Past Advice

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Tip #
16
OTC treatments I recommend for inflammatory acne

If you have inflammatory acne, you are not alone!!! This is the most common type of acne among adult women. I hope you have read my previous posts in “Tip #14” about knowing your acne and “Tip #15” discussing treating comedonal acne because that will help you better understand today’s advice. Today’s advice is not meant for pregnant or nursing women.

A quick note for those of you who have cystic acne (large lumps under your skin). You should really make an appointment with your dermatologist because cystic acne causes permanent scarring and the best treatment for scarring is prevention. Cystic acne usually requires prescription oral treatment as well as supervision of your progress by a dermatologist. But if you prefer not to go that route, you can benefit from today’s advice.

When using acne products, the best way is to use these treatments as preventions and not as spot treatments. These products are meant to be used in areas where you typically get acne even if that area is temporarily clear because there is likely something brewing that you are not even aware of. You should avoid areas where you do not get acne and areas that are overly dry or sensitive.

If you are new to the field of over-the-counter (OTC) treatments for inflammatory acne, the best place to start is with a benzoyl peroxide (BPO). BPO’s range from 2.5% to 10% and come in washes, solutions/pads/wipes, lotions, creams and gels. BPO’s have not only an antibacterial effect that helps with inflammatory acne, but they also have a keratolytic effect that helps break down comedones and comedones can lead to pimples, or inflammatory acne. Washes tend to be the least irritating but the least effective because of the short contact they have with the skin. Lotions and creams tend to be less drying than most solutions and gels. But, in general, solutions and gels tend to penetrate the skin better so they can be very effective if your skin tolerates them. BPO’s can cause irritation, redness, flaking and burning especially at the higher %’s. So like in my previous advice, I recommend starting out at a lower % (2.5% - 5%) product and to 2-3 times per week. If you tolerate the product after 1-2 weeks, I recommend working up in frequency of use (daily or twice daily) and then working up the % if you tolerate daily use. But take things slowly and don’t change things too quickly or you may end up with painful skin. Also, if, after a couple of weeks, your acne is getting better or at least not getting worse, you should consider sticking with that product instead of trying a stronger treatment. Remember, it can take 6-8 weeks to see the true results of the product you are using. One note on BPO’s: besides being irritating to the skin for some individuals, they also bleach fabric. So, if you are using them on your face, either use them during the day under your make-up (unless you are using a wash) and be sure to not let it touch your clothes or use a white pillow case at night. If you are using them on your back or chest, I recommend using them at night and wearing an old tee-shirt.

Because salicylic acids (SA’s) work primarily on comedonal acne and that is really their best use, they can also be effective for inflammatory acne. As I discussed in my previous advice, the comedone is the precursor to a pimple, even if you aren’t always seeing the comedone. So, I’d refer you to “Tip #15” discussing OTC treatment for comedonal acne. But, if you have primarily inflammatory acne with pimples, BPO’s are a better bet because they have both a keratolytic effect to break down comedones and an anti-inflammatory effect to help with the inflammation of pimples.

Sulfurs are also an effective treatment for inflammatory and occasionally cystic acne. OTC sulfur treatments for acne come in cleansers and soaps, lotions, creams, gels and masks. This category of treatment is usually quite drying and so I only recommend it for those of you with oily skin. If you like spot treatment these creams and gels can really dry up a pimple in a hurry. If you’ve already tried BPO’s and you have oily skin that usually tolerates drying treatments this is a good second choice for treatment. I would recommend starting with a soap or cleanser and then work up to lotions, creams and gels. But beware of masks unless you are experienced in this category. Also, sulfur acne treatments can sometimes be a little stinky (so read the reviews) and are more difficult to find than BPO’s and SA’s.

Let’s say you just have never been able to tolerate BPO’s, SA’s, and even the sulfur soap/cleansers are too drying. Then, I would recommend trying azelic acid. This comes as a prescription but you can also find it on the internet. It’s generally not drying or irritating, except you may experience a little tingling or stinging initially. Start once per day and work up to twice a day. I don’t recommend this for darker skinned individuals because it can lighten skin. Although this isn’t a terrific treatment for inflammatory acne, it’s something I recommend trying if you just can’t tolerate anything else and aren’t ready to see a dermatologist yet.

Finally there are combination products or products with more than one “active ingredient” such as a combination of BPO with SA or glycolic acid (see “Tip #15) in the same bottle or used together in different bottles as different “steps”. If you are new to any of these products I don’t recommend starting out with more than one active ingredient. This is because if you get a reaction to a combination product or a treatment with different “steps,” it’s difficult to know which ingredient you reacted to. So first start out with a product with a single active ingredient (only BPO, only SA or only GA). If you prefer buying acne treatments with different steps, use only a single step with an active ingredient (BPO or SA or GA) for the first 1-2 weeks and if you don’t have a reaction, then add another step with another active ingredient. It’s o.k. to use steps that don’t have an active ingredient right away in combination with other steps.

Other things to remember:

  • Do not scratch or pick at your acne.
  • Do not overwash or scrub your face.
  • I don’t recommend astringents because they make your skin less tolerable to the active ingredients in the above products.
  • Use a gentle wash (unless you are using and tolerating a medicated wash).
  • If you are dry, use a gentle moisturizer over or after you use your acne treatment and use moisturizer at times when you are not using acne treatment. I recommend CeraVe lotion for mild to moderate dryness, irritation and redness and CeraVe cream or Cetaphil lotion if you are experiencing more significant symptoms.
  • Finally, take “vacations” for 2-3 days from using your treatment if you are getting too dry or irritated.
  • http://www.youtube.com/watch?v=nEJsDvUSMHw
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    Tip #
    15
    OTC treatments I recommend for comedonal acne (and a bit on inflammatory acne too)

    Today, I am going to discuss the things you can do at home, without seeing your dermatologist, if your main problem is comedonal acne. My following posts will discuss what you can do at home about inflammatory acne (although today’s advice can also be helpful for inflammatory acne), as well as when it’s time to see your dermatologist and what things you should ask when you do see your dermatologist. You should read my previous post “Knowing Your Acne” to help you best understand today’s advice. And, if you are pregnant or nursing, today’s advice is not meant for you.

    If you have comedonal acne there are a few good topical treatment options that you should consider for your medicine cabinet. Topical treatment consists of using topical creams, lotions, washes, solutions and gels. The best options are salicylic acids (SA’s) and benzoyl peroxides (BPO’s). Of these, SA’s are better for purely comedonal acne. (I will talk about BPO’s later.) SA’s unclog “pores” and can help with the mild to moderate forms of comedonal acne. SA’s do this by exfoliating or sloughing off keratin material…and the keratin plug is part of the problem with comedones. But SA’s can cause flaking, dryness and even irritation. This is because they can’t tell the difference between the normal keratin layer (that covers the entire skin surface) and the keratin plug of a comedone. So, it sloughs everything leading to these side effects in some sensitive individuals.

    Salicylic acid products range from 0.5-2% over-the-counter. If you have sensitive skin, I would recommend starting with a mild salicylic acid (0.5%). Washes tend to be the least irritating but the least effective; that’s because they are considered “short contact,” meaning they are only on your skin for a short while during the time you are washing your skin. Lotions and creams tend to be less drying than solutions and gels, but at the same time solutions and gels typically penetrate the skin better rendering them more effective but sometimes more irritating at the same time. I recommend starting with a lower strength SA once a day but initially only 2-3 times per week. Gradually work up to daily use and if you are still tolerate them, you can increase the strength of your treatment or increase the “vehicle” strength. By increasing veheicle strength I mean switching from a wash to a lotion or cream, for instance, or from a lotion or cream to a solution or gel at the same strength percent. This is a very safe way to go but takes patience!

    Glyclolic acids (GA) (typically 3-10% over-the-counter) may also be helpful for some people with comedonal acne. Their action in unplugging plugged pores (or comedones) is similar to SA’s but they are less effective. So I almost always recommend starting with an SA over a GA for comedonal acne unless your main complaint is skin discoloration. In this case, GA’s are probably a better choice. GA’s are better at treating skin discoloration but SA’s are better at treating comeedonal acne. GA’s have the same side effects as SA’s and come in the same vehicles (washes, lotions, creams, gels, solutions). The same strength comparison between washes, lotions and creams, gels and solutions holds true for GA’s. I recommend starting with a low % (3-5%) treatment 2-3 times per week and working up to daily just like with SA’s . You can also increase vehicle strength (washes->lotions and creams->solutions and gels) like with SA’s.

    If you have inflammatory acne in combination with comedonal acne, you are not out of luck! Because the comedone is the initiating step to developing a pimple (even if the comedone is not visible to the naked eye), SA’s and, to a lesser extent, GA’s are also useful for treating inflammatory acne!! What a bonus! But I will talk about other, typically more effective treatments for treating predominately inflammatory acne on my next post. Inflammatory acne is the most common type of acne in adult female acne.

    In summary, I recommend starting with a salicylic acid for comedonal acne but glycolic acids may be a better place to start if you also have discoloration left by acne. In general, start with weaker products infrequently and work up first in frequency to daily or even twice daily and then you can go up in strength. If you know your skin and you think you can handle it you can start with a higher strength product but I still recommend using it only 2-3 times a week and working up. If you get dry or irritated, it’s o.k. to use non-medicated lotion or cream on top of or after using a SA or GA.

    Remember:
    Moisturize with light lotions such as CeraVe lotion for mild dryness or CeraVe cream or Cetaphil lotion for more significant dryness. Stay away from astringents and avoid over washing and scrubbing! Use a gentle cleanser (more on these later).

    http://www.youtube.com/watch?v=9BAmm2uvjIg
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    Tip #
    14
    Know your acne

    If you are struggling with acne, the best place to start is with topical over-the-counter (OTC) treatment, and some of you may even be able to use at-home treatments.

    Today, I will focus on evaluating your own acne to prepare for my next posts on over-the counter-and at home treatments. This will also prepare you to talk to and better understand your dermatologist if it gets to that point.

    Acne and acne treatments are big topics. So I need to break them up into segements to really help you understand your acne and do a thorough job helping you.

    First, in order to treat acne effectively, you need to understand what type of acne you have. The general categories are comedonal, inflammatory and cystic acne. Most people have a combination of more than one type of acne.

    Comedonal acne consists either of tiny skin colored bumps which are called “closed comedones.” There are also “open comedones” that appear as brown to black little bumps, most people refer to as blackheads. These are usually most noticeable on the forehead but are also common on the chin and around, or on, your nose and sometimes scattered on cheeks or even in ears.

    Some people mistake pores with dark centers as “black heads.” This mistake is usually made on the nose. Even if you can get something out of these pores it does not make them blackheads. There has to be an actual small bump or plug to be considered a true blackhead or comedone. If there is not, you may not have real blackheads or comedonal acne but just larger pores with normal keratin material in the pores. But because the pores are somewhat larger (such as those on the nose) for some individuals, there is often a shadowing effect in the opening which visually accentuates the opening making it look like a blackhead. What’s even more confusing is that when you use a Biore strip or tape, or when you try to get something out of the pore, you can actually get what looks like a little plug or white stringy material! But, in reality, normal pores are programmed to make this keratin material. The difference is there is no real backing up or plugging of the pore so it doesn’t develop a small bump.

    True comedones cause actual plugging of pores and can lead to inflammatory acne or pimples. In fact, comedones are felt to be the first step in the development of inflammatory acne, even if the comedones are not obvious to the naked eye. Sometimes acne is simply comedonal which causes skin to look bumpy.

    Inflammatory acne consists of pimples and sometimes pustules. The frustrating part of this type of acne is that it often leaves a discoloration on the skin once the pimple is resolved. Many women refer to this discoloration as scarring when they are talking to me about it. Fortunately, it is not true scarring and will go away, eventually, but usually last for months. There are treatments that will help it go away quicker (I will touch on this too), but there is no magic quick eraser cream. That’s why it’s so important to prevent this type of acne as much as possible. Inflammatory acne is the most common type of acne women struggle with.

    Cystic acne consists of hard bumps on the skin which are usually pink or red but can be skin colored too. These cysts can be very tender and can scar even if you leave them alone. Anyone with cystic acne should really make an appointment with a dermatologist because my next advice on the over the counter treatments will probably not help you to the extent you need. And as I stated, cystic acne can often scar and acne scarring (which I will also discuss in a future post) is expensive and difficult to treat.

    As I mention above, my next post (which will publish early next week) will cover specific OTC product types and recommendations. But in the meantime, here are some important things to know:

    Washing your face is important but will not treat your acne. In fact, excessive washing and scrubbing can actually make acne worse.

    Try to keep your hair off your face. Avoid any thick or greasy hair products if you have acne around your hairline.

    Avoid wearing tight hats over your acne, and if you still talk on the phone (:)), don’t lean against your hand or phone while you’re talking.

    Sun typically helps with acne, but the long term side effects of wrinkling and premature aging of the skin outweigh the benefits of outdoor and indoor tanning! That’s not even mentioning the risk of SKIN CANCER!

    You all know not to pinch or pick at your acne. If you do, you are more likely to end up with long lasting discoloration in the areas that are picked at, and it can also cause scarring. So hands off :).

    http://www.youtube.com/watch?v=R9kQqRn2ZpQ
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    Tip #
    13
    Aren't I too old to be dealing with acne?!!

    Adult female acne is actually very common. There are many causes, known and unknown. Genetic factors and hormonal changes are the most common. But there are other things that can cause flares of acne such as facial and hair products, sweating in areas of occlusion and environmental changes such as weather or lots of traveling. Occasionally, some medications (such as steroids) can cause acne. Stress can also cause flares, but this is probably due to hormonal changes. Believe it or not and despite lots of claims out there, there are no consistent studies that show that any specific foods cause acne, and most make-ups these days (except for some costume make-ups) are not acne-provoking (non-comedogenic). Despite the lack of evidence linking diet and acne, some people feel strongly that diet is, in fact, associated with their acne.

    My next posts will be devoted to discussing different treatment options. In the meantime, my strong advice is to think carefully about your acne in relation to the factors mentioned above, as well as other things you may think are causing your acne. Before trying over the counter acne medications, make any lifestyle changes you feel are contributing to your acne. Because of the weeks to months of delay in provoking acne, the association between these factors is sometimes difficult to pinpoint. But most of us don’t have the patience to take this on or can’t bear the thought of struggling with acne through this trouble shooting period and just want treatment. And that is o.k. too since most women’s acne is genetic and hormonal, remember :), and there’s typically nothing you can change about these factors.

    Another thing to think about is where your acne occurs. For instance, does it mostly affect your hairline, back & chest, jawline, areas that are under occlusion from hats or clothing, or areas near where you use hair products, etc.? Does the acne occur all month long or does it cycle with your period? Is it better or worse in the summer? When did it start? What seems to make it better or worse? Is it worse during times of stress? Does your acne consist primarily of little skin-colored bumps, small pink pimples or pustules, or deep tender cysts?

    Being able to answer these things will help your dermatologist better manage your acne if you’re not able to treat it yourself. A good dermatologist will base your treatment not only on how the acne looks, but also on the information you provide at a consult. And take heart, even dermatologists get acne—I’ve had intermittent acne several times over the course of my adult life after nursing my four children, and I’ve even had to give up some beloved hair products as well! During the next posts I will talk to you about the steps you should take at home and when it’s time to see your dermatologist for prescription treatments.

    http://www.youtube.com/watch?v=EEBC5SzzJbo
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    Tip #
    12
    Why do I have dark circles under my eyes and can I do anything about them?

    Dark circles under your eyes are a combination of many things. They can be structural—the way your eye sits in its socket and how the skin, fat and muscle drape over and around it, creating a shadowing effect under the eye—and that’s often genetic. Sometimes the darkness has a bluish hue to it due to the fact that the skin around the eyes is the thinnest skin on a woman’s body, and you can see hints of the blue venous blood under the skin. “Bags” under your eyes can be worse in the morning from fluid collecting under your eyes during the night, and this may be seen if you’re retaining water, creating puffy lower eyelids and a shadowing effect.

    So what can you do about it? If “bags” are your problem, the simplest thing you can do is to make dietary changes and avoid salty foods that cause you to retain water. If you are puffy in the morning, cold compresses and natural herbal diuretics such as dandelion, ginger, nettle, fennel, linden and juniper or foods such as grapes, strawberries, watermelon, lemon and pineapple juice may help to redistribute and lessen extra fluid.

    If dark circles are your problem, the easiest and least expensive thing to do is to talk to a make-up specialist about using lighter make-up under your eyes to control the shadowing. For more dramatic results, a dermatologist may be able to use filler under your eyes to minimize the shadowing by physically changing the way the skin drapes around the eye. Besides bruising and the cost (hundreds of dollars) this can be a terrific treatment if you are a good candidate. This may be all you need and can last many years.

    For some individuals, however, an even more aggressive treatment may be indicated. This may include a combination of ablative or fractional lasering and/or a lower lid blepharoplasty consisting of the removal of fat from the lower eyelid, which treatments will actually tighten the skin and remove the puffiness, respectively. This can be done in addition to adding a filler and can have dramatic effects. But there is longer recovery time for these procedures and they are more expensive. Fortunately, this is usually not necessary for younger women.

    Personally, the most effective thing I’ve done for my lower eyelids was CO2 lasering with just a touch of JUVEDERM (filler) which helped not only with my dark circles but also helped my wrinkly lower eyelid skin without changing my appearance. The recovery time for the lasering was painfully long (that’s why I looked like Jackie O. for a month with my big sunglasses!) but for me it was well worth it!

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