Dr. Rockoff received his undergraduate degree from Yeshiva College with the distinction of Summa Cum Laude. He received his medical degree from the Albert Einstein College of Medicine. His internship and two years of Pediatric residency were at the Bronx Municipal Hospital Center, followed by training in Dermatology at the combined residency program at Tufts and Boston Universities. Dr. Rockoff is certified by both the American Board of Dermatology and the American Board of Pediatrics.
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Cosmetics: Don't be afraid to hide blemishes with flesh-tinted coverups
or even foundation, as long at it is water-based (which makes it noncomedogenic). There are many
quality products available.
Facials: While not absolutely essential, steaming and "deep-cleaning" pores
is useful, both alone and in addition to medical treatment, especially for
people with "whiteheads" or "blackheads." Having these pores unclogged by a
professional also reduces the temptation to do it yourself.
Pore strips: Pharmacies now carry, under a variety of
brand names, strips which you put on your nose, forehead, chin, etc., to "pull out"
oil from your pores. These are, in effect, a do-it-yourself facial. They are
inexpensive, safe, and work reasonably well if used properly.
Toothpaste? One popular home remedy is to put toothpaste on zits. There is no medical basis for this. Ditto for vinegar.
What is a good basic skin regimen?
These are all good basic skin regimens that may help with the acne battle:
Cleanse twice daily with a 5% benzoyl peroxide wash. An alternative for
those who are allergic to benzoyl peroxide is 2% salicylic acid.
Apply a gel or cream containing 5% benzoyl peroxide; an alternative is
sulfur or resorcinol.
At night, apply a spot cream containing sulfur to the affected areas.
Use a light skin moisturizer and water-based oil-free makeup.
What can the doctor do for acne?
If you haven't been able to control your acne adequately, you may want to
consult a primary-care physician or dermatologist. The goal of treatment should be the prevention of scarring (not a flawless complexion) so that after the condition spontaneously resolves there is no lasting sign of the affliction. Here are some of the options available:
Topical (externally applied) antibiotics and
antibacterials: These include
erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone),
clindamycin (BenzaClin, Duac),
sulfacetamide (Klaron), and
azelaic acid (Azelex or
Finacea).
Retinoids: Retin-A (tretinoin) has been around for years, and preparations have become
milder and gentler while still maintaining its effectiveness. Newer retinoids
include adapalene (Differin) and
tazarotene (Tazorac). These
medications are especially
helpful for unclogging pores. Side effects
may include irritation and a mild increase in sensitivity to the sun. With
proper sun protection, however, they can be used even during sunny periods.
In December 2008, the U.S. FDA approved the combination medication known as Epiduo gel, which contains the retinoid adapalene along with the antibacterial cleanser benzoyl peroxide. This once-daily prescription treatment was approved for use in patients 12 years of age and older.
Oral antibiotics: Doctors may start treatment
with tetracycline (Sumycin) or one of the related "cyclines," such as
doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others) and
minocycline (Dynacin, Minocin). Other oral antibiotics that are useful for treating acne are
cefadroxil (Duricef),
amoxicillin (Amoxil,
DisperMox, Trimox), and
the sulfa drugs.
Problems with these drugs can include allergic reactions (especially
sulfa), gastrointestinal upset,
and increased sun sensitivity. Doxycycline, in particular, is generally safe but
can sometime cause esophagitis (irritation of the esophagus, producing
discomfort when swallowing) and an increased tendency to sunburn.
Despite many people's concerns about using oral
antibiotics for several months or longer, such use does not "weaken the immune
system" and make them
more susceptible to infections or unable to use other antibiotics when
necessary.
Recently published reports that long-term antibiotic use
may increase the risk of breast cancer will require further study, but at present
they are not
substantiated. In general, doctors prescribe oral antibiotic therapy for acne
only when necessary and for as short a time as possible.
Oral contraceptives:
Oral contraceptives, which
are low in estrogen to
promote safety, have little effect on acne one way or the other. Some
contraceptive pills have been to shown to have modest effectiveness in treating
acne. Those FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary physicians or gynecologists when recommending these medications.
Spironolactone (Aldactone): This drug blocks androgen (hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it.
Cortisone injections: To make large pimples and cysts flatten out fast,
doctors inject them with a form of cortisone.
Isotretinoin: (Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem.) Isotretinoin is an excellent treatment for severe, resistant acne and has been used on millions of patients since it was introduced in Europe in 1971 and in the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, which has been unresponsive to conventional therapies like those listed above. The drug has many potential serious side effects and requires a number of unique controls before it is prescribed. This means that isotretinoin is not a good choice for people whose acne is not that bad but who are frustrated and want "something that will knock acne out once and for all."
Used properly, isotretinoin is safe and produces few
side effects beyond dry lips and occasional muscle aches. This drug is
prescribed for five to six months. Fasting blood tests are monitored monthly to check
liver function and the level
of triglycerides, substances
related to cholesterol, which often rise a bit during
treatment, but rarely to the point where treatment has to be modified or
stopped.
Even though isotretinoin does not remain in the body after therapy is stopped,
improvement is often long-lasting. It is safe to take two or three courses of
the drug if unresponsive acne makes a comeback. It is, however, best to wait at
least several months and to try other methods before using isotretinoin again.
Isotretinoin has a high risk of inducing
birth defects
if taken by pregnant women. Women of childbearing age who take isotretinoin need
two negative pregnancy tests (blood or urine) before starting the drug, monthly
tests while they take it, and another after they are done. Those who are
sexually active must use two forms of contraception, one of which is usually the
oral contraceptive pill. Isotretinoin leaves the body completely when treatment is
done; women must be sure to avoid pregnancy for one month after therapy is
stopped. There is, however, no risk to childbearing after that time.
Other concerns include inflammatory bowel disease and the risk of depression and
suicide in patients taking isotretinoin. Government oversight has resulted in a highly publicized and very burdensome national registration system for those taking the drug. This has reinforced concerns in many patients and their families have that isotretinoin is dangerous. In fact, large-scale studies so far have shown no convincing evidence of increased risk for those taking isotretinoin compared with the general population. It is important for those taking this drug to report changes in mood or bowel habits (or any other symptoms) to their doctors. Even patients who are being treated for depression are not barred from taking isotretinoin, whose striking success often improves the mood and outlook of patients with severe disease.
Laser treatments: Recent years have brought reports of success in treating
acne using lasers and similar devices, alone or in conjunction with
photosensitizing dyes. It appears that these treatments are safe and can be effective, but it is not clear that their success is lasting. At this point, laser treatment of acne is best thought of as an adjunct to conventional therapy, rather than as a substitute.
Chemical peels: Whether the superficial peels (like glycolic acid)
performed by aestheticians or deeper ones performed in the doctor's office, chemical
peels are of modest, supportive benefit only, and in general, they do not substitute
for regular therapy.
Treatment of acne scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed
acne scars and laser resurfacing to smooth out shallow
acne scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and they may need to be repeated
three or more times. These treatments can help, but they are never completely successful at eliminating
acne scars.
A boil is a skin abscess, a collection of
pus localized deep in the skin. There are several different types of boils. Among them are the following: furuncle or
carbuncle, Cystic acne, Hidradenitis suppurativa, and Pilonidal cyst.
Ingrown hairs may be caused by improper shaving, waxing or blockage of the hair follicle. Symptoms and signs of ingrown hairs include itching, tenderness, and small red pus bumps. Ingrown hairs usually heal on their own, but topical antibiotics, chemical depilatories, and hair-removal laser may be used in the treatment of ingrown hairs.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Folliculitis is a skin condition that causes small red bumps to form around the hair follicles. Skin bacteria such as Staphylococcus and Pseudomonas my infect the follicles. Treatment involves over-the-counter bacterial washes, topical antibiotics, and/or topical steroids.
A keloid is a scar that doesn't know when to stop. When the cells keep on reproducing, the result is an overgrown (hypertrophic) scar or a keloid. A keloid looks shiny and is often dome-shaped, ranging in color from slightly pink to red. It feels hard and thick and is always raised above the surrounding skin.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Premenstrual syndrome (PMS) is a combination of physical and emotional disturbances that occur after a woman ovulates and ends with menstruation. Common PMS symptoms include depression, irritability, crying, oversensitivity, and mood swings. For some women PMS symptoms can be controlled with medications and lifestyle changes such as exercise, nutrition, and a family and friend support system.
The time when boys and girls begin the process of sexual maturation is called puberty. During this time, both sexes undergo a series of biological changes that include a rapid increase in height, bone growth, weight increase, the growth of pubic hair, breast development and the onset of menstruation in girls, and testicle, penis, and muscle enlargement in boys.
Blepharitis is inflammation of the eyelids. Acne rosacea, Staphylococcal bacteria, allergies, sensitivities to makeup or contact lens solutions, head lice, or other conditions may cause blepharitis. Symptoms and signs include itchy eyelids, burning sensation in the eyes, crusting of the eyelids, light sensitivity, red, swollen eyelids, loss of eyelashes, and dandruff of the lashes and eyebrows. Proper eyelid hygiene and a regular cleaning routine controls blepharitis.
Molluscum contagiosum is a skin infection caused by the poxvirus. Molluscum contagiosum appears as small tan or pink bumps on any part of the skin. Symptoms include a red or flushed appearance of the infected skin. Treatment may involve cryotherapy, manual extraction, surgical removal, the use of Retin-A, or the application of chemical acid.
Scar formation is a natural part of the healing process after injury. The depth and size of the wound incision and the location of the injury impact the scar's characteristics, but your age, heredity and even sex or ethnicity will affect how your skin reacts.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
Teenagers recognize that they are developmentally between child and adult. Teen health prevention includes maintaining a healthy diet, exercising regularly, preventing injuries and screening annually for potential health conditions that could adversely affect teenage health.
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