Acne Treatment - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Acne Treatment or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Acne treatment is among the most common treatments performed at our practice. Fortunately, there are various ways to treat acne effectively. Using experience, knowledge, medication, and technology, we treat acne aggressively to deliver the best results possible.
Photodynamic therapy and medication (e.g. Accutane) are most effective for the treatment of severe acne. Medications, facials, and laser treatment with PDL (Pulsed Dye Laser) are the most effective treatments for moderate acne. Mild acne is best treated by a combination of facials, chemical peels, and microdermabrasion.
|mild acne||moderate acne||severe / cystic acne|
|Pulsed Dye Laser||-||+++||++|
Effective at least as Accutane!
Prefer to take no medication? Photodynamic therapy is your best option!
Effective treatment often requires the combination of different modalities to treat all components that cause acne. For best and fast results, medical treatment or photodynamic therapy should be supported by various procedures.
Medical extraction facials, salicylic acid peels, and microdermabrasion open up the microcomedones, the starter lesions of all acne. Glycolic acid products and peels also diminish pigmentation from past breakouts.
|mild acne||moderate acne||severe / cystic acne|
|time||1-2 months||2-4 months||4-6 months|
Topical medical treatments target several components of acne and are usually used to prevent acne breakouts.
When acne is very severe and scar formation is impending, photodynamic therapy or systemic treatments are indicated.
|Photo-dynamic Therapy||Medi-cations||Acne Facial||Acne Facial Extraction (*)||Chemical Peels||Micro-derma-brasion||Pulsed Dye Laser||Smooth-beam laser|
|# of treatments||4-6||NA||2-6||2-6||3-6||3-6||3-4||3-4|
|Price per treatment||$650||varies||$98||varies||$100,$500/6||$120, $600/6||$250||$250|
|Insurance Coverage (**)||no||yes||no||yes||no||no||no||no|
(*) A prior medical consultation and an explicit recommendation by the medical provider (not by an aesthetician) is required. Please check the specific rate, your deductible, coinsurance, and co-pay on this procedure with your insurance using ICD9 code 706.1 and CPT 10040.
(**) Copay and deductable might result in out-of-pocket cost
|Medicine||Laser/light device||Nutrition||Other supportive treatment|
|Overgrowing skin clogging oil ducts||
|Hormone regulation+ response||
Appearance is important at any age yet undoubtedly it seems most important in your teenage years and in young adulthood. You are at the prime of your life in a time to form relationships and build your career. A flawless look is most desired during an interview or on your date. It seems unnatural that nature poses the extra burden of acne during this time, as if it wants to test your self confidence.
While some deal with acne very naturally, most people with blemishes, pimples, zits, painful cysts, dark marks and even scars from past breakouts have a significantly lowered self-esteem. They feel insecure, may not want to go out, develop depression, Many engage in activities that distract them from their ailment which can be positive but unfortunately also negative.
Despite the common factors that cause acne, everyone’s expression of acne is unique. Acne needs different treatment on oily skin compared to dry skin. Many people have so called “combination” skin. Therefore treatment must be customized to each person. Care must be taken to avoid over drying of the skin as many prescription acne medicines tend to be formulated in drying rather than emollient bases. Medical treatment should be supported effectively by general skin care such as the use of very gently exfoliating cleansers (not scrubs), sunscreen that do not clog pores and moisturizers when necessary.
Targeting acne from only one angle may work when acne is extremely mild or just beginning. Customized treatment usually targets multiple causative factors. Retinoids promote proper turn-over of the skin, thereby unclogging the oil duct; acne facials unclog the oil duct and facilitate proper drainage of the oil gland and remove the bacteria infested content. Oral antibiotics and the pulsed dye laser reduce the inflammatory response. The Smoothbeam laser destroys oil glands. Topical and oral antibiotics reduce acne-promoting bacteria. Spironolactone and oral contraceptives help regulate hormonal levels or reduce the available androgens in women. Topical antiandrogens that can be used in men are still under investigation. Please see table below for more detailed information.
The severity of acne can depend on our emotional well-being. Emotional distress can worsen many conditions. Hence, if you have acne stress can break you out more. This is not an imagined response; in fact stress increases your androgen levels and androgens turn up oil production. Effective relaxation techniques may be learned. Sometimes a simple exercise program is all it takes. Yoga, meditation or biofeedback techniques can be extremely beneficial.
Reestablishing your balance should be a major effort on the road to healthy skin and will include paying attention to a well balanced diet. Under certain circumstances it can mean going back to basics such as eating raw foods or avoiding dairy, refined carbohydrates, cooked fat and meats. Hormone production is tweaked by alkaloid caffeine found in coffee or black tea and its cousin theobromine in chocolate. Hence avoiding these compounds may be necessary in more difficult to tackle acne or if you notice increased breakouts after ingesting these substances.
A number of fruit and vegetables are said to reduce acne such as mangos, rhubarb, dark berries, papayas, olives, watercress, fennel, garlic, celery, parsley, wild greens, salad leaves, avocado, olives, flaxseeds, alfalfa, Brazil nuts, pumpkin seeds , oats.
Hello, I have three recent small dark spots on my face due to acne that’s healed…what is the best treatment for it?
If you are prone to making dark marks in response to acne breakouts, you should consider prevention and treatment.
1. Prevention: Please see your dermatologist to help you control your acne until it naturally stops. This includes topical or oral medicines as well as a supportive skin regimen with sun protection. Response is achieved in 2-4 months with occasional adjustments along the way.
2. Treatment: Apply benzoyl peroxide or sulfa spot treatment for a break through pimple 5 times a day for 3 days in a row. On day 2, start applying a fading agent with Q-tip twice daily. This should not be at the same time as the spot treatment. Be extra diligent with sun protection n the newly inflamed spot.
Hello, Dr. Ringpfeil, I am a 50 year old woman with rosacea and history of cystic acne with Accutane use as 22 year old (which yielded phenomenal results for 15 years afterward). My rosacea has led to a mildy “bumpy, roughened, slightly reddish” skin texture with very large pores but then in my mid-40s I began experiencing adult hormonal acne with mild-moderate cystic acne again forming (depending on time of month), this time on chin/jawline/chest. After failing to find improvement with antibiotics, topicals, I found improvement with spironolactone. The problem is that spironolactone 50 mg caused profound vertigo, so I switched to 25 mg, vertigo got better but now I have ringing in my ears that I fear is due to the spironolactone as I have stopped any other medications. I feel like I have 2 options- low dose accutane (but I have dry eye from ocular rosacea so I’m worried about drier eyes) or IPL. If I try IPL, I have read (and my ophthalmologist agrees) that it can also be used for improvement with ocular rosacea- does your office treat around the eyes for ocular rosacea? I’d love to have one treatment that could help both my acne and my dry eyes.
Low dose isotretinoin does not increase dry eyes with rosacea. It fosters natural skin turnover and often improves all symptoms associated wit rosacea, including the swelling of the Meibomian glands which inhibits proper secretion of fluids onto the cornea. We treat rosacea with IPL and PDL. We use neither directly on the lash line due to their possible side effects on the retina. However, treatment of skin often improves eye symptoms indirectly.
Hi, I have moderate/severe acne right now and I’m also seeing a dermatologist where he prescribed me doxycycline to take but it seems like the acne is only under control if I’m on medication. I’m wondering if I have to take the medication but can still get the treatment here?
You can be on doxycycline and receive photodynamic therapy. However, longterm treatment with doxycycline is not favored. In our practice, we rarely extend treatment of acne with doxycycline beyond 3 months due to the possibilty of side effects on the gut and the way our body might handle infections. If acne is only controlled on an oral antibiotic, isotretinoin, photodynamic therapy or spironolactone (in women) must be considered.
How would you recommend treating pimples which are under the skin? I believe it is milia. They are not painful. They do not come to a top. They can be felt under the skin.
Milia are clogged sweat ducts that show as minute firm white bumps in the skin. Pimples under the skin that do not come to a surface can be cysts of varous origins. I recommend evaluation by a dermatologist to confirm a diagnosis and learn about a suitable treatment plan.
I’m suffering from cystic acne and was wondering if your practice offers cortisone shots along with other treatments?
Absolutely. Cortisone shots as well as intense benzoyl peroxide treatment shrink cysts quickly, and we typically offer short-notice injection appointments (except weekends) to our patients. We strongly encourage evaluation for treatments that prevent cystic acne. Please set up a new patient consultation with one of our dermatologists.
I have either an enlarged pore or ice pick scar, either way it’s a deeper “hole”. I’ve been to several places and they always recommend microneedling which has helped slightly. I was wondering if TCA CROSS would be a better option and what it would cost for treatment on one spot? I am fair skinned. Thank you.
If the enlarged pore or ice pick scar is in a concave area of your face, TCA CROSS might be a great option. Please schedule a consultation with me to learn about your options. Cost of TCA CROSS in a small area is around $150.
Hello, I’ve been trying to figure out the cost of Accutane, so that I can plan my finances. How much does a prescription generally cost without insurance? I have insurance, but I just want to know what percentage I would have to pay, based on the initial cost.
Most non-chain pharmacies charge $500 per months but there might be one that charges a bit less. Chain pharmacies like Rite Aid and CVS have a much higher upcharge.
What is/are the treatment options for blind pimples? Home remedies haven’t worked!
Apply topical benzoyl peroxide, e.g. Neutrogena on the spot available in most drugstores, 5 times a day for 5 days in a row. If you cannot commit to this, start when you can. Please be aware that benzoyl peroxide bleaches fabric and take necessary precautions. If the blind pimple does not resolve with this, please make an appointment with your dermatologist.
Hi! I have moderate hyper-pigmentation/scarring on my shoulders from back acne. The pimples have ceased but the scarring remains. Do you offer treatment for that?
Yes, we do. Please set up a consultation.
Female in my 20’s. I have ice pick scarring from past acne what kind of treatment would you suggest?
Ice pick scars can be treated with TCA CROSS technique in fair skinned individuals. When skin has a Mediterranean or darker hue, treatment is very limited. Picosecond lasers provide some help but results do not equal that of TCA CROSS.