General Dermatology
Acne
Acne is a skin disease that disrupts the smooth surface of the skin and can cause unsightly scarring. Acne can occur on the face, upper back, or upper chest. It can occur very early in adolescence and persist continuously into the late twenties or thirties, or it may occur at any time and last only a few brief months.
Acne occurs more frequently and more severely in some families than in others. Additionally, certain hormones are abundantly produced during adolescence causing excess sebum (oil) production from specific glands of the face, chest, and back. Sebum, debris, and naturally shed skin scales combine to form a hard plug in the opening or along the canal of the oil gland. This hard plug is variously called a comedone, "blackhead", or a "whitehead".
Pores in the skin harbor bacteria which are usually harmless, but can cause inflammation and infection resulting in acne papules if they get trapped and proliferate in a comedone. If the inflammation persists, the comedone or oil-gland ruptures and the inflammation spread to nearby areas and there may be deep-pitted scarring when healing takes place. Scarring may also result from "scratching" at acne papules.
Acne Treatment
Acne can usually be treated with a specific regimen suite to each individual case.
- The skin should be thoroughly be cleansed of dirt and debris twice a day and the scalp shampooed frequently.
- Loosening of comedones is accomplished by certain medications called “keratolytics” such as Retin-A®, Differin and Tazorac®.
- It is generally agreed that certain foods such as chocolate, peanuts, and Coca-Cola® do not play an important role in acne. However, a diet high in vitamin A, found in fresh fruits and vegetables such as broccoli, spinach, and other green leafy vegetables, is probably helpful.
- Acne often has periods of improvement and flare-ups. Women will usually notice a flare of acne near their menstrual period. Males will also notice a cyclic variation in the intensity of their acne. Acne can flare during periods of stress (such as final exams or relationship conflicts).
- Birth Control Pills (BCPs) can aggravate or alleviate acne depending on their exact composition. Be sure to discuss this with your doctor if you are taking BCPs, or are considering them.
- Oily moisturizers and make-ups will aggravate acne. Only oil-free products should be used on the face.
- For severe or persistent acne, a medication called Isotretinoin (Accutane®,Sotret® or Amnesteen®) may be used. These medications are related to vitamin-A. They require close monitoring for the four to six month treatment period.
Hyperpigmentation
Hyperpigmentation is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits on the skin. Hyperpigmentation can affect any skin color or texture.
What are the types of hyperpigmentation?
- Lentigines (also called age or liver spots) are a common form of hyperpigmentation that occurs as a result of sun exposure over many years. These small, darkened spots are usually found on the hands and face or other areas frequently exposed to the sun.
- Melasma or Chloasma spots involves larger areas of darkened skin that appear most often as a result of hormonal changes and sun. Pregnancy, for example, can trigger overproduction of melanin that causes the "mask of pregnancy" on the face and darkened skin on the abdomen and other areas. Women who take birth control pills may also develop hyperpigmentation because their bodies undergo the same kind of hormonal changes that occur during pregnancy.
- Changes in skin color can result from outside causes. For example, skin diseases such as acne may leave dark spots after the condition clears. Other causes of dark spots are injuries to the skin, including some surgeries.
- Freckles are small brown spots that can appear anywhere on the body, but are most common on the face and arms. Freckles are an inherited characteristic.
Can areas of hyperpigmentation get worse?
Freckles, age spots, and other darkened skin patches can become darker or more pronounced when skin is exposed to the sun. The already darkened spots may deepen in color as more melanin is produced. Wearing protective clothing and using a sunscreen can minimize the effect of sun exposure.
How is hyperpigmentation treated?
The application of skin lightening products is frequently prescribed to lighten and fade darkened skin patches. These products slow the production of melanin. Prescription bleaches contain twice the amount of hydroquinone, the active ingredient, than over-the-counter skin bleaches. A Q-switched ND-YAG laser can be used to effectively treat small lentigines (age spots), or an intense pulsed light device (IPL) can be used to reduce mottled hyperpigmentation.
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