Acne, Uncategorized

Adult acne- what’s the deal with that?

Acne is one of the most common reasons for visiting a dermatologist. Everyday I see several patients with acne, and many of these are adult women. It is a myth that only teenagers suffer from acne. About 35% of women will suffer from acne at some point in their adult life- which just isn’t fair- to be fighting acne and wrinkles at the same time!

Why do we (I say we because I am part of the unlucky thirty five percent) get acne as an adult? The theory is that most adult female acne is related to fluctuating hormones. If you think about it- our hormones fluctuate as adults frequently. There are normal monthly fluctuations and then you add fluctuations due to birth control, pregnancy, post pregnancy, pre-menopause and menopause, it is a wonder that anyone has clear skin! 

Fortunately there are many treatment options for acne. When considering treatments in adult women it is important to remember that our skin is aging and traditional acne medications may be too harsh. 

One category of topical treatment, Retin A (also called tretinoin), is very good for light acne and is also anti-aging, win-win! With Retin A I am very careful to prescribe the appropriate strength, as it can be drying and irritating to the skin. I usually prescribe a low strength and recommend applying a small amount (such as a fingertip) over a moisturizer and starting application every other night (or even every third night).  It is important to use Retin A at night because it is in-activated by sunlight. It is also VERY important to use sun protection if you use Retin A because it will make your skin very sensitive to the sun.

Other topical treatments that are commonly used for acne are topical antibiotics and medicated washes (salicylic and glycolic are my favorite for mature skin).

If your acne is cystic (those big deep, red ones), scarring and more severe then we consider oral medications. Oral antibiotics can be used to clear the skin and then creams are used to keep the skin clear as oral antibiotics are not meant to be used long term. If someone needs a longer term treatment, an oral medication called Spironolactone can be very helpful. Spironolactone is a blood pressure medication that is used off label for acne, it works by blocking the effect of male hormones (women have male hormones too and they are part of the reason we get acne) at the level of the skin. Spironolactone works very well for some women- but it is not a cure- it only works when it is being taken. 

Which leads me to our most powerful medication for acne, Isotretinoin (commonly called Accutane). Accutane is our only cure for acne. Most people who complete a course of Accutane are cured of acne. Accutane can be a difficult medication to take due to lab testing and office visits, but it can be life changing for people whose acne is severe, scarring, resistant to other treatment or just persistent for many years. I prescribe Accutane frequently for both teenage and adult patients.

I recommend calling your dermatologist if acne is a concern for you, there are many treatment options to help you achieve clear skin!



First of all, sorry for the lack of posting in December. Like everyone, things get very busy for me with work (everyone wants to get in before deductibles roll over), the holidays and family. It was fun, but I’m glad to be back to normal.

This post is focused on a common skin condition called rosacea. There are different types of rosacea. The most common types are “papular” and “erythematotelangiectatic,” with most people having a combination of these two (either simultaneously or at different times). The least common type of rosacea is phymatous, which is charcterized by thickening of the nose and facial skin (it often involves the other types as well). So what is rosacea? I describe rosacea (which I have) as skin that has all or some of the following characteristics:

1. Tendancy to break out (you wake up with red bumps on your nose)

2. Tendancy to get red easily (blushing, flushing, with exercise, wine- pretty much anything)

3. Reacts to products easily (sunscreens, makeup, anything)

4. Your face stays red and you have blood vessels on your cheeks and nose.

Does this sound like your skin on more days than you would like? You might have rosacea.

What causes rosacea? There are many theories – in the simplest terms we think it represents an inability of the skin to react to changes or stressors. Resulting in red bumps and red faces.

Luckily we have several treatments for rosacea. Some people are able to avoid triggers (such as sunshine or wine) and control their rosacea, but most people are unable to find a specific trigger or it is difficult to avoid.

Treatments are categorized into topical (creams) and oral (pills) treatments. I find that topicals work best on mild rosacea and for maintenance, as they can take several months to get things under control (when used alone).

The most common oral medications are antibiotics. These are generally used in low dose fashion for short time periods (2 weeks to 2 months) to get flares under control. I usually prescribe doxycycline 50 or 100 mg once per day. Rosacea is not an infection but the antibiotics are used for their anti inflammatory properties.

There are several different topicals, which I either prescribe with an oral medication or alone. My favorite topicals are Azelaic Acid (brand Azelex or Finacea) and Sulfacetamide (brand Klaron, Clenia, Ovace and others).  Other topicals are Metrocream and Metrogel, which we often use first as they work well for some people and cost much less than brand name medications.  There is a newer topical called Soolantra, which is topical ivermectin. Some people will have great results with this medication, as there is a theory that rosacea can be triggered (in some people) by a kind of mite that lives on the skin (sounds gross but it’s normal). Soolantra targets these mites, called demodex.

The most common treatment in my practice is a short course of an oral antibiotic combined with a topical. This will get you clear quickly, but in order to stay clear it is necessary to continue the topical treatment (sometimes indefinitely).

For people with very severe rosacea (such as phymatous), isotretinoin (accutane) can be very effective.

I also recommend using products by Elta Md (this can be considered a natural approach too) as they are formulated for rosacea prone skin and the moisturizers (AM and PM) and some sunscreen (UV Clear) have niacinamide.

I encourage you to see your doctor if you think you might have rosacea. It is an annoying and even painful/itchy condition that can be treated. Additionally, untreated rosacea can lead to a persistently red face (because of dilated blood vessels) or an enlarged nose (phymatous rosacea)

I welcome any comments or questions.





Winter Skin

The days are shorter and there is more (lots) rain than sun in Seattle these days. Slowly I have noticed the signs of winter skin creeping in. For most people winter skin = dry skin, and mine is no exception. For those with sensitive or acne prone skin it can be a trying time- trying to keep the skin moisturized without causing irritation or acne breakouts.

Some tips that I find helpful to keep my skin looking bright and hydrated during the winter.

1. Decrease use of anti aging and acne products. Anti-aging and acne treatments can be drying to the skin. It is important to keep them in the regimen- but decrease the frequency. Alternate your washes, using a very gentle wash (I like Cetaphil gentle skin cleanser or Neocutis gentle cleanser) on most days and your more aggressive washes (anything with salicylic acid, benzoyl peroxide or hydroxy acids) only a few days per week. This gives you the benefit of the treatment washes without the irritation.

2. Change to more gentle anti-aging products. During the winter I rarely use a prescription retin-A, relying instead on a less drying retinol such as the skinceuticals retinol or Beauty Pacifica Super 3 Vitamin A or Neocutis Nouvelle (retinol).  These give the benefit (treating wrinkles and acne) of a retinol without the drying. I also rely more on peels- which give you the peeling/dryness all at once (over 3-5 days)- instead of every day.

3. Find a good moisturizer and eye cream. I need to switch to a more hydrating moisturizer during the winter. I have acne/rosacea prone skin- which can make moisturizers difficult to find. In the summer I use EltaMD and in the winter often use Neocutis Biogel or Biocream (sometimes both) for extra moisture. My skin tends to breakout with topicals that contain hyaluronic acid, but if your skin is ok with this product the can be very hydrating.

4. Take care of your hands. We often neglect our hands until it is too late. Use a good moisturizer (I like Cerave hand cream and Neutrogena Norwegian hand formula) and rub into the nails as well. Carry a non irritating hand sanitizer such as Avagard D to avoid washing hands too much and harsh sanitizers such as Purell. At night I coat my hands with vaseline and rub vaseline into my cuticles. In the winter I avoid wearing rings because I get eczema underneath- sometimes I even need to take off my wedding ring. If you get a rash under your ring in the winter it doesn’t mean you have an allergy- more likely irritation from water and eve sweat that gets trapped under the ring.

5. Wear your sunscreen!  UV light penetrates through the clouds and can be very intense when reflecting off the snow. I carry my sunglasses and hat even during the winter. When skiing make sure to apply a high SPF sunscreen every 1-2 hours.

6. Take care of your lips. I always have a little pot of vaseline with me during the winter. Be careful with deeply pigmented and long wearing lipstick as they can be very drying to the lips.

7. Hydrate your body. This is a hard one for me- I love coffee! Try to increase your water intake or at least drink one glass of water for every cup of coffee or alcoholic drink.

Hopefully these tips will help keep your skin bright and glowing during the winter months. Please share any winter skin tips that you have or winter skin products.