Dr. Michele Green takes a global approach to treating acne and acne scars. Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually. Acne is the most common skin disease presented in most dermatology offices in the United States. To help effectively fight acne, Dr. Green recommends a combination of the best at-home acne fighting skin care products, in-office treatments, and lifestyle modifications, to help you achieve beautiful, clear skin. From acne treatments for controlling breakouts and blackheads, to the best skin care products, to cutting edge lasers to treat your acne and acne scars, Dr. Green offers the best treatments in NYC for acne.
What is acne?
Acne vulgaris, or acne, is a common skin condition which involves blockage and inflammation of pilosebaceous units. Acne may be present on the face, chest, or back. Typically, acne forms in the areas of skin which have the highest amounts of sebaceous follicles. There are many different types of acne lesions present including noninflammatory lesions and inflammatory ones. Inflammatory lesions are described as inflammatory papules, pustules, and nodules. Noninflammatory lesions are characterized by open and/or closed comedonal lesions.
Why does acne develop?
Much of acne is genetic with some patients prone to acne. There is a a tendency for acne to run in families. Hormones and androgens can also play a role in acne. Androgens cause your oil glands to increase in size and produce more sebum. It is this excess oil production and excess androgen activity which clogs your pores and causes acne. Bacteria is another cause of acne and the skin gets clogged by oil and dead skin cells. Bacteria, like Propionibacterium acnes, gets trapped inside the clogged pores, multiplies, and causes swelling, redness and acne.
What is the Best Way To Manage Acne?
Depending on the degree of your acne, there are different skin care products or over-the counter treatments which your dermatologist can prescribe. 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 may only need to be treated with the right choice of cleansers and topical acne treatments. Moderate to severe or cystic acne may need oral antibiotics, birth control pills, Spirinolactone, or Accutane, to help control these acne pustules and cysts.
Before & After: Accutane 3 months
Topical Acne Treatments:
There are many different soaps, cleansers, and toners, and pads for treating acne. Dr. Green recommends using gentle cleansers and generally washing your face twice a day, without intense scrubbing. Scrubbing your face aggressively can lead to skin irritation or further infections. These acne cleansers work by exfoliating the skin and reducing the amount of bacteria that lie on the skin and within the sebaceous glands. It is worth noting that excessive use of these cleansers can be drying and special care must be used not to over treat your skin. Acne prone skin can be very sensitive and get clinically worse with the overuse of abrasive cleansers or drying agents.
Cases of sensitive skin can get much worse from overusing drying products. Some of the most common active ingredients include for these exfoliating washes and antibacterial cleansers are:
- Benzoyl Peroxide
- Salicylic acid
- Glycolic acid
- Sodium sulfacetamide
What are the Different forms of Acne?
Papules are small red bumps which form on the skin when oil glands get clogged with bacteria and sebum. The contents of the blocked pore spills out into the surrounding tissue and the bacteria cause inflammation and erythema. Papules do not contain pus whereas pustules do.
Pustules/Pimples are acne lesions which are small, bulging bumps, which are red and inflamed with a white center. They are typically filled with pus and are formed as the blocked pore gets infected with bacteria. It is important not to squeeze these pustules on your own as the pus can spread and lead to further infection. It is best to consult your dermatologist who will drain the pustules safely using the correct procedure.
Comedones are Blackheads, which may appear black on the surface of the skin. Blackheads are also referred to as closed comedones, whereas whiteheads are known as open comedones. These comedones cannot be “squeezed” and need extractions by a dermatologist to make sure that the removal is done correctly, without any scarring. Hydrafacials are a popular way to treat acne in Dr. Green’s office as the blackheads are extracted and the skin is cleaned and refreshed.
Cystic acne develops when deep acne cysts form under your skin. Initially the pimple can form when a pore gets clogged with bacteria and dead skin cells. As the amount of bacteria increases and gets trapped, the area becomes more erythematous and swollen. Cystic acne is formed as these cysts increase in size and number, and these infections go deep into the skin. These deep acne cysts are largely filled with pus. Cystic acne is often extremely painful and can easily cause scarring. If you develop cystic acne, is is important to consult at dermatologist immediately to treat the infection and prevent acne scarring. Treatment of cystic acne typically requires oral medications such as Doxycycline or in recalcitrant cases, Accutane.
Topical Acne medications
There are a host of topical medications for acne, which work by increasing skin cell turnover, killing bacteria, or helping to unclog pores, and preventing further acne from forming. Acne presents itself in so many ways, from small blemishes to severe acne cysts. Some of the most popular topical acne medications contain the following active ingredients:
Salicylic acid is a type of phenolic acid and a beta hydroxy acid (BHA) which works extremely well for comedonal acne, blackheads and whiteheads. Beta hydroxy acids, like Salicylic acids, exfoliate the skin and are oil-soluble. Since Salicylic acid is oil-soluble, it can penetrate the skin at a deeper level than water soluble products. Salicylic acid both unclogs the pores and acts as anti-inflammatory agent by reducing pustules and inflamed pimples.
Benzoyl Peroxide is a popular spot treatment for acne pustules and pimples. Benzoyl Peroxide works by destroying the bacteria in the skin and helping to unclog the pores and reduce excess sebum and dry out acne zits. Common brand names are Benzac, Perea-Gel, Brevoxy, and PanOxyl.
Topical Antibiotics like Erythromycin and Clindamycin are commonly prescribed by Dr Green. These topical medications, when combined with Benzoyl Peroxide, have even better efficiency and decrease the likelihood of antibiotic resistance. Some topical antibiotics are combined with benzoyl peroxide such as Clindamycin (Clindagel, Benzaclin, Duac, Acanya) and some have have Erythromycin combined with Benzoyl peroxide (Benzamycin). These topical antibiotics can be used for spot treatments for zits, much like benzoyl peroxide alone is used for acne.
Azelaic Acid is found naturally in whole grains such as barley, wheat, and rye. Azelaic Acid is produced naturally by yeast that live on the skin. Azelaic acid goes by the brand name Finacea contains 15% Azelaic Acid as its active ingredient. It has effective antibacterial and anti-inflammatory properties, and encourages skin cell turnover. Because of its antibacterial properties, Azelaic Acid can reduce bacteria from clogging your pores and prevent future breakouts.
Retin-A, Retinoids and retinoid-like drugs are extremely popular at treating inflammatory acne, cystic acne, and mild acne as well. Retin-A is the brand name for the generic tretinoids. Retin-A is a Vitamin A derivative which is effective at skin cell turnover, and helps exfoliate dead skin cells. There are various brand names of tretinoin including Atralin, Avita, Refissa, Renova, and Retin-A micro. One of the main side effects of retinoids is dryness. If you have sensitive skin, you may not be able to tolerate the irritation from this topical medication.
Differin gel, is a retinoid-like drug, composed of adapalene, which has all of the same anti-inflammatory effects and skin cell turnover effects as Retin-A, but with less irritation and fewer cases of dry skin.
Epiduo Forte is a combination of adapalene with benzoyl peroxide gel and is a very popular acne medication. Strict sun avoidance and sunscreen use is necessary with all of these topical retinoids since are very photosensitizing. A non-comedogenic, oil free moisturizer or lotion , is also recommended for patients to combat the dryness with retinoids.
Dapsone gel, or its brand name Aczone, is an antibiotic which is used to decrease the number and severity of acne pimples and allows the acne to more quickly. The main side effect of Dapsone gelis dryness and skin irritation.
Which Oral Medications are used to Treat Acne?
Oral Antibiotics such as Minocycline, Tetracycline, and Doxycycline are highly effective to treat acne papules, rosacea (adult acne), and inflammatory acne.
Oral Contraceptives or Birth control pills are used to keep hormonal acne in balance and decrease 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.
Spironolactone is used to treat ormonal 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.
Isotretinoin more commonly known as Accutane, is commonly used for severe acne, cystic acne, or recalcitrant acne, which has not responded to any other treatment including oral antibiotics and retinoids. Dr. Green utilizes Accutane for nodular cystic acne, which has a high potential to cause acne scars. Accutane is a vitamin A derivative, and can cause dry lips, eyes, and skin. Moisturizers and eye drops are commonly used while taking Accutane to help relieve this dryness. Accutane has also been associated with elevated liver enzymes and birth defects. Women who are on Accutane for their cystic acne are required to get monthly blood tests to make sure that they are pregnant. Strict sun avoidance and sunscreen use is needed while taking Accutane as it can make you very susceptible to sunburns during the course of your treatment.
Female treated for Acne, 8 months
Other Acne Treatment Options
Acne surgery/extractions are an important tool to extract blackheads and remove trapped sebum and dead skin cells. Extracting these blackheads prevents acne scars and allows the skin to heal.
Intralesional cortisone 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.
V-Beam is used to treat the redness and erythematous patches from acne and the resulting inflammation. V-Beam also works on reducing the redness and telangiectasis from rosacea and broken blood vessels as well.
Hydrafacial is a medical grade “hydradermabrasion” device which carries out a patented three-part regimen – cleansing, exfoliating, and infusing skin with intensive serums. This gentle approach vacuums out the pores while simultaneously infusing potent active ingredients, which treats redness, brightens, and rejuvenating the skin.
Blue light and red light therapy using LED-based blue and red light therapies helps to kill bacteria which causes acne and shrinks the oil-producing glands. Dr. Green often utilizes this light therapy in conjunction with hydrafacials.
Photodynamic Therapy (PDT) is a procedure where Levulan is applied to your face and is activated with blue light to help kill the bacteria and the associated inflammation which causes acne. Strict sun avoidance is necessary after the Photodynamic Therapy procedure for 48 hours.
Chemical peels, using glycolic acids or trichloroacetic acids, are used by Dr. Green to exfoliate the dead skin cells and help treat acne and rejuvenate your skin.
Acne Scar Treatments is a speciality of Dr. Michele Green and she is known as one of the best acne scar dermatologists in NYC. Through a combination of injectable dermal fillers such as Restylane, Juvederm, and Sculptra, and an arsenal of cutting edge lasers such as Fraxel, eMatrix, V-Beam, she safely and effectively removes your acne scars.
Dark Marks from acne are best treated with a combination of hydroquinones, Vitamin C serums, and retinoids combined with chemical peels. Dr. Green custom designs treatments for you to use at home to combat these dark marks from her MGSkinLabs Inc, line of products available here.
Female treated with Accutane – 3 months
Homeopathic Remedies for Acne
There are some patients who prefer a holistic approach to treating their acne. Some patients have had good success with topical treatments such as tea tree oil, as it has antibacterial properties associated with it. Some patients like using apple cider vinegar, oral zinc supplements, use clay or honey masks, or green tea to their skin. Using witch hazel to clean the skin is an older common way to treat acne. Some patients take vitamins and other supplements such as Fish oils to help with their skin and acne. There are a myriad of natural, alternative treatments in addition to the traditional medical treatments for acne.
Recommendations for minimizing acne and its side effects:
- Use gentle products to wash and exfoliate your skin
- Do not overuse drying agents like benzoyl peroxide and retinoids which can cause irritation.
- Use non-comedogenic make-up and skin care products, including moisturizers,to help reduce breakouts.
- Limit sun exposure which can make your acne worse and also be careful to use sunscreen when using photosensitive medications.
- Keep hair products like sprays and gels away from your face, as this will decrease the amount of blackheads and papules which form, especially on your forehand.
- Wash your face after exercising or sweating.
- Do not squeeze or pick at your acne as this cause scars and you want to try and avoid injuring your skin and creating acne scars
- Stress relaxation and sleeping more will help as stress can exacerbate your acne.
Treating acne, whether blemishes or pustules, or more severe cystic forms, is what the best dermatologists in NYC, like Dr. Michele Green, are trained to do. If you’d like to find out more about your options for acne treatments, contact us online today or call 212-535-3088