Krauss Dermatology

Madeline Krauss, MD

1 Washington Street, Suite 401, Wellesley Hills, MA 02481 | Tel: 781.416.3500

Archive for February, 2011

The “A” Word: Treatment of Teen Acne

Friday, February 25th, 2011

Often at the completion of a skin check or other dermatologic visit, a patient will say, “Before you leave, I just want to ask you one thing about my 12 (13,14…) year old.” Parents are naturally concerned about the adolescent transformation of their young teen. Part of this transformation for most children, is that disturbing rite of passage, acne. Blackheads, whiteheads and pimples begin to erupt.

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Blackheads are commonly seen in adolescent acne.

For some there are subtle breakouts over the T-zone (chin, nose and forehead) only. For others the changes are more dramatic, and can lead to scarring of the face, chest and back.  If the acne lesions are painful, large, or resolve leaving behind a pitted or discolored area, or if there is extensive involvement of the face, chest or back, it is time to see the doctor.  Some pediatricians are adept at treating acne, particularly of the mild to moderate variety. A dermatologist, however, can provide a full array of treatment for mild acne all the way to severe scarring acne. If acne is mild, as it is for most teens, a trial of over-the counter acne medication is in order.

The least irritating treatment is a wash that contains salicylic acid (such as Olay Total Effects Cream Cleanser with Blemish Control or Neutrogenal Oil-Free Acne Wash). This helps unclog pores which prevents the formation of pimples and comedones (black heads and white heads). Start the wash and wait at least 1 week before adding a second treatment to assess if your child is allergic to the active ingredient, salicylic acid.

Week 2 add a cream containing benzoyl peroxide (BP). BP kills bacteria and decreases inflammation in the follicle where acne pimples form.  Creams that contain 10% BP are very harsh and irritating and work no better than creams containing a lower percentage. Try to find a product containing 2.5% to 5% benzoyl peroxide.  Apply a small amount of BP product to the entire acne prone area, not just active pimples, once per day (try Neutrogena On-the-Spot Acne Treatment or Proactiv Repairing Treatment lotion).   Keep in mind that BP can bleach clothing and bedding, so white pillow cases and towels are recommended. About 5% of people are allergic to or irritated by benzoyl peroxide, so if the skin becomes red, itchy or swollen, stop the cream immediately. Pregnant women should not use any over-the-counter or prescription acne medication without first consulting their doctor.

Combination of pimples and whiteheads in moderate acne.

It takes a full 2 months to see the improvement from any acne treatment, even the strongest oral therapy. So patience is the key here. At the 2 month point, if the skin still has multiple pimples, blackheads or whiteheads, prescription medication is the next step. Topical medications include creams that are made of Vitamin A derivatives to unclog the follicles. These include the topical medications adapalene (Differin), tretinoin (Retin-A) and tazarotene (Tazorac). Prescription washes that contain a blend of sulfacetamide and sulfer can also be helpful in killing bacteria and decreasing inflammation, as can gels containing antibiotics such as clindamycin or erythromycin. Again, 8 weeks are necessary to see results.

Once the topical treatments have been exhausted, oral medications may be necessary for persistent acne. Oral options include antibiotics, hormonal medications for women (such as birth control pills) and finally the oral Vitamin A derivative isotretinoin (Accutane). The risks and benefits of all of these options should be reviewed with a knowledgeable dermatologist.

Acne is largely genetic, and is also affected by hormones, hence its appearance and persistence throughout puberty, and sadly reappearance during early menopause. It is important to understand that foods do not cause acne. Though it may be tempting to tell your teen that french fries and donuts cause their acne, that isn’t the case. Some moisturizing creams and sunscreens can, however, make acne worse. Make sure all products used on the skin have the words “non-comedogenic” or “oil free” on their label. Moisturizers are often necessary to counteract the dryness from the acne treatment medications. Good non-comedogenic choices are Neutrogena and Cerave moisturizers.

Although facials and glycolic peels may be helpful in some patients, they do not replace the need for evaluation and the prescription of appropriate medications. Likewise the Smoothbeam Laser is used in our office for acne resistant to medications, or patients that are unable to tolerate oral medications, as well as for acne scarring. However, we recommend this laser only after optimal treatment with prescription medication is instituted.

Don’t wait until scarring sets in to have your child’s acne treated. Acne treatment is a process. It may take months to come up with the best treatment while minimizing the potential side effects of acne medication.

Madeline Krauss, M.D.

 

First Krauss Dermatology Post- How to Battle Dry Winter Skin

Friday, February 25th, 2011

Welcome to our new blog! We hope to answer the commonly asked questions by our patients. Hopefully with these tips and advice, we can make your skin healthier and perhaps even save you a trip to the dermatologist!

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The skin of the shin is often the driest on the body.

For our first blog entry we will try to help you solve one of New England’s most difficult problems. How to help the dry, itchy skin of winter. Dry skin is not only uncomfortable, unsightly and extremely common, it can also become inflamed leading to dermatitis (eczema) and can even become infected. But have no fear, there are simple and inexpensive ways of improving your scaly epidermis.

The skin resembles the "craquelae" finish used in porcelain.

First, identify the problem. Dry skin begins to resemble the craquelae finish of a porcelain vase.Often this is accompanied by itch in the area. The first step is to use a fragrance free moisturizer every day immediately after you get out of the shower and bath. Good choices are Cerave lotion , or Cetaphil Restoraderm . In addition, the use of a moisturizing body wash (also made by Cerave or Cetaphil Restoraderm) in the bath or shower can prevent the irritation and dryness caused by many soaps. Very dry skin is more prone to allergic reactions to products, so avoid fragranced lotions and cleansers. Do not scratch, as the injury to the skin and the bacteria on your hands and under your nails can encourage infection.

If you still have dry itchy areas despite the above regimen, apply 1% hydrocortisone ointment (not cream!) to the area twice a day. Although ointment is greasy, the petrolatum in the ointment will help heal and treat the skin and allow better penetration of the hydrocortisone which will stop the inflammation which is causing the itch. If itch continues to be an issue, an oral antihistamine such as Benadryl can help stop itch and help sleep when taken before bed. If itch is an issue during the day, try Zyrtec in the morning. This over the counter antihistamine does not cause the drowsiness that Benadryl does.

Dry skin resistant to basic moisturizers can resemble the shell of an armadillo.

So now you are better, but somehow that scale on the legs is still visible no matter how much moisturizer you use, resembling the plates of an armadillo.Ask for Amlactin Lotion at the pharmacy desk. This over-the-counter lotion contains lactic acid. It dissolves the dead skin accumulating on the surface and makes the skin a better barrier to moisture loss. Be careful not to get Amlactin in open, scratched skin as it will cause a really uncomfortable burning sensation.

If all of this has failed to improve your skin, a visit to the dermatologist in order. You may have a different cause for your itching such as a fungal infection (ringworm), bacterial infection (impetigo) or other condition.  Other clues that you should see your doctor right away are pain, swelling, or fever.

Madeline Krauss, M.D.