Acne is a skin disease that occurs in conjunction with the rise in hormones associated with puberty. Poor hygiene is not linked to acne. Also, studies have failed to produce a link to certain foods. Many people will find stress as a trigger of acne flares, probably due to a surge in adrenal hormones, which are released to handle stress. Often, people who are stressed do not eat well, which may be the link we notice to increase consumption of "junk food."

What leads to acne is a blockage in the pore (opening in the skin), which allows the oil created in the oil gland to travel up the oil duct and be released onto the skin for lubrication. If the blockage occurs close to the surface of the skin, a blackhead (open comedone) results; if a little deeper, a whitehead (pustule) occurs. Cysts occur when the blockage is deepest in the skin. These are red, tender, boil-like lesions and may never come to a head. Also, these are the only lesions that will scar without a person picking them. For this reason, this type of acne is treated more aggressively often, with oral medication.

A major contributing factor to acne is the bacteria, Propionibacterium acnes (p. acnes) which feed off the oil behind the blockage. P. Acnes breaks the oil into substances which cause inflammation. Inflammation leads to rupture of the oil duct with spillage of the contents into the flesh, which causes further inflammation. White blood cells come to the area to clean the spill up and it is the large numbers of white blood cells we see as pus or a whitehead.

Four main contributing factors occur in acne. Hormones (stress induced and sexual), bacteria, pore blockage, and inflammation. Genetics also play a key role in susceptibility to acne. Let's explore these factors other than genetics, which we can't change (at least for now).

In the vast majority of acne sufferers, the level of hormone is normal. People with acne just may be more sensitive to normal levels of hormones. Only if a person has other signs of hormonal imbalance, such as early onset of puberty, growth abnormality, or menstrual irregularities, are hormonal studies performed.

For many females, if a strong relationship exists to the menses, certain birth control pills, which have an anti-male hormone effect, are beneficial. Females naturally have male hormones (androgens) in low levels.

Bacteria may be controlled by both topical (placed on the skin) and oral agents. Benzoyl peroxide is a good general antibacterial agent which is found in both OTC and prescription products, in both leave-on products and washes. Benzoyl peroxide may cause dryness and is available in many different strengths. Prescription products often include antibiotics-benzoyl peroxide is added to prevent bacterial resistance. Oral antibiotics are used when acne is widespread, cystic or unresponsive to topical measures.

Blue light is a novel treatment to treat acne. Interestingly, P. acnes makes a substance called a porphyrin-which is a photosensitizer. This chemical, when exposed to the visible wavelength of light, which is blue, kills the P. acnes bacteria. This treatment is given in a series of eight treatments, ideally, twice a week. Unfortunately, many insurance companies do not cover this treatment, at this time. Atlantic Dermatology LLC is able to offer this innovative technology.

Retinoids, derivatives of Vitamin A and Azelaic acid, help prevent plugging of the pores. Examples are: Retin A, Differin, Tazorac, and Finacea. Salicylic acid, found in many OTC products, helps to dissolve plugs.

The cycline group of antibiotics, which include Tetracycline, Doxycycline and Minocycline, are used for their anti-inflammatory as well as antibacterial effects. In severe cystic cases, oral steroids, such as Prednisone, are used to suppress the production of androgenic hormones as well as to suppress inflammation.

Accutane, a derivative of Vitamin A, is reserved for the most severe cases of acne. Serious complications occur in approximately one in ten thousand patients. This medication requires monthly physician visits and blood work. Accutane is much safer than large doses of Vitamin A. No amount of Accutane is safe in a pregnant female and will cause severe birth defects in the baby.


Warts are a common viral infection. They are unsightly and can be painful depending on location. In immuno-suppressed persons, the wart virus has been linked to the increased rate of squamous cell carcinoma of the skin. Certain strains of wart virus are associated with cervical cancer. Wonderfully, a new vaccine is available to administer to children to prevent this potentially fatal infection. This is available through many pediatricians.

Treatment of common warts is still in the dark ages. No oral medication is available to treat warts. Methods of treatment involve ways to physically remove the infected cells.

OTC products include salicylic acid, which is a keratolytic, a substance that helps to dissolve the outer dead layer of the skin. Salicylic acid is available in band-aid form and paint on products. The salicylic acid is applied after shower or bath and left on until the next bathing. An emery board is useful to remove the softened callous prior to reapplication of salicylic acid. Those who have impaired sensation, such as diabetics, must be very careful if this method is chosen.

Occlusion with tape, such as duct tape, has been reported to be occasionally successful and can be combined with salicylic acid to help soften the warts.

Warts may be responsive to the placebo effect-which is, if the patient believes something will work, it will. So, as long as so and so's treatment isn't painful, harmful or expensive, go right ahead; however, you must believe!

When my son was young, we were in church on Christmas Eve. I was holding his hand. To my dismay, I found that he had a big wart. Two weeks later, I told him we better go down to my office and take care of it. When I looked for it, the wart was gone, without a trace. What may have happened was his immune system finally kicked in and rid him of this viral infection, or it could have been me rubbing his hand in church on Christmas Eve. You choose!

Aldara is a prescription medicine in cream form, which is used to increase the production of interferon, part of the immune system, in the skin. Basically, Aldara stimulates the immune system to help get rid of the viral infection. It is used in large, multiple or recalcitrant warts, by itself or combined with other modalities.

Cryosurgery, in the form of liquid nitrogen, is the most common in-office treatment for warts. Usually, it is done without anesthesia. Topical anesthetic may be applied after treatment to lessen the discomfort. OTC cryosurgery is available. This does not achieve the same degree of coldness as liquid nitrogen and may be difficult to judge how long to treat oneself.

Warts may also be removed by burning, which does require a local anesthetic. Usually, a scar is left after the area heals. However, this may be the best choice when warts are particularly large, usually requiring fewer visits for eradication of the warts.

Fortunately, even though it may seem a person will never "outgrow" warts, they usually do resolve with a combination of perseverance, treatment and the immune system.



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