COVID-19 Niagara Dermatology Notice/What you need to know. COVID-19

    ACNE

    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.

    A blister is a soft area of skin filled with a clear fluid. Blisters may form in response to an irritant. Frequently, the blister is caused from friction, such as a coarse fabric rubbing repeatedly against a person's skin. In other cases, blisters form in response to a chemical or allergic irritant, which is known as contact dermatitis. Some oral and topical drugs may cause blisters to appear. Blisters can also be symptomatic of bacterial or viral skin infections, such as cold sores, chicken pox, shingles, impetigo or ringworm. Lastly, blisters occur when the skin is exposed to a flame, comes in contact with a hot surface or is overexposed to the sun.

    Most blisters do not require medical attention. The most important information to remember is never to pop or break open a blister. A blister acts as a protective covering for damaged skin and helps prevent infection. If a blister does open on its own, be sure to leave the covering in place to support further healing. Simply wash the area gently with mild soap and water, pat it dry and apply an antibacterial ointment. Cover the blister with bandage to keep it clean. Replace the dressing at least once a day. Watch for signs of infection, such as a white or yellow pus coming from the blister, redness or red streaks around the blister or an increase in skin temperature around the blister.

    To avoid blisters, you need to eliminate the irritant. Some simple ways to avoid blisters are to avoid tight clothing, make sure socks and shoes fit properly, and when doing heavy work with your hands, wear work gloves.


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    5320 Military Road Suite 104
    Lewiston, NY 14092 (Main office)