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Medical Dermatology Cosmetic Dermatology

Category: Acne

What you need to know about Accutane

What is Accutane? Accutane is a molecule that is very similar to Vitamin A in that it is a ring-like structure. Its primary mechanism of action is to reduce the size of the oil-producing sebaceous glands in the skin to almost imperceptible levels so that it oil secretion, clogging and inflammation due to not result in acne. No sebaceous glands = no acne. However, we can remove sebaceous glands from skin, so Accutane or isotretinoin is the next best thing. Considered the gold standard in the treatment of acne, there are two indications for its use. The first indication is cystic scarring acne. The second indication is acne that is refractory to all other traditional therapy. When a patient is prescribed Accutane properly, it is dosed by weight and considered a cumulative or additive effect. Typically treatment courses last 5-6 months, and it is dosed twice daily with food. The “with food” is important because this medication is better absorbed by the body with consumption of food. Specifically, it is best absorbed with consumption of fatty foods. I recommend patients take their pill twice daily with some type of fat–nuts, cheese, avocado, meats or fatty fish such as tuna or […]

How can I reduce the oil production of my skin?

  Oil production occurs at the level of the sebaceous gland. There are many more sebaceous glands located in such areas as the face, the chest and the shoulders but sebaceous glands can be found virtually anywhere on the body. When patients with very active sebaceous glands tell me they do not use a moisturizer daily because they do not need it, I always caution them that this is important in the re-training of their glands to secrete oil or sebum when we need it. In oily skin, the sebaceous glands are active and very good at what they do. They sense on a neurologic level what is going on at the surface of the skin. If someone cleanses her face, and then does not immediately apply a light daily non-comedogenic moisturizer, she will typically see a rebound flush of oil production causing a shiny or greasy complexion an hour or two later. The reason for this is that the skin sense a dryness occurring at the site of cleansing, and it now instructs the sebaceous glands to get to work and produce sebum or oil to take care of the temporary dryness. To counteract this rebound oiliness, it is […]

Does Food Cause Acne?

  In a single word, “no”. Although there have been several studies that looked at the possibility acne could be caused or worsened by certain foods, it appears that no single food can be represented as an issue amongst acne patients in general. Myths have circulated that junk food or fried food causes acne. This is incorrect. It is certainly not a healthy food choice to eat fast food or fried food but there is no medical study that points to this as a cause of acne. Additionally, there was a study to look at dairy products to determine possible link with acne formation. No direct link could be found. Gluten-free is everywhere, but gluten is a very specific protein that most people can digest. However, there are some people who are truly gluten-sensitive and should avoid gluten for health reasons. If someone has not been tested and found to be gluten-sensitive, I would not encourage anyone and everyone to eliminate gluten from their diet as it can be a very difficult diet to maintain. If in doubt, patients can be tested through an allergist and/or gastroenterologist for gluten sensitivities. I believe the single best dietary advice to give patients […]

Adult Female Acne: A Practical, Safe and Effective Approach

Enter the dermatologist. This one of the easiest things to treat in my practice, and I see more adult female acne patients, than I do see teenager acne patients! Don’t waste time running from salons and spas to spending tons of cash on over-the-counter treatments that don’t work. My favorite medication for this condition is spironolactone. Many of my patients consider it the “miracle drug”. When used at low doses such as 50-150mg per day, the androgen hormones are not cycling so rapidly which in turn causes the cystic acne, especially located on the lower cheeks, jawline and neck regions. Interestingly, spironolactone is an older drug that has been used since the 50s but at different doses, it acts by a completely different mechanism of action. Thus, it is as though it is two completely different drugs, depending on the dose, but it has the same name. I have even had patients come to me after leaving the pharmacy, and the pharmacist is telling them that this drug is “unsafe” or it “lowers blood pressure”. That is absolutely not true at all. The only negative aspect of spironolactone dosing at these levels is that a woman should never get pregnant […]

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