Trouble-shooting causes of acne and breakouts is one of my favorite things to do. It's a fun challenge, like trying to solve a mystery. I'll always start by asking LOTS of questions, and keep it up until we get an ah-ha moment. Below is a list of some of the things I ask patients about. If you're having trouble with acne, try troubleshooting your routines and products.
1) Liquid Makeup It's a mean cycle: you break out, so you need to cover up. But liquids and creamy formulas can contribute to congestion, causing another breakout. Remember that oil is sticky, and in an acne scenario, dead skin cells and debris are already getting glued down with oil. Frequently, more coating on the surface can cause more congestion and breakouts.
Contrary to popular belief, there are mineral powder foundations that deliver high coverage. My faves for great coverage without contributing to acne:
Tip: Try a liquid foundation brush with these powders to lay down more opacity/ coverage where you need it.
Not every blackhead or follicular deposit is going to cause issues. And that little tiny blemish won't actually ruin your day. If you tend to break out, Hands Off!
See an esthetician for a pro extraction and ask for a conservative session. Hard truth to swallow: If you break out after a facial, (or home extraction) it might be because of over-stimulation... NOT because the skin is "purging" - an idea you'll hear suggested from time to time. Bring post-facial-breakout feedback to your skin care pro and they can adjust appropriately for your next treatment.
Tip: The use of Tretinoin, retinol, or another treatment product recommended by your doctor or esthetician can act as a pre-treatment and make extractions easier on you... and your facialist.
3) Benzoyl Peroxide and Spot Treating:
Benzoyl Peroxide is a great acne treatment. However, it works as a preventative by killing off pimples in the early stage. (Zits can take up to 90 days to form). Sometimes we feel like it helps as a spot treatment because it can be drying to an acne lesion, but you're doing yourself a disservice if you're not applying it all over. My favorite BPO is in the Obagi Clenziderm System because it's a solubilized BPO, not a micro-crystal (like other BPO). It's 1/10,000th the size of a standard BPO crystal - this means it penetrates most effectively into the follicle. Give it a try!
4) Bar Soap:
I've never met a bar of soap that I liked. Picture a bar of soap: waxy and skin-coating, dry-looking, or simply sitting in a little pool of water getting mushy: whatever it is, we just don't get along- and neither should you.
Two things about bar soap:
1) Just to physically get it into bar-form, the pH here has to be higher than other formulations like creams, gels, or liquids. This means that they can be more drying. Lets not freak out your skin any more than we need to.
2) Bacteria likes to live on bars of soap. Doctors don't seem too concerned with this from a disease-proliferating perspective (washing your hands with bar soap seems to be fine), but if we're trouble-shooting, we're trouble-shooting. I say, use a liquid, non-soap cleanser instead.
5) Use of Topical Vitamin C:
Topical Vitamin C's are great as a brightening product and anti-aging measure, but you should avoid this one when troubleshooting breakouts. In my experience, vitamin C's are not always acne-friendly and are not often recommended for those who break out easily.
That being said, Vitamin C's are great to lighten acne marks (post-inflammatory hyperpigmentation or PIH) from old breakouts. If you currently have active acne, get your breakouts under control first, and then consider choosing a formula meant for all or oily skin types. I prefer Phloretin CF for oily types.
6) Makeup Sponges
If you're breaking out, ditch the sponges - they harbor bacteria. If you are currently in the sponge club, really, try brushes! You can get much better coverage and get much more mileage out of your makeup. Just be sure to clean them regularly.
My favorite brush cleaners are:
Tip: If you HAVE to use a sponge, grab a bag of disposable wedges, snip them in half (so you get double the use) and throw them out EACH TIME you use them.
If you've exhausted these possibilities and you're still having trouble, see your dermatologist. They will troubleshoot further and might look at additional factors like hormones. They might also prescribe a topical or oral medication as well.
Until next time, stay fabulous my friends!
I wanted to share a quick video I put together of/for Dr. Erickson (amazing and fabulous board certified Chicago dermatologist) explaining and demonstrating the Kybella treatment during an event to introduce the procedure last week. Kybella was recently FDA-approved for the treatment of the *dreaded* double chin, AKA 'sub-mental fat'. Once injected, the product will actually destroy the fat cells under the chin, which can make for a much slimmer and younger appearance. Everyone is different, so the amount of treatment sessions you may need can vary, but are typically spaced one month apart.
…and until next time, stay fabulous my friends!
Here is the blog I am writing for work (Erickson Dermatology in Chicago on Michigan Avenue), thought I'd share the first post! We are soft launching Dr. Erickson's new cosmetic dermatology practice now, and are ready to see patients! We're already doing fabulous things with BOTOX Cosmetic, Juvederm VOLUMA, all the awesome dermal fillers, an amazing new Sciton laser, and a brand new Hydrafacial. YEAH! It's a very exciting time. We also just launched the new website, created by yours truly =)
What is Mohs surgery?
Lately, I've been working like crazy to help launch a brand new cosmetic dermatology office on Michigan Avenue in Chicago. The highly credentialed and super smart dermatologist (Dr. Quenby Erickson, who is my boss, the owner, and the medical director all-in-one) is board certified and fellowship trained in Mohs Surgery. Sometimes, when I'm bragging about how talented Dr. Erickson is, people will say: "NOSE surgery??" No, actually: MOHS Surgery. Here's what it is:
With more than 2 Million Americans estimated to be affected by skin cancer this year, Mohs Micrographic surgical technique is more in-demand than ever. In addition to Mohs, Dr. Erickson also really enjoys the reconstruction aspect, which has saved patients from disfigurement. It's a pretty great process.
Step 1: A conservative amount of tissue is removed. Step 2: While the patient waits, the tissue will be examined under a microscope to see if the margins are clear Step 3: If the margins are clear, the patient is good to go. Slightly more tissue will be removed and the steps will be repeated only if the margins aren't clear.
Imagine if you had a cancerous lesion on your cheek (yikes). You'd want the cancer to be gone, but with the smallest amount tissue removed as possible. Beyond that, you'd want to be reconstructed beautifully. That's what a Mohs surgeon can do for you. (Sometimes, closures can be sent out to a plastic surgeon). As Dr. Erickson says: "Removing tissue from a person's back is one thing; it becomes a bigger deal on the lip, eyelid or nose." Glad to have you, Mohs surgeons!!
Click here for what sets fellowship-trained Mohs surgeons apart from the rest, and click here for patient information on Mohs surgery.
Until next time: Stay Fabulous, (and wear your sunscreen!!) My Friends!
I sometimes get some questions about the 'mole-hills' or little bumps that you get right after a BOTOX Cosmetic treatment. This is a very, very temporary occurrence (between 5-15 minutes usually) that some people tend to get anxious about or hung-up on. So, I thought I would post pictures of my own latest treatment in an effort to put some worries to rest. The reason these little temporary 'mole-hills' occur:
When the BOTOX Cosmetic arrives at an office, it is in concentrated, sort of freeze-dried or vacuum-dried form. There are 100 units in a typical bottle, but they need to be reconstituted to properly use them and measure them out. Saline is used to do this. The injector will determine how many units need to be injected into each area, and will inject the BOTOX Cosmetic, Diluted with saline, into the area. It takes your body a couple of minutes to absorb it, which is why the molehills occur. They are gone really quickly!
Despite how many questions we hear about this, this little side effect should probably the least of your concerns. Be sure that your injector is a physician or a nurse injector, and that they are using authentic BOTOX Cosmetic. You can even ask them to see the bottle, which has a hologram on it. There are sometimes little bruises (like just bigger than the size of a pin-point) that can occur, and we most typically see them around the eyes (crowsfeet). I didn't get any bruises this time, but every once in a while I will. Usually not a big deal at all!
Always do your homework, and you will be better off! Here's a full list of side-effects, and always discuss the risk vs benefit of any treatment with your doctor!
Enjoy your treatment and Bye Bye, Crinkle-Eye!
As I sit here with a blemish so large that I may end up naming him (Thor? Steve? Brutus?), about to get my Kenalog Injection, it occurred to me that I may want to share a few of my emergency acne treatment ideas. Yes, it's true. Even the skincare-obsessed (and skincare professional) will get the occasional blemish. If you are like me, you might have a fabulous dermatologist in your back pocket. A quick and almost-painless injection of a steroid and will have you like new in 24-48 hours. What I have is called Kenalog- it’s a glucocorticoid corticosteroid meant for intralesional, (meaning: in-the-zit-itself), injection.
This is one of the best 'break glass in case of emergency' treatments before weddings/prom/reunions. There's risk of a scar when you have these injections, so talk it out with your doc. Sometimes the blemish itself threatens a scar, like when it's big enough to have its own name. So depending on your situation, despite the risk you may still opt for the shot.
Don't have a derm? No time for an appointment?
Here are 5 of my top at-home emergency blemish treatments:
(I prefer the cream version, but it's also available in an ointment form) you can apply hydrocortisone 1% a couple times a day for up to 7 days to help reduce inflammation and redness.
Ice, Ice, Baby (better yet, cool packs):
Reduce inflammation by holding a cool pack on for 15 minutes at a time, or as long as is comfortable. It's good to do while you're checking email or watching a movie.
If you have some of this (generally for use all over the facial skin at night) I have found that if you use a dab during the day, it can help to flatten things out a bit faster. Tretinoin is typically for anti-aging and /or acne treatment and prevention- it's a power house prescription. If you don't happen to have any laying around, Salicylic Acid is always a good one to dry and flatten things out. I love Obagi's Clenziderm MD Pore Therapy.
Try taking Benedryl or Claritin, if its appropriate for you (i.e, your md says you're good to go) ... It's all about reducing the inflammation!
Benzoyl Peroxide products are awesome for prevention and treatment of the pustule-type of lesions… the yucky ones with the ‘head’ on them. This is because BPO works by bringing oxygen in to murder the anaerobic (O2-hating) bacteria in the follicles. A crazy awesome Rx version is called Acanya, otherwise my fave and most-recommended BPO is Obagi's Therapeutic Lotion.
Of course, always follow the recommendations of your own skin care professional or physician- and may the force be with you!