Monday, September 28, 2009


This weeks topic is "Sunscreens". Many people ask us our recommendations on sunscreens. There are a couple points to keep in mind when selecting a sunscreen that many people are not familiar with or do not consider. We hope this blog helps you select a good protective sunscreen that is also comfortable to wear.

1. You need to frequently apply the sunscreen—every hour if you are swimming, sweating or are continuously in sunlight. Sun screen will break down and wear out over time, get rubbed or washed off. Therefore, by paying attention and re-applying it, you will protect yourself better.
2. You need a sunscreen with an SPF of 30 or higher. Studies have shown that most people do not put sun screen on heavily enough to achieve the advertised SPF. When the SPF is measured, it is measured with a controlled amount of sunscreen per square inch of skin. That amount basically equals about 1 ounce of sunscreen to cover the normally exposed parts of the body. Most sunscreen containers contain about 4 to 8 ounces of sunscreen, so spending 4 hours in full sunlight, reapplying sunscreen as you should, would completely use up a 4 ounce bottle and half of an 8 ounce bottle of sunscreen. Most people purchase a bottle of sunscreen in the early summer and are still using that same bottle at the end of the summer which means that they are not putting the sunscreen on thick enough or frequently enough or both, to get the advertised SPF.
3. The SPF only tells you how much protection you will have against a sunburn which is caused by UVB rays. There is another ray of the sun, UVA, that at least one cancer center has theorized may be responsible for causing skin cancer. We know that UVA does cause uneven pigmentation and wrinkles--the signs of aging. The concern is that you may use a sunscreen with a high SPF and not get a sunburn, since you are blocking the UVB, but you will still get lots of UVA which may still cause skin cancer and the signs of aging. There is currently no number or factor like “SPF” that tells you how much UVA protection a sunscreen has. A high SPF does not mean you have good UVA protection. Therefore, you need to look at the back label for active ingredients. Make sure your sunscreen has either “Titanium dioxide”, “Zinc oxide”, “Parsol 1789”, "Avobenzone", or "Mexoryl". These are currently the only FDA approved UVA blockers in the US. In the near future, there will be an "A", "B" or "C", etc. (for example SPF 30-A) that will tell a consumer both the UVB protection and the UVA protection a sunscreen has. For now, we have to read the labels.
4. Match your sunscreen to your activity. If you are going to be sedentary, pick a thicker, creamier sunscreen or sunblock. If you are playing sports, then pick a spray or gel based sunscreen to avoid getting the product in your eyes.
5. We have several sunscreens available here at Greenville Dermatology, all of which have both good UVB and UVA protection. "Anthelios" is a great daily UVA blocker to be used under makeup and as a daily moisturizer. “Kinesys” is an excellent spray-on for sports active children and adults and will not block pores for those of you with acne. “Blue Lizard” which comes in regular, sport, kids and face versions is a great standby.

Friday, September 11, 2009

Causes and Treatments of Acne

Acne makes up more than 10% of Greenville Dermatology’s patient population so it is a very common affliction of not only teens, but adults as well. I know from personal experience, having acne myself as a teen and missing my senior prom because of it, that it can significantly affect your self-image. Compared to when I was a teen, there are so many more options for treating acne these days. Acne can start as early as 8 years old, although most people get it later in their teens.
CAUSE: Contrary to what some believe, acne is not caused by eating chocolate cake, pizza, coke or junk foods. These beliefs arise I think since most teens eat these types of foods and also have acne. Only one food product, milk, has actually been shown to make acne worse and it is believed that it is because we inject cows with hormones to produce more milk and these hormones get passed into our children when they drink the milk. Getting organic milk, which is supposed to be hormone-free, may help. So, the rapid change in hormones during puberty causes the oil glands to enlarge more quickly than the skin can handle it. The skin cells start to stick together and clog up the pores creating a situation where the acne bacteria start to grow more effectively causing acne. Hormone-rich milk just makes this worse. Acne is also not caused by a dirty face—you cannot “clean” acne away by scrubbing several times a day. In fact, this may actually make acne worse by upsetting the natural bacterial flora on the face enabling the “bad” acne bacteria to grow while the good bacteria are scrubbed away.
TREATMENT: At first, over the counter medications such as benzoyl peroxide or salicylic acid cleansers and gels, or combination packages such as “Proactiv”, etc., can be very effective and for a lucky few, is all that is ever required. Once red bumps (called ‘papules’) and white heads (called ‘pustules’) begin to form, prescription medication is often required and signals the time when an appointment with your dermatologist should be made. Most dermatologists, including myself, will treat acne with a combination of prescription medications. Unfortunately, we do not have any simple, single medication treatments for acne that are relatively side effect free once acne reaches this stage. I usually will treat the papules and pustules with an oral antibiotic. There are many to choose from and currently, there are at least two once-a-day medications, Solodyn and Doryx, that make taking an antibiotic as easy as possible. Oral antibiotics like these usually take at least a month of use before any improvement can be seen. Even at one month, there will still be some residual papules and pustules remaining that will improve with continued use of the medication. I like to see my patients back at this time to ensure that the medication is working. If not, then a switch to another antibiotic is sometimes needed. Unfortunately, we cannot perform a lab test such as a culture or blood test to see what antibiotic a patient will respond to. This makes treating acne somewhat a “trial and error” activity. In addition to the oral antibiotic, I also prescribe a benzoyl peroxide cleanser. This helps to keep the acne bacteria from becoming resistant to the antibiotic we are using, and treats the surface acne. Some dermatologists prefer to prescribe benzoyl peroxide as a gel or cream. I see nothing wrong with this and it is a matter of personal preference. Benzoyl peroxide can bleach the color out of clothing and when using it as a gel or cream, this seems to happen more easily which is why I prefer to prescribe it as a cleanser. Finally, I prescribe a topical “retinoid” product such as Retin-A, Differin, or Tazorac. The American Academy of Dermatology (AAD) suggests using a retinoid on all acne patients as it helps the skin to “turn over” more rapidly, preventing the skin cells from sticking together and clogging up the pores. Therefore, these retinoids prevent acne. Unfortunately, retinoids also are irritating and drying to the skin and take the longest (about 3 months) to see results. Most teens (and adults) tend to quit using these medications long before that because of the lack of quick results and the irritation they sometimes cause.
So, in my clinic, a patient with acne will be treated with an oral antibiotic, a benzoyl peroxide cleanser, and a retinoid which they are instructed to start all at once. The oral antibiotic should start working in a couple weeks to a month, with continued improvement as time goes on. Ideally, if the patient has been using the retinoid and cleanser regularly, they should be able to taper off the antibiotic after two to three months. However, acne changes, getting worse sometimes and better other times, and most of us get lazy with our medication regimens and often times patients are on antibiotics constantly or off and on for many months to years. So, it is VERY important that the patient use the medication as prescribed. Way too often, a patient of mine will come back for their follow up and say that they only took the pills since that was the only thing that seemed to be working. Unfortunately, without the benzoyl peroxide or retinoid, they will always have to take the pill to keep their acne under control.
ACCUTANE: Accutane, or “isotretinoin” is a powerful and special acne medication that has been available to patients for almost 30 years. It acts like high doses of vitamin A in our bodies and so is not an antibiotic as some people believe. In the past, before Accutane, dermatologists would sometimes give acne patients vitamin A injections for their acne. This worked well, but caused some liver problems as well as very dry flaky skin as high doses of vitamin A can be toxic. Accutane is a way to get the effects of high doses of vitamin A, clearing up acne, but minimizing the side effects. Even so, Accutane has a lot of side effects, the most prominent being that it can cause birth defects if a female who taking it gets pregnant. These effects last only a month after completing Accutane, but require that females on Accutane practice strict birth control measures. In addition, it has been known to cause depression in some individuals. We prescribe Accutane for patients who do not respond to multiple antibiotics as described above, or patients who have more severe, deeper acne that is causing scarring. I personally have treated close to if not over 1000 patients with Accutane and have not had any serious problems occur and in fact my own son has successfully been treated with it. Despite its side effects and risks, Accutane works extremely well and is taken usually for only 20 weeks. I cannot recall a case of acne that Accutane did not clear. However, I have seen some patients require a second and rarely, a third course of Accutane, or patients who have had to be on Accutane for 24 or 28 weeks.
I hope that one can appreciate that acne can be a difficult skin affliction to treat and takes both the dermatologist and patient working together in an honest trusting relationship to achieve success. We do our best here at Greenville Dermatology to accomplish this. Please come and see us for your acne. Call 864-242-5872 to make an appointment.

Monday, September 7, 2009


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