Acne

When people delay taking care of their skin, they can often end up with skin that is more difficult to treat. If you do not treat acne in its early stages, some patients may scar. Scarring is often more common in people who pick at their skin. Another result of delayed treatment is dark spots, especially in people of color. Even with proper care, these spots can take many months to become like your normal skin. Effective treatment for acne commonly takes time, even many months, so you must be patient.

Your hormones, your family history, and your stress levels are the main causes of your acne. Diet seems to play a minor role, though if you repeatedly notice breakouts after a certain food you should eat less of that food. Some foods that may play a role in acne include dairy products, milk, chocolate, nuts, seafood, greasy foods, and French fries. Our physician, who treats many professional athletes, also notes that keeping an area covered by clothing such as a hockey helmet or football chin strap, or taking certain steroids, or heat and sweat can aggravate acne.

While decades ago acne was generally limited to teenagers, for unknown reasons, currently acne often begins for the first time in patients in their 20’s or even their 30’s, and especially in women. “But I never had this as a teenager”, is a common lament that we hear.

Fortunately, many treatments can help control acne and often even keep it away or possibly cure it for months to years. If your acne is mild, often all you may need are over-the-counter treatments such as 5% benzoyl peroxide. For more stubborn pimples, topical creams such as vitamin A preparations and topical antibiotics, prescribed by a dermatologist, can generally help.

When your acne is bumpy, leaves scars or dark spots, affects you emotionally, or physically hurts, that’s when you need additional help from a board-certified dermatologist. With deeper bumps, otherwise known as cysts or nodules, the acne is causing inflammation deep within the skin. With these patients, topical creams cannot penetrate deep enough into the skin and thereby are often not effective by themselves. You will frequently need prescription medicines taken by mouth. Often these medicines need to be given for weeks or months at a time, but if the acne persists the oral medications may need to be used longer. Antibiotics are most commonly used, but sometimes patients require hormonal treatments such as the birth control pill or injections with a minuscule amount of cortisone.

Dark spots commonly affect people of color and can take months or longer to go away. Treatments include bleaching creams, sunscreens, vitamin A preparations, and exfoliating peels. Of course, your underlying acne must be controlled or else new spots will form. We recently treated a woman whose acne and dark spots were so active she refused to go out socially. With treatment, her skin has improved to where she no longer feels self-conscious. She now feels comfortable dating.

So there is little reason to suffer from your pimples, zits, and breakouts. A visit to our office to see our board-certified dermatologist could often help even the most stubborn conditions. Don’t delay!

Our dermatologist has been quoted about acne in major daily New York City newspapers such as the Daily News and the New York Post

Spironolactone is a medication that is used primarily for the treatment of high blood pressure. However, for many years it has been used to treat acne and excess hair growth in women because of its ability to block the effects of certain hormones (testosterone). By blocking the effect of these hormones, spironolactone reduces oil gland secretion, which helps prevent acne, and reduces hair growth on the face. This medication can only be used in women and is recommended for women whose acne is largely hormonally controlled.

The optimal dose of spironolactone varies in different individuals and may require some adjustment. The beneficial effects can usually be seen within two or three months, but frequently within one month. With over 25 years of use, this drug has been quite safe. Serious side effects are extremely rare, but there are some nuisance side effects that you should be aware of: the most common side effect is irregularity of menstrual cycles, which, if you are taking birth control pills, should be minimal. Mid-cycle spotting, early periods, or longer periods can be seen.

Since spironolactone has diuretic properties, there may be a “water-pill” effect during the first week. This is what causes a slight lowering of the blood pressure. It is important to prevent dehydration if you are active in sports and exercises. Adequate fluid intake should prevent light-headedness.

Some people have experienced fatigue, breast tenderness, nausea, and decreased sex drive, but these occur infrequently. Hormonal treatment of acne can be associated with darker pigmentation on the face, which is accentuated by sun exposure.

You must not get pregnant while on spironolactone. If you accidentally do, you must stop your medication immediately and notify our office and your gynecologist.

Spironolactone causes your potassium level to increase; it is important to avoid excessive eating of bananas and citrus fruits, orange juice, etc. However, these foods do not have to be eliminated. It is recommended to check your blood potassium level after one or two months of therapy, depending on your dose.

CONCLUSION:  Spironolactone can be quite effective in the treatment of acne in women and is generally well tolerated. If side effects develop, the dose can be adjusted to a more tolerable dose. Whether spironolactone is helpful or not can usually be determined within two or three months of therapy.