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    Acne is an inflammatory condition of hair follicles that is prompted by occlusion (clogging) of pores.  Treatments are thus directed at opening the pores and controlling the inflammation.  Acne is stimulated at puberty when increased oil production occurs under hormonal influence (particularly androgens such as testosterone).  Oil leads to occlusion and is a source of nutrients for bacteria that live on the skin.  When the bacteria feed on the oil they break it down into factors that cause inflammatory cells to migrate into the follicle.  Understanding these processes will help you understand the basics of acne treatment. 

    Treatments for follicular occlusion (clogged pores).  Follicular occlusion leads to whiteheads and blackheads.  Factors affecting this include oil production and a build up of dead skin cells around the opening of the follicle (the pore).  Treatments include keratolytics that break up these dead skin cells such as the common over-the-counter treatments benzoyl peroxide, salicylic acid, and glycolyic acid.  Treatments that break up oil include various cleansers.  The gold standard for treating follicular occlusion are the Vitamin A-derived topicals called retinoids.  Retinoids both decrease oil production and decrease the stickiness of dead skin cells around the pore.  Retinoids can be either over-the-counter topicals such as adapalene 0.1% or prescription topicals such as higher strength adapalene, tretinoin or tazarotene.

    Treatments for inflammation.  Anti-inflammatory strategies include antibiotics to decrease bacterial presence on the skin as well as products that work directly to inhibit inflammatory pathways.  Antibiotic therapies include many topicals such as the facial cleansers as well as benzoyl peroxide; prescription topical antibiotics include clindamycin, erythromycin, and azelaic acid.  Products that inhibit inflammation directly include the prescription topical dapsone.  When inflammation is severe, oral antibiotics are often considered.  The most common class of oral antibiotics is the tetracycline family which includes doxycycline and minocycline; tetracyclines are both anti-bacterial and have an ability to inhibit inflammatory pathways directly.

    Severe cases of acne: In cases in which the standard therapies have failed to control the severest form of acne (nodulocystic), isotretinoin, an oral retinoid commonly known by its previous brand name Accutane, can be considered.  Because of the many potential side effects of this medication, this drug should only be prescribed by the professionals in a dermatology office.

    Other strategies:

    spironolactone and certain oral contraceptives (OCPs) for women:  these reduce levels of pro-acne testosterone; these agents are particularly helpful for women who have acne in the beard area and who have pre-menstrual flares

    photodynamic therapy (PDT) (Blu-U): PDT can decrease oil production in the skin and appears to kill bacteria as well; it is used for moderate to severe acne

    As always, you can contact our office to answer any questions or concerns.

    There are literally hundreds of different kinds of lumps, bumps and cysts associated with the skin. Fortunately, the vast majority of these are harmless and painless. The chart below provides a guide for some of the most common forms of skin lumps, bumps and cysts.



    • Red, brown or purple growth; generally benign
    • Usually found on arms and legs
    • Feels like a hard lump
    • Can be itchy, tender to the touch and sometimes painful


    • Usually does not require treatment
    • Most common removal by surgical excision or cryotherapy (freezing it off with liquid nitrogen)

    Epidermoid Cysts (Sebaceous Cysts)


    • Round small bumps, usually white or yellow
    • Forms from blocked oil glands in the skin
    • Most commonly appear on the face, back, neck, trunk and genitals
    • Usually benign; occasionally leads to basal or squamous cell skin cancers
    • If infected, will become red and tender
    • Can produce a thick yellow, cheese-like discharge when squeezed


    • Antibiotics might be prescribed if there is an underlying infection
    • Dermatologist removes the discharge and the sac (capsule) that make up the walls of the cyst to prevent recurrence
    • Laser surgery may be used for sensitive areas of the skin, like the face



    • Red pimples around areas having hair
    • Inflammation of the hair follicles
    • Caused by infection or chemical or physical irritation (e.g., shaving, fabrics)
    • Higher incidence among people with diabetes, the obese or those with compromised immune systems


    • Topical antibiotics
    • Oral antibiotics
    • Antifungal medications
    • Eliminating the cause



    • Red, dome-shaped, thick bumps with craters in the center
    • Abnormal growth of hair cells
    • Triggered by minor skin injury such as a cut or bug bite
    • Ultraviolet radiation from sun exposure is the most common risk factor


    • Cryotherapy (freezing off the bump with liquid nitrogen
    • Curettage (surgically cutting out or scraping off)

    Keratosis Pilaris


    • Small, rough white or red bumps that neither itch nor hurt
    • Usually worse during winter months or when there is low humidity and the skin gets dry


    • Usually does not require treatment
    • In most cases disappears on its own by age 30
    • Intensive moisturizing is the first line of treatment
    • For more difficult cases, use of medicated creams with urea or alpha-hydroxy acids



    • Soft fatty tissue tumors or nodules below the skin's surface
    • Usually slow growing and benign
    • Appear most commonly on the trunk, shoulders and neck
    • May be single or multiple
    • Usually painless unless putting pressure on a nerve


    • Usually does not require treatment unless it is compressing on the surrounding tissue
    • Easy to remove via excision



    • Soft fleshy growths under the skin
    • Slow growing and generally benign and painless
    • Pain may indicate a need for medical attention
    • May experience an electrical shock at the touch


    • Usually does not require treatment, particularly if it does not cause any symptoms
    • If it affects a nerve, it may be removed surgically

    Skin Cysts


    • Closed pockets of tissue that can be filled with fluid or pus
    • Can appear anywhere on the skin
    • Smooth to the touch; feels like a pea underneath the surface
    • Slow growing and generally is painless and benign
    • Only needs attention if it becomes infected or inflamed


    • Usually does not require treatment; often disappears on its own
    • May need to be drained by a physician
    • Inflamed cysts respond to an injection of cortisone, which causes it to shrivel

    Questions or Comments?
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    Lewiston, NY 14092 (Main office)