Acne and other common skin problems

Additional Information

Acne is a common skin condition that, although not physically disabling, has a significant impact on depression, low-self esteem, and anxiety (Graber, 2017). As tempting as it might be, avoid squeezing pimples! The scars and hyperpigmentation left behind can be lifelong.
Stress, family history, hormones, and lack of exercise can all contribute to acne. However, the main contributor is a bacteria called Cutibacterium, which thrives in sebum produced by sebaceous or oil glands.

There are three clinical stages of acne, which are important to determine before advising a specific acne treatment plan.

1) Comedonal (non-inflammatory) acne or mild papulopustular (whiteheads) and mixed comedonal (blackheads) : 
2) Moderate papulopustular and mixed acne
3) Severe acne (eg, nodular acne or cystic acne). 


The steps toward acne treatment may include combinations below

1) Medications. Keep in mind, certain medications can contribute to acne, such as glucocorticoids, phenytoin, lithium, isoniazid, androgens (Graber, 2017). 
2) Regular face washing morning and night with a good cleanser, such as DermNurse Salicylic acid wash or ZO Oilacleanse, is the foundation to improving acne. 
3) Wear less make-up or make-up that is non oil based
4) Exfoliating with ZO Glycogent or DermNurse AHA clarifier product
5) Birth control pill for female clients. Acne can flourish under androgen hormone excess such as high testosterone or estrogen levels. If you also suffer from menstrual irregularity and facial hair you should get your blood checked to rule out underlying health issues contributing to your acne. 
6) Red and Blue light laser therapy
7) Topical Retin A such as ZO Retamax or prescription Retin A. Not recommended for women who are pregnant or breastfeeding. Cream applied in a thin layer at night (avoid eyes and mouth) after washing and drying face. Alternatives to Retin A include azelaic acid and salicylic acid (Graber, 2017). 
8) Benzoyl peroxide 
9) Topical antibacterial prescription gels such as Biacna or Clindoxyl gel
10) Oral antibiotics such as Minocycline or Aprilon 
11) Accutane or Isotretinoin. This is the last resort solution for acne because it can have multiple adverse effects and is highly teratogenic (harmful to fetus). It works by shrinking sebaceous glands and reducing sebum secretion. You can not be pregnant or breast feeding while taking this medication and it is mandatory for females to be taking a reliable form of birth control. Your liver function will be assessed regularly, via blood tests, to ensure this medication is not harming your liver. 

DermNurse has been treating acne in Calgary over the last 10 years and is passionate about treating this common skin problem.

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How to apply acne medication to your skin 

Other Common Skin Problems

Milia

These are small raised multiple cysts (pearly white bumps) containing keratin (skin protein) and can be present in all ages. Usually seen on the eyelids and cheeks. 

Treatment is cosmetic and often includes using a sterile needle to extract the contents. Electrocautery and Plasma therapy can also be used. 

Rosacea

Most common in fair skinned females ages 40-50. Common symptoms include flushing and blushing which eventually lead to redness (erythema) and broken superficial blood vessels (telangiectasia) on the central part of the face. May involve tiny pustules and red eyes.

Triggers: Hot liquids, spicy foods, sun exposure, alcohol, and wind. 

Management: Metronidazole topical 0.75% or 1% 

Minocycline or Doxycycline 50-100mg once or twice daily. 

Sebaceous Hyperplasia

Enlarged or hyperactive oil glands often seen on the forehead or cheeks of middle to older aged adults. This is a benign condition. 

Treatment is cosmetic and includes electrocautery or Plasma therapy.

Dermatofibroma

A benign firm nodule often found on the lower legs. More common in females. They are sometimes painful or itchy but usually do not cause any further problems. More than 15 can indicate autoimmune disease or lowered immunity.

Treatment is usually cosmetic and involves surgical removal.

Skin Tags

This is usually a benign condition involving fleshy lesions tethered to the skin on the neck, armpits, and groin region. More common and numerous in obese individuals or those with diabetes type 2.

Treatment is cosmetic and includes snipping the skin tags off, or burning them off with electrocautery or plasma therapy.


Telangiectasia

Small superficial benign broken blood vessels red in color often caused by sun damage, rosacea,  or skin injury.

Treatment can include electrocautery, IPL, or sclerotherapy. 

Moles

Moles are pigmented lesions which may be flat or raised. Fair skinned people usually have more moles than darker skinned people. Sun exposure, and family history are common causes of mole production in adults. They can vary in color from nude, pink, to brown black or blue. Moles which require a biopsy are those which are asymmetrical, have uneven colouring, with irregular border and a diameter greater than the end of a pencil eraser. 

Warts

Warts are produced by a skin infection involving the human papilloma virus. Children or those who are immune suppressed have a higher infection rate. Warts are highly contagious and spread via direct skin contact. 

Treatment inlcudes liquid nitrogen, salicylic acid, Plasma therapy or CO2 laser, 

Scars

A scar results when fibrous tissue replaces normal tissue to fill a wound or skin injury. They can be flat or raised (hypertrophic or keloid). 

Treatment can include plasma therapy, liquid nitrogen, or steroid injections. 

Eczema

A type of dermatitis resulting in excessively dry and irritated skin. The most common irritants include soaps, detergents, and alcohol hand sanitizers.  

The affected areas are often describes as burning, stinging, or itchy. 

Treatment includes eliminating topical triggers, cortisone cream, and wet dressings. 

Sebborheic Dermatitis

A form of eczema which involves the sebaceous or gland rich areas such as the face, scalp and trunk. Often includes a yeast infection of the skin which causes an inflammatory reaction. Often appear as salmon pink patches that may have flakes. May be itchy. Usually worse in winter.

Treatment involves topical salicylic acid, ketoconazole shampoo, topical anti-fungals or topical corticosteroids. 

Reference

Wolff, K., Johnson, R.A., Saavedra, A.P., and Roh, E.K. (2017). Fitpatrick's color atlas and synopsis of clinical dermatology. 8th ed. McGraw Hill : New York.