation.
Doxycycline—may cause significant sun sensitivity, nausea or diarrhea.
Spironolactone—can cause dizziness upon standing, low blood pressure, high blood potassium, menstrual irregularities and fetal harm if taken during pregnancy
Birth Control Pills—can cause headache, weight gain, depression or mood changes, nausea, blood clot, stroke and fetal harm if taken during pregnancy
Surface Medications—may cause dryness or irritation. See instructions below.
Chemical Peels— there may be some peeling or crusting for a few days after treatment.
About Possible Side Effects of Acne Medications
Oral Medications—acne antibiotics are not used during pregnancy to prevent staining of fetal bones and teeth. Any antibiotic may interfere with effectiveness of birth control pills, increasing the risk of pregnancy. If you develop rash, persistent headache, pigmentation or think you are having a reaction to medication, stop it and call the office. As with any medication, if you have significant rash, severe reaction or difficulty breathing go directly to the Emergency Room.
Surface Medications—Retin A, Tazorac, Differin should be stopped 5 days before facial waxing, hair removal, facial procedures or peels done outside this office to avoid damage to the skin.
Hormonal Treatment (BCP's, Spironolactone)—discuss risks and benefits with your Gyn or Family physician.
Tips to Help Your Acne Get Better
Oral Mediations— containers often have warnings not to take the medication with food or milk. This only means less is absorbed, it is not dangerous. It is better to take pills with food or milk than to not take them at all.
Surface Medications—some dryness and flaking is normal, discomfort is not. Dryness and flaking can be reduced by applying Oil Free Moisturizer twice a day and on top of your medication, and changing from Balancing to Gentle Toner. Flaking can be reduced by using Antioxidant Enzyme Peel first thing in the morning before washing your face. Discomfort can be reduced by applying Oil Free Moisturizer under neath your medication, or applying medication only every other night. If you are still having problems, call us for further instructions, don't just stop your medicine.
Skin Care— oil and dirt don't cause acne; however, wash your face twice a day and after workouts to remove oil, bacteria and dead skin cells. Shampoo regularly and avoid hair styling products or bangs that touch your forehead. Keep a bottle of your cleanser both in the shower and at the sink so you will use it twice a day.
Picking— can cause scars. If a blackhead or pus drop is visible at the surface, one gentle squeeze with clean fingers (never fingernails) is acceptable. Do not continue to squeeze many times, or squeeze deep pimples.
Sports— may worsen acne, but it is not a reason to discontinue sports. Antibiotic pads kept in gym bag or locker to wipe off sweat and oil and apply antibiotic after sports help. Keep container capped tightly or they will dry out.
Diet— usually dietary changes do not significantly improve acne. Cosmetics— Use non-comedogenic, non-acnegenic products. Don't use "all day wear" or "long lasting" foundations. Use a sponge not a brush to apply mineral powder. Dr. Cook recommends our powders.
To Conceal or Cover Up Pimples— don't use concealer. Follow these steps: 1)press on powder with sponge 2) put drop of foundation on fingertip 3)pat, pat, pat on pimple 4) let dry 5) press powder to set. Do not rub powder with sponge or rub foundation on, or it will wipe off.
Scarring— acne should be treated to help prevent scarring. Picking can cause scarring. Dents or raised areas may be scars. Red or brown discoloration is not, and may take many months to fade. Tazorac often improves true scars over time. More significant scarring may be improved by laser resurfacing with either Fraxel Laser or Clear + Brilliant.
Side Effects— if you are having side effects or problems that do not respond to the above, call the office and speak with the nurse, or let us know at your visit, and we will modify your program.