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The American Academy of Dermatology (AAD) has identified acne vulgaris as the most common skin condition in the United States, affecting individuals from early adolescence through adulthood. Despite how common acne breakouts may be, starting acne treatment can often seem like a daunting task. With all of the various targeted cleansers and topical treatments that are available over-the-counter, it can be a challenge to determine the best potential approach for resolving acne. The easiest, fastest, and most efficient way to treat acne is by consulting with a board-certified dermatologist, such as Dr. Michele Green in NYC. Dr Green is a world renown specialist in acne treatment, acne prevention, and acne scar treatment in New York.

There are a number of factors that contribute to the formation of acne including genetics, hormones, skincare regimen, environmental factors, diet, stress, and sleep patterns. Determining the underlying causes of acne is often the best way to discern as to which combination of treatments, products, and medications are best-suited to resolving the breakout. Although we can usually do a quick internet search and find an answer to (almost) anything, the story of our skin is best managed by a specialist with the experience and expertise to accurately diagnose and treat various conditions, including acne breakouts. Being treated by a dermatologist, like Dr. Green, for acne early on helps patients to better understand and manage their skin condition, develop proper skincare routines, prevent acne scarring, achieve a long-lasting clear and healthy complexion, and feel confident in their skin.

Dr. Michele Green is an internationally renowned board-certified dermatologist with over two and a half decades treating some of the most discerning men and women from around the world. Dr. Green takes pride in the relationships that she builds with her patients, taking the time to understand the specific skin concerns of every individual to artfully customize their treatment approach in a way that centers the particular needs and goals of each patient. She is consistently voted as on of New York’s best physicians by Super Doctors, Castle Connolly, and New York Magazine. When you work with Dr. Green to resolve your acne and reduce your acne scars, she will recommend a combination of the best specially formulated skincare products, acne medications, and in-office treatments to provide you with ideal results and a clear complexion that lasts.

What is Acne?

Acne is a medical skin condition that involves blockage and inflammation of pilosebaceous units. Acne may occur anywhere on the body where there are sebaceous glands, though it is most commonly found on areas such as the face, chest, and back, where there is the highest distribution of sebaceous follicles. There are many different types of acne, caused by a number of contributing factors. Acne usually begins to present in early adolescence, accompanying changes in hormones during puberty. Although the skin condition is most closely associated with teenage years, it often persists or develops in adulthood, too.

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Before and after Accutane 1 and 5 months

What causes acne?

Acne forms when sebaceous glands at the base of hair follicles in the skin become clogged with excess sebum. Sebum is oil that is essential for skin health, keeping it soft and moisturized. Sebum is usually released from the pore onto the skin, but when too much oil is produced or there is an excess of bacteria or dead skin cells that have built up in the pores, the sebum can then be trapped in the follicle. When pores become clogged with excess sebum and bacteria, preventing the oil from leaving the pore properly, then acne lesions form.

Although anyone can potentially develop a pimple, there are some factors that contribute to an increase in ones chances of having a breakout. Acne is a medical skin condition that is considered to have a genetic component, usually observed as something that tends to run in families. Patients can simply be more prone to experiencing acne breakouts as a result of the way their skin naturally produces and secretes sebum. Patients who have a family history of acne should always seek treatment from a dermatologist since there is an increased likelihood of forming acne scars for these individuals.

Fluctuations in various hormones are also associated with a higher incidence in acne breakouts. Androgens, in particular, have been linked to higher rates of acne breakouts. Androgens are sex hormones, like testosterone, that have been shown to cause acne to develop in men and women alike. Although testosterone is a male sex hormone, women do have testosterone, too, it is just present in lower amounts. Androgens can change the activity of the follicles of your skin, leading to an increase in both sebum production in the sebaceous glands as well as a rise in the presence of acne-causing bacteria and inflammation. It is this excess oil production, bacteria (Propionibacterium acnes) and excess androgen activity that then clogs pores and ultimately causes acne to form. Acne breakouts can also be influenced by factors such as increased stress, diets that are rich in sugar and fat, and poor sleeping or hygiene habits. When you consult with board-certified dermatologist Dr. Green in her private dermatology office located in the Upper East Side neighborhood of Manhattan, you will thoroughly discuss your family and medical history as well as skincare regimen and other environmental factors that may be contributing to your acne breakouts. Dr. Green may collect and send a sample of blood to the laboratory to be evaluated for any hormonal abnormalities that could indicate for increased breakouts. Determining the underlying cause of your acne with Dr. Green is the best way to understand and manage your acne breakouts.

When do you need to consult a dermatologist for your acne?

Ideally, consulting with a board-certified dermatologist is step one for patients who are struggling with any type of acne. Treating acne quickly and correctly is the best way to prevent acne scars from developing, which are often more difficult to treat than the acne itself. If you have a family history of acne, have inflammatory acne that has started to lead to the development of acne scars, or have acne that is persistent or unresponsive to over the counter treatments, you should consult with board-certified dermatologist Dr. Green. Although these indications may mean that it’s time to visit a dermatologist, you can schedule a consultation with Dr. Green at any time to learn more about how to keep your skin healthy, radiant, clear, and youthful. Patients with acne breakouts often have feelings of self-consciousness due to their breakouts, and early treatment of their skin condition can restore feelings of confidence.

In addition, if your acne lesions have resolved and you are someone who is now struggling with the appearance of acne scars that have been left behind from previous breakouts, Dr. Green in New York City can help. Just as there are many varieties of acne lesions, there are many different types of acne scars that may form. No two patients with acne will develop acne scars in exactly the same way, and for this reason it is important to customize acne scar treatment to each individual patient. Dr. Green is a board-certified cosmetic dermatologist who is recognized and appreciated around the world for her holistic approach to treating acne and acne scars.

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Female treated for acne with Accutane: 5 months

What are the different forms of acne?

There are six different types of acne that fall into one of two categories: inflammatory or non-inflammatory. Inflammatory acne is most closely associated with the development of acne scars, as the inflammation of these acne lesions can cause extensive damage to skin tissue and lead to collagen loss that is irreparable. Papules, pustules, cysts, and nodules are inflammatory types of acne. Blackheads and whiteheads are non-inflammatory types of acne.

  • Papules – Papules are acne lesions that appear as raised bumps on the skin, typically 1 centimeter or smaller in diameter. Papules are lesions that do not contain pus, but rather are composed of a solid material. Papules can develop into pustules if they later become filled with pus.
  • Pustules – A pustule is an acne lesion, usually less than 1 centimeter in diameter, that is filled with pus and appears as an inflamed and red bump on the skin.
  • Blackheads – A blackhead is a type of comedone that has an opening at the surface of the skin. Having this exposure to the air is what gives this type of acne its dark color, as the buildup of sebum, dead skin cells, and debris becomes oxidized.
  • Whiteheads – A whitehead is a closed comedone. Whiteheads are a type of pimple that forms as a result of a pore becoming clogged with dead skin cells and sebum that do not have any exposure to air but instead are covered with skin, preventing oxidization of the material built up inside the pore.
  • Cysts – Cysts, often referred to as “blind pimples”, develop deep below the surface of the skin where topical treatments can not penetrate them. Cysts are lesions that are filled with pus and do not come to a “head” like other pimples, but appear as a red bump on the skin and are often painful and large in size. Cystic acne should be treated with a dermatologist as soon as possible in order to effectively prevent acne scars from developing.
  • Nodules – Nodules, much like cysts, are larger and more painful than many other types of acne. These lesions form deep below the skin’s surface, too, and do not form a “head” but instead look like a firm red bump. The biggest difference between cystic acne and nodular acne is that cysts are pus-filled, whereas the material that is within nodules is a harder, firmer substance. Similarly to cystic acne, nodules are closely associated with the formation of acne scars and should be treated by a dermatologist immediately.

How to treat acne breakouts

The most effective acne treatment for any given patient varies depending on the type of acne that the patient presents with. Patients may have a single type of acne or a combination of types. Depending on the underlying cause of acne and the type of acne present, treatments can include oral antibiotics (such as doxycycline, minocycline, and tetracycline), topical antibiotics, oral contraceptives (birth control pills), chemical peels, laser treatments, and HydraFacials. During your acne treatment consultation with Dr. Green, you will determine which combination of in-office treatments, acne medications, and skincare products is best-suited to clearing up your skin.

  • Isotretinoin, commonly known as Accutane, is often recommended for treatment of severe acne, cystic acne, or recalcitrant acne, which has not responded to any other treatment including oral antibiotics and retinoids. The most common side effect associated with this oral vitamin A derivative is dry skin, lips, and eyes. Patients have to take certain precautions while using Accutane, as the medication can cause increased photosensitivity as well as elevate liver enzymes. Refraining from alcohol consumption and limiting dietary fat intake are recommended for patients on Accutane. In addition, female patients need to have monthly blood tests for pregnancy throughout the course of Accutane, since the medication can cause severe birth defects in a developing infant.
  • Acne surgery entails opening of acne lesions and removal of excess sebum, debris, and dead skin cells, followed by intralesional corticosteroid injections to shrink the acne. Intralesional cortisone (corticosteroid) injections are used to reduce inflammation in pustules and acne cysts. If the cystic acne is large, the lesions may need to be drained first before cortisone is injected into the lesions. Usually this type of acne benefits from topical and oral antibiotics as well. Oral Antibiotics such as Minocycline, Tetracycline,  and Doxycycline are highly effective to treat acne papules, rosacea (adult acne), and inflammatory acne. Topical antibiotics like Erythromycin and Clindamycin are commonly prescribed for reducing acne-causing bacteria and minimizing inflammation associated with acne.
  • HydraFacials are a medical grade hydradermabrasion treatment that is used to deeply cleanse, gently exfoliate, and intensely nourish the skin. The vortex fusion technology is exceptional for extracting sebum, dead skin cells, and debris that are trapped in the pores and causing acne. The infusion of antioxidants, vitamins, and peptides that follows the cleansing and exfoliating steps helps to enhance the natural protective barrier of skin and can be used to aid in prevention of breakouts.
  • Chemical peels are a great treatment option for rejuvenating the overall appearance of the skin, exfoliating away dead skin cells, and helping to treat acne breakouts. Dr. Green often employs trichloroacetic acid to perform chemical peel acne treatments. TCA application stimulates skin cell turnover and clears the pores of the skin, resulting in a clear, healthy, smooth complexion.
  • Spironolactone is used to treat hormonal acne in patients with an underlying hormonal imbalance, such as patients with Polycystic Ovary Syndrome.  For these patients, Spironolactone will help decrease the androgen (testosterone) excess, lower these levels, and treat their acne.  In other patients, it helps regulate the hormonal fluctuations which can cause adult acne.
  • Oral Contraceptives are used to manage hormonal acne breakouts by regulating your hormonal cycle. Oral contraceptives have been approved by the FDA to treat women with hormonal acne. Two popular brands of birth control pills to treat acne are Yaz and Ortho Tri-Cyclen, which combine estrogen and progestin. Some potential side effects of birth control pills are weight gain, nausea, mood swings, and an increased risk of blood clots. Women should avoid cigarette smoking while on oral contraceptives as this increases your risk for blood clots.

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Before & After: Accutane 3 months

How much is acne treatment?

The cost of acne treatment is influenced by a number of contributing factors including the experience level of your provider, the geographic location of the office in which you are treated, the extent of your insurance coverage, and the type and severity of acne being treated. Acne breakouts that are more severe, including cystic or nodular acne, will require more involved treatments than breakouts that consist of blackheads or whiteheads. During your consultation for acne treatment with Dr. Green in her private dermatology office, located in the Upper East Side neighborhood of Manhattan, you will discuss in-depth your medical history and any previous treatments that you may have had. Some blood samples may be collected and sent to the lab for evaluation if deemed necessary. You will then have the opportunity to develop with Dr. Green a customized acne treatment plan that works best for you and addresses the underlying causes of your acne. At this time, the total cost of your acne treatment can be estimated.

What are good topical acne treatments?

There are countless options when it comes to “good” topical acne treatments. The best way to approach treating acne through the use of topical treatments is understanding what kind of acne you are treating. Different forms of acne may be more responsive to certain active ingredients than others. Cystic acne and nodular acne typically do not respond well to topical acne treatments and require more intense intervention such as oral antibiotics or Accutane (isotretinoin). The best topical acne products work by speeding up skin cell turnover, decreasing sebum and oil production, reducing inflammation, and inhibiting bacterial growth. Mild acne is usually responsive to topical treatments and may be resolved through the use of ingredients like salicylic acid, benzoyl peroxide, and glycolic acid.

Salicylic acid is a beta hydroxy acid (BHA) that is a powerful ingredient against comedonal acne, such as whiteheads and blackheads. Salicylic acid is oil-soluble and works against acne by gently chemically exfoliating the skin. Since it is oil-soluble, salicylic acid is able to penetrate deep within the pores and breakup sebum and debris that are clogged.

Benzoyl peroxide is an excellent skincare ingredient for treating inflamed types of acne such as pustules and papules. This ingredient works by killing bacteria on the skin that contributes to the development of acne, as well as by drying up the excess sebum within the pores.

Dapsone is a topical acne treatment that may be prescribed by your dermatologist for mild or moderate acne breakouts. Dapsone, known by its brand name Aczone, reduces the amount of acne-causing bacteria on the skin. This helps to eliminate acne lesions and clear up the complexion. Other topical antibiotic treatments such as Clindamycin and Erythromycin work to reduce acne in a similar way.

Retinoid topical treatments for acne, like Differin, tretinoin, and retin-a, are discussed in detail in the following section.

What does adapalene do for acne?

Adapalene, more commonly known as Differin, is a retinoid-like topical treatment that is best used for eliminating and managing mild to moderate acne blemishes and comedones. Cystic acne, on the other hand, typically requires oral treatment and does not respond readily to topical treatments like adapalene, since the product cannot penetrate the skin at a depth necessary to eliminate the cysts.

Retinoids and retinoid-like products such as adapalene are a class of skincare products derived from vitamin A that work by exfoliating dead skin cells from the top layers of the skin. Dead skin cells, sebum, and debris are sloughed away at an increased rate, preventing the material from becoming trapped within the pores and causing acne to form. Dryness is the most common side effect that patients experience from using adapalene and other retinoid topical treatments, as well as mild flaking and some redness. It is normal for patients to experience a skin purge when they begin treatment with a product like adapalene, as it works to reveal new and healthy skin cells below the surface layers, it also removes the material in the pores that clogs them and contributes to the development of acne. A purge may last for up to twelve weeks after you begin using a new product like Differin. Other topical retinoids that are available in prescription-strength when you consult with a board-certified dermatologist like Dr. Green include tazarotene and tretinoin (retin-a). When you consult with Dr. Green regarding your acne treatment, she will recommend the skincare products that are best for your skin type and specific skin concerns.

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28 year old female, acne treatment – 3 month

Can I use moisturizer after acne treatment?

To keep your skin healthy, hydrated, and functioning at its best, it is important to maintain a regular skincare routine that is suited to your skin type and your specific skin concerns. Moisturizer is a non-negotiable step in any skincare regimen, including for individuals with skin that is oily or acne-prone. Acne breakouts can actually be worsened by avoiding the application of moisturizer, since moisturizing helps to loosen sebum in the pores, making it easier to remove with other acne products, as well as enhances the natural protective barrier of the skin. Choosing the right moisturizer for your skin type is imperative for keeping your skin looking and feeling its best. When you consult with Dr. Green you will have the opportunity to discuss proper skincare routine, including which products should be a part of your regimen as well as learn which active ingredients would be best-suited to your skin type and your skin concerns.

Sunscreen is another essential component of any good skincare routine. Patients may be averse to the application of sunscreen at the end of their routine if they struggle with acne since many sunscreens may have formulas that clog their pores with the product and lead to more breakouts. Choosing a noncomedogenic lotion formula for sunscreen is an ideal option for those who have oily or acne-prone skin. Dr. Green’s MGSkinLabs, Inc. produces a non-comedogenic Hydrating Sunscreen with SPF 50 that combines a moisturizer and SPF into a single product. This kind of sunscreen is the perfect option for those who want to reduce the number of steps in their skincare routine, keep their skin moisturized and healthy, as well as protect against UVA and UVB rays that contribute to the development of skin cancer and signs of premature aging.

Does insurance cover acne treatment? Is acne treatment covered by HSA/FSA?

Most health insurance policies will cover acne treatments with a dermatologist since acne is considered a medical skin condition. HSA/FSA can usually be applied towards acne products and acne medications, too. Although insurance typically covers acne treatment, prior to undergoing any acne treatment, reach out to your individual insurance provider to learn more about your specific benefits and coverage for acne treatment.

Does laser acne treatment work?

Yes! Patients with acne breakouts can absolutely benefit from having laser treatments with Dr. Green in NYC. Dr. Green often treats her patients with acne and rosacea utilizing the V-Beam laser. The V-Beam laser is an excellent treatment option, and considered as the gold standard treatment, for patients with rosacea, post-inflammatory hyperpigmentation, broken capillaries, and other forms of facial or bodily redness. The laser operates on a wavelength that exclusively targets skin cells with red pigment, effectively reducing the appearance of redness while leaving surrounding skin untouched. One of the greatest benefits of the V-Beam laser is that there is no downtime involved with the treatment, meaning that patients can resume normal daily activities immediately upon completion of the procedure and that treatment sessions can be scheduled with ease. Additionally, the V-Beam laser incorporates a patented Dynamic Cooling Device, the DCD, that releases a burst of cool air prior to emitting the laser beam. This feature makes the treatment much more comfortable for the patient, and treatment can be performed without the use of a topical anesthetic first. If you are struggling with inflammation and redness associated with acne breakouts or other skin condition, schedule a consultation with Dr. Green who can advise you on whether you are a good candidate for treatment with the V-Beam laser.

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Accutane, 6 months before and after

How to use blue light for acne treatment

The blue light is a non-invasive, anti-inflammatory, in-office treatment that works by reducing acne-causing bacteria on the skin. This treatment option has been FDA-approved for treatment of mild and moderate cases of acne. The procedure for delivering effective photo dynamic therapy entails that the patient sit in front of the blue light lamp for just over fifteen minutes. Patients usually require several treatment sessions with blue light to produce optimal results. There are also many blue light devices that are available to purchase over the counter for at-home use, and these devices are safe and effective when used up to three times a day.

Another popular treatment option that incorporates LED light to reduce acne is the HydraFacial. The HydraFacial is a three-step medical-grade facial that deeply cleanses, gently exfoliates, and intensely nourishes the skin. The result is a clear, healthy complexion and a radiant glow. Patients can customize their HydraFacial experience through the addition of a Booster serum. Boosters are designed to target specific skin concerns and include Britenol, Rozatrol, Regen-GF, and Dermabuilder. When you consult with Dr. Green in her boutique dermatology office in the Upper East Side neighborhood of Manhattan, you will have the opportunity to discuss the ideal HydraFacial Booster serum for your skin and learn more about the skin benefits of having a HydraFacial treatment.

Can acne treatments make acne worse? Why is my acne getting worse with treatment?

Acne treatments may worsen the appearance of your acne if you are using the wrong ingredients for your skin type or type of acne, using acne products incorrectly, or if you’ve recently started a new kind of acne treatment.

When you start a new acne treatment, whether it is a topical treatment or an oral acne medication, your skin may enter a purge period. A purge describes the process of skin shedding the dead skin cells, debris, and sebum that are in the pores deep below the surface of the skin. This can look like red bumps on the surface of the skin that may be mistaken for an acne breakout, though it can often be expected when starting out a new acne treatment that works by stimulating skin cell turnover at an increased rate. Give your new acne treatment a few months to determine if it’s effective before giving up on it due to a purge period, skin may look slightly worse before it starts to look better. Being treated for acne by a dermatologist like Dr. Green means that throughout the duration of your acne treatment, your progress will be continually evaluated and it can be determined whether you are purging or if you would benefit more by changing treatment methods.

Using acne products incorrectly could indicate a number of different things. Scrubbing skin too aggressively with an abrasive cleanser can result in skin irritation, dryness, and exacerbation of acne. It’s recommended to cleanse your skin twice a day with a gentle cleanser containing an active ingredient such as benzoyl peroxide or salicylic acid, depending on the type of acne you have. Benzoyl peroxide is best-suited to treating inflammatory acne, whereas salicylic acid is better for treating comedonal acne such as blackheads and whiteheads. Both of these ingredients can be rather drying, and using too many acne-fighting ingredients in your routine, using your acne products too often, or using the wrong kind of active ingredient can result in dry, flaky, irritated skin and worsened acne breakouts. Consulting with board-certified dermatologist Dr. Green is the easiest way to learn which skincare ingredients would be best for resolving your acne breakouts and the correct way to deliver those active ingredients in your skincare routine.

What acne treatments are safe during pregnancy?

During pregnancy and while breastfeeding, treatment options for acne breakouts are much more limited. The reason for this is that topical and oral acne treatments have the potential to enter the bloodstream and, if pregnant, have the potential to affect a developing infant. Many acne treatments have not been evaluated for safety in pregnancy and are not advised for use in order to avoid risking any side effects. Azelaic acid, clindamycin, and erythromycin are topical acne treatments that are considered safe for pregnant and breastfeeding individuals. Always consult with both your board-certified dermatologist and OBGYN prior to beginning any acne treatment while pregnant, breastfeeding, or planning to become pregnant. Isotretinoin, Spironolactone, and Tazarotene should never be used during pregnancy. While pregnant, continue the use of your gentle cleanser twice a day and refrain from applying products that may clog the pores of the skin and cause acne to form. In addition, never pop your pimples! Attempting to perform your extractions can worsen an infected acne lesion and lead to scarring, which is often more difficult to treat than acne itself.

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Age 25-30: 6 months before and after Accutane

Does acne treatment work?

Acne treatment works when the skincare products, in-office treatments, and acne medications in your treatment protocol are designed to reduce the specific types or type of acne that you have. Since acne may be caused by multiple underlying factors, and there are so many forms of acne that may present in many various combinations, acne treatment should be customized for each individual patient to produce the best results. Dr. Green is an authority in the field of cosmetic dermatology with over 25 years of experience treating patients with acne and acne scars to reveal a healthy, radiant, and clear complexion that lasts. The most efficient way to resolve your breakouts and reduce the appearance of your acne scars is by having acne treatment with board-certified dermatologist, Dr. Green. When you work with Dr. Green, she takes the time necessary to understand the underlying factors that are causing the formation of your acne. Your acne treatment with Dr. Green will be specific to the causes of your acne and the types of acne that are present, guaranteeing that your acne treatment protocol works best for you and your skin.

Which acne treatment is best for me?

Acne, whether it be a single pimple or a persistent breakout of severe acne, can be a frustrating skin condition to try and treat with over-the-counter acne products. Additionally, untreated or ineffectively treated inflammatory acne is closely related to the development of acne scars, which can be even more challenging to resolve than the acne lesions themselves. One of the greatest benefits of consulting with a board-certified dermatologist early on about your acne is that they can recommend the best acne medications, treatments, and skin care products for you depending on the type of acne that you’re experiencing.

Dr. Michele Green in New York City is a board-certified cosmetic dermatologist who is internationally renowned for her holistic approach to treating acne and acne scars, with over two and a half decades of treating some of the most discerning men and women from around the globe. Dr. Green takes the time to understand the underlying factors that are contributing to the presence of acne, designing acne treatment protocols that have been customized to address the specific concerns of each individual patient. Her dedication to her patients and to her expertise is reflected by the fact that she is consistently voted as one of New York’s best dermatologists by Castle Connolly, Super Doctors, and New York Magazine. To get started with eliminating your acne and achieving a clear, healthy, radiant complexion that lasts, please call the NYC office of Dr. Michele Green at 212-535-3088  or contact us online today to schedule a consultation.

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