QUESTION 1: What helps with acne scarring?
ANSWER: When it comes to acne scarring, there are many options that can smooth out those scars, but they usually work best when used as part of a personalized treatment plan. Topical retinoids are key to use at home, as they help to rebuild the collagen especially in atrophic scars (ones that appear depressed or have a shadow). If scars are raised (so called hypertrophic scars), then cortisone shots can make a huge difference. For ice pick scars, and many types of rolling scars, I usually combine lasers with microneedling and fillers. I use lasers like the Fraxel laser to resurface the skin. Microneedling is amazing for acne scars as well. I can combine microneedling with your own plasma (the so-called Vampire Facial), or I can combine microneedling with radiofrequency energy (the Endymed Intensif). Last, chemical peels can also help to slowly even out the tone and textural changes associated with acne sequelae. (more…)
QUESTION 1: What helps with acne scarring?
Question 1: How do I get rid of cystic acne?
ANSWER: Cystic acne is usually a result of hormones, stress and diet. The cysts are deep, and often tender or even painful, and they tend to stick around for what feels like FOREVER! If you try to pop them, nothing comes out because they’re not connected to the surface. You usually end up making things worse. When the cysts resolve, they leave marks that can sometimes last for weeks or even months. Ok, enough doom and gloom. What can we do to treat or prevent cystic acne? Although the typical acne creams with retinoids and benzoyl peroxide can’t hurt, they don’t do much in cases of cystic acne. To treat cystic acne, it’s best to use a multimodal approach. First, diet and stress are key factors in this kind of acne. More on how to make some dietary and lifestyle changes that will help prevent cystic acne below. Second, many of my patients with cystic acne benefit from prescription hormonal medications such as birth control pills or a medication called spironolactone. If you’re going the birth control route, you should make sure your pill contains BOTH estrogen and progesterone. Progesterone only forms of contraception (the “mini pill,” implantable devices and even some IUDs can make cystic acne MUCH worse). Spironolactone has literally been a game changer in my practice. It’s a pill you take every day that blocks the effects of male hormones on the skin, and can dramatically clear up adult female acne. But I like to keep the doses low, and to do that, I need to make sure my patients are following the right diet and reducing their stress levels as much as possible. That’s one of the reasons I wrote The Beauty of Dirty Skin (link below). It’s easy to write a prescription, but diet and stress management is complicated! You can write chapters on those topics… so I did! Last, I like to tackle cystic acne using minimally invasive procedures in my office like cortisone injections, chemical peels and light based therapies.
Question 2: Is there anything other than Retin A, cortisone injections to treat? What preventative steps can be taken in terms of diet and lifestyle?
ANSWER: Cortisone injections can be amazing if you can get in to see a derm, but that’s easier said than done for most people! When it comes to diet, it’s essential to avoid skim milk, as this has been shown in a number of studies to trigger acne. But also beware of milk proteins that might sneak their way into your diet: whey and casein can play a major role in acne for some people, and they are commonly found in protein powders and “healthy” bars that are high in protein. High cortisol levels can also make cystic acne lesions explode all over your chin. It’s essential to start making lifestyle changes that drop those cortisol levels and keep them in a healthy range. One tip for doing that is incorporate regular exercise. Regular exercise reduces stress levels very effectively, and helps you sleep better (which in turn further reduces your stress hormone levels in your blood).
Question 3: Are regular treatments like peels or lasers something that should be considered to minimize future breakouts and/or reduce residual scarring?
ANSWER: Absolutely! My patients who can afford to get regular peels and light based therapies see a huge difference in their skin FAST. Salicylic acid chemical peels combined with Theraclear (also called Acleara) light treatments are incredibly effective and work FAST. In my practice, I use a number of lasers and devices to improve acne scarring and minimize pore size, including Fraxel, Endymed Intensif and Microneedling. However, these treatments can be costly and those costs can add up. Even without these therapies, if you use the right skincare products and make certain lifestyle changes (detailed in my book – The Beauty of Dirty Skin), you can achieve beautiful, radiant skin on any budget!
I wanted to share more insight into the food swaps for beautiful, clear skin that I discussed on GMA!
As I discussed on Good Morning America, a number of studies are now showing that if you drink dairy milk, you will be more likely to struggle with breakouts and acne. We believe this issue arises from a combination of hormones that are found in the milk as well as milk proteins like casein and whey. Skim milk has actually been found to show the STRONGEST link to acne flares.
SIMPLE SWAP #1:
Instead of SKIM MILK, choose ALMOND MILK OR COCONUT MILK. Both are low in calories and are delicious!
Whey Protein Dietary Supplemnents:
As I also mentioned on GMA, the vast majority of protein powders and nutritional bars are made with whey protein, which has also been shown to contribute to inflammation and acne in the skin. Many of my friends and even my family members drink shakes containing whey protein daily as part of their meal plan! However, many athletes who use whey powder in their shakes or eat protein bars made with whey are finding that they are breaking out on their faces, chests and back.
SIMPLE SWAP #2:
Instead of WHEY PROTEIN SUPPLEMENTS, opt for VEGAN OPTIONS. Many of the companies that make these dietary supplements now offer vegan alternatives which do not contain whey. Look for pea protein or rice protein!
If you are breaking out, you want to make sure to avoid refined carbohydrates like white bread, cornflakes, chips and pretzels.
SIMPLE SWAP #3:
Instead of REFINED CARBS, choose QUINOA, BARLEY or SWEET POTATOES. These choices are great for your skin and for your waistline!