Acne

Question 0

Is there a cure for acne?

Answer 0

No, there is no known cure for acne, but there are treatments to keep it under control.

Question 1

Define acne

Answer 1

An inflammatory disease of the sebaceous glands. Another name for acne is “retention hyperkeratosis”. (Retention of dead skin cells and rampant proliferation of additional cells).

Question 2

what is another name for a pore?

Answer 2

Follicle (these two words can be used interchangeably)

Question 3

Describe a pore / follicle

Answer 3

A follicle is the tiny structure that opens onto the skin’s surface whether or not a hair grows out of it or not. A developing follicle has two choices: it will either produce a hair (a hair follicle) or it will predominantly produce oil (sebaceous follicle).

Question 4

if a baby is genetically ance-prone and has acne flares on the face as a baby

Answer 4

neonatal acne

Question 5

what hormone stimulates the development of our sebaceous follicles and their attached oil glands?

Answer 5

Testosterone

Question 6

what is sebum?

Answer 6

sebum is the skin oil produced by the sebaceous glands. sebum is a complex mixture of lipids (fats)

Question 7

what is anaerobic bacteria

Answer 7

bacteria that grows without the presence of oxygen and feeds off of the triglycerides produced by our sebaceous glands. this bacteria flourishes in the follicles.

Question 8

why does acne appear on different areas of the body at different times?

Answer 8

not all sebaceous follicles mature at the same time, instead they mature and begin producing oil in a progression that moves across the face and body like a wave.

1. central forehead, nose and central chin (12-14)
2. cheeks, upper back and chest (15-16)
3. jaw line, upper neck, low back (18-19)

Question 9

Describe retention hyperkeratosis

Answer 9

the stratum corneum sloughs off a layer of dead skin cells each day, inside the pore as well. the keratin loaded skin cells (keratinocytes) are produced at an abnormally rapid rate, 4-5x’s more in the acne affected pore. in the process of acne, these dead skin cells begin to stick togeter and form a mass (an impaction) down inside the follicle. dead skin cells, sebum, rudimentary hair, bacteria and their by-products are retained inside the pore.

Question 10

how does stress effect acne?

Answer 10

stress activates the adrenal glands to produce extra hormones which eventually results in flare ups in the acne prone pores. this is more common in women because they produce most of their male hormones in the adrenal glands whereas men produce it mostly in the testes.

another way stress effects acne is by weakening the body, causing healing of the lesion to be interrupted.

Question 11

what are some of the factors that contribute to acne from the outside in

Answer 11

climate
pressure or friction
picking
industrial chemicals & oils

Question 12

what are some factors that contribute to acne from the inside out?

Answer 12

iodides/iodines
diet - food containing hormones (peanut, corn & wheat germ oils)
steroid drugs (systemic) used for RA, kidney disease, etc.
steroid drugs (topical) used for acne rosacea
testosterone injections or pills (steroids for athletes)
danazol or danocrine (med. for endometriosis, similar to testosterone)
lithium (for depression)
dilantin (for epilepsy or anti-convulsions)
marijuana

Question 13

androgens?

Answer 13

androgen is a general term for male hormones. the main one is testosterone which is tied to acne.

Question 14

how do male hormones effect acne?

Answer 14

it causes flare ups by stimulating greater production of sebum.

Question 15

what usually happens when taking estrogen dominant birth control pills?

Answer 15

flooding the body with extra estrogen clears acne for many acne-prone women by shutting down testosterone production in the ovaries.

Question 16

when do most acne-prone women see post pregnancy acne flare?

Answer 16

acne often flares 90 days or so after pregnancy, and can also happen when getting off of birth control pills (from hormonal fluctuation)

Question 17

what is comedogenic mean?

Answer 17

comedogenic refers to a substance’s ability to penetrate down into the pore and cause the formation of comedones.

Question 18

what is acne cosmetica?

Answer 18

acne caused by comedogenic ingredients in cosmetics. it can take up to 6 months to surface, often making it difficult for sufferers to make the connection. usually manifests as numerous whiteheads, sometimes a few of them may turn into inflamed pustules.

Question 19

how is zinc used in the treatment of acne

Answer 19

zinc helps cut down the inflammatory response to acne for many grade 3-4 sufferers. recommend 100mg or more per day for serious sufferers.

Question 20

explain the use of tetracycline (antibiotic) for acne

Answer 20

when tetracycline is taken orally, it eventually filters through to the skin and becomes bound to the protein in the stratum corneum, which can suppress the c. acnes bacteria.

many long term users experience toxic side effects: nausea, heartburn, yeast infections, brown stained teeth, or liver or kidney damage

Question 21

explain the use of cleocin (antibiotic) for acne

Answer 21

more potent antibiotic than tetracycline suppressing the c.acnes bacteria.

side effects: diarrhea and abdominal cramps, if not treated can lead to serious colitis.

Question 22

how does sun exposure help some acne sufferers?

Answer 22

it’s actually not helping, but it can have a drying effect on the skin which can be misconstrued as helpful. also the darker pigment from a tan can help blend the discoloration of lesions. it may even be the relaxation that comes with laying by the beach, etc.

Question 23

what is cryotherapy?

Answer 23

the science of applying cold to improve diseases is called cryotherapy (cryo=Latin for cold). freezing produces anit-inflammatory benefit reducing redness, and stimulating healing of papules, nodules, and cysts.

example=liquid nitrogen
icing daily 2x’s for 3-5 minutes for serious acne sufferers

Question 24

what are some other names for Vitamin A Acid?

Answer 24

tretinoin
retinoic acid
Retin-A (sold by Johnson & Johnson)

Question 25

what does vitamin a acid do for acne?

Answer 25

vitamin a acid (retin-a) successfully peels down the inside of the pore, unblocking and preventing further formation of impactions. it does not, however, combat the bacteria action in the pore.

Question 26

how does benzoyl peroxide work with clear acne?

Answer 26

benzoyl peroxide causes loosening of impactions and also fights the bacteria down in the pore. the benzoyl pulls the peroxide down into the pore where the c.acnes bacteria reside (anaerobic=can’t survive in the presence of oxygen)

bp causes peeling like vitamin a, it does not cause as much redness.

Question 27

the cornerstone of dr. fulton’s acne treatments are what?

Answer 27

1. bp scrub cleansers
2. vitamin a (speeds up peeling)
3. extractions
4. steroid injections into lesions (lessons scaring &reduces inflammation)
5. cryotherapy
6. topical antibiotics (erythromycin lotion) good for those who don’t want to peel as much
7. systemic antibiotic for stubborn acne (tetracycline or minocycline)
8. birth control pills (high estrogen)
9. zinc (oral- to reduce inflammation in severe acne

Question 28

what is another name for Accutane?

Answer 28

isotrentinoin (causes a dramatic reduction of sebum production)
should only be used in the most severe cases of grade 4 cystic acne

Question 29

what is pseudofolliculitis barbi?

Answer 29

when coarse, curved beard hairs penetrate into the skin just before they would normally exit out of the follicle. very common in black men, and causes acne-like eruptions. treat like acne and use single blade with the grain & plain shaving cream (no menthol)

Question 30

explain in a nutshell what an acne regimen is and how it works.

Answer 30

benzoyl peroxide cleansers: kill bacteria
ice: reduces inflammation
AHA: strips off the dead skin cells
Vit-A: increase metabolism of the skin, speeds up peeling.

Question 31

what is the purpose of an acne treatment?

Answer 31

the purpose of an acne treatment is to irritate your skin, to cause peeling down inside the pore and zap the bacteria at the same time. it is normal to have some redness, stinging, irritation and peeling/flaking. it’s only too much if your face is very red, hurts and feels so tight that you feel like it will crack if you smile

Question 32

tips for acne with severe dry skin?

Answer 32

in the beginning, wash with lukewarm water and wait one or two hours before applying your active products (give your natural oils an opportunity to shield against the full effects). gradually shorten the time, eventually working toward applying right after washing.

Question 33

benzoyl peroxide warnings:

Answer 33

dont use a moisturiser with BP, it can migrate into the eyes and down onto the neck causing irritation. also, it does stain sheets/clothes

Question 34

when can i stop my regimen?

Answer 34

once you have achieved total clearing of acne, continue on the regimen for the next 3 months or so. at that point you can move down to a lower maintenance and probably stay clear until you reach your “burnout stage”. normally a BP cleanser twice daily will be good maintenance to keep you clear.

men burnout = early to mid 20’s
women burnout = mid 20’s to mid 40’s

Question 35

how does sulfur work on acne?

Answer 35

sulfur is a peeling agent, when used on its own it has questionable value. when mixed with BP, the BP becomes twice as effective.

Question 36

explain the difference between an enzyme and a peel

Answer 36

enzymes work by digesting and dissolving dead skin cells and imparting nutrients into the skin. they soften the skin and prepare it for more advanced treatments.

chemical peels do the same, only they penetrate more deeply to trigger various mechanisms to make new, healthier and younger skin cells. they in essence trick the body into making new skin.

Question 37

explain the effects of BP and Vit-A on black skin

Answer 37

benzoyle peroxide can darken (hp) black skin

vit-a lightens black skin. combining the two on black skin works well.

Question 38

when using retin-a perscription topical, which is the best type to use and why

Answer 38

retin-a gel or lotion is best, the retin-a cream usually has isopropyl myristate which may make acne worse.

Question 39

what is the main function of benzoyl peroxide?

Answer 39

kills bacteria in the pores

Question 40

what is dr. fulton’s favorite topical antibiotic (when needed in addition to bp for more antibacterial action)

Answer 40

erythromycin lotion (because it carries minimal side effects) or
clindomycin (Cleocin-T) some patients say this one is more effective.

he likes to use this at the beginning of treatment when the skin is acclimating to bp, but once the skin can tolerate the bp for longer periods of time, the erythromycin is stopped. it also works great on women with acne, and often times is enough to control the acne altogether along with mild bp at night.

Question 41

what are some of the common oral antibiotics prescribed for stubborn pustules or cysts?

Answer 41

teeetracycline
minocycline (Minocin)
erythromycin (EES-400)

Question 42

when is High-Estrogen birth control used as a possible therapy for acne?

Answer 42

women with chronic, persistent nodular scarring acne

example of high dose estrogen is Ortho-Novum 7-7-7
Demulen is a medium dose of estrogen

Question 43

for a woman who is starting birth control for acne, how long before she will see results?

Answer 43

it takes 2-3 months to see benefts, but give it 6 months. if you are clear after 6 months, stay on it for at least a year