I love my iPhone. (No, that’s not me in the photo.)

My iPhone is teeming with apps that help me get through my day (like Doodle Jump for instance). An emerging iPhone trend is the development of apps that diagnose and treat diseases. For example, there is the stethoscope app to help diagnose heart murmurs. In dermatology, there is an app designed to treat acne.

We know that specific wavelengths of light can have medicinal effects such as killing bacteria (red light) and reducing inflammation (blue light). This app produces light at those wavelengths to treat acne. The claim is that by holding the iPhone to your face, the light produced from the app will treat your acne.

Although it scores a 10 on 10 in the coolness factor, it scores a 0 on 10 for proof of efficacy. The studies that looked at treating acne with light used much more intense light than an iPhone uses. The studies with more powerful light exposed faces for 60 minutes every week, which is about 8 minutes on each side every day. Even then, light treatments for acne have not been shown to be consistently better than standard acne treatments such as antibiotics and tretinoin.

So does the acne app work? Well, there are no studies to tell us. Given that the light intensity is low and that most people would not do the treatment — try holding your phone for 2-5 minutes on each side of your face every day for months — I doubt it works.

Acne is common and naturally gets better and worse at times no matter what you do. It is unfortunate that products like this are sold that do not have any proof that they work. There will be people who buy this app and believe that it helped them, (“My acne was clear in just THREE DAYS!”) but the two bucks is better spent on Doodle Jump.

See also:

Can an iPhone App Clear Up Your Acne?

In Light and Heat, Gadgets Claim to Fight Acne

Better Skin to the Touch?

Can You Treat Acne With an iPhone App?

A study to determine the effect of combination blue (415 nm) and near-infrared (830 nm) light-emitting diode (LED) therapy for moderate acne vulgaris.

Photo: Aye Shamus (flickr)

Proactiv® is the most popular acne treatment in the US. If Proactiv is so popular (and used by all those now-acne-free celebrities), then it must be a great product, right? Well, maybe. Here are the pros and cons of Proactiv.

Pros

Proactiv works. It attacks the two main causes of acne: blocked pores and buildup of bacteria. Proactiv uses exfoliants to unclog pores and uses an antibiotic, benzoyl peroxide, to kill acne-causing bacteria.

The three part Proactiv system is mild, but because it is repeated twice a day, every day, it is effective. By sending you products every two months, the company encourages you to continue using it (after all, it’s already paid for) even when you don’t have a breakout. This helps prevent new acne, which is better than treating pimples you have.

Cons

Although it is designed to be mild, Proactiv can cause redness, stinging and peeling. Some people cannot tolerate the active ingredients in Proactiv and have to limit their use to once a day or less.

Like any acne treatment, Proactiv takes about 8 weeks to see results; you won’t see much improvement before then. Also the benzoyl peroxide in Proactiv can bleach clothes, towels, pillow cases, and even hair.

Proactiv can be expensive. The active ingredients in Proactiv can be purchased separately for less money than if you paid for the Proactiv brand.

Proactiv does not cure acne, but nothing does. The average teenager has acne for 7 years and adult women can have acne for 20 years! Even if your acne is well controlled, as soon as you stop treating it, it can come back.

The primary reason why Proactiv and other acne treatments fail is because people stop using them. Treating acne is time consuming and continuous. Just like exercise, treating acne only helps you if you keep it up.

If you have moderate to severe acne, painful acne cysts, or scarring from acne, then Proactiv is not potent enough to treat you. A dermatologist can prescribe medications that are stronger and more likely to improve your acne.

That is, if you use them.

Photo: Uh, Bob (flickr)

Dear Dr. Benabio,

OMG, my face is a disaster! My acne is worse than ever. PLZ help me!

Desperately,

Your Patient

Many of my patients email me; this is the most common email I am getting this week. Why is everyone’s acne flaring up all of a sudden? It’s because of this simple formula: [High School Stress + Hormones = Acne].

Acne results when your pores clog, trapping sebaceous oils and bacteria deep in the skin. When you’re under stress, your body releases cortisol, a hormone that helps you stay alive in life or death situations. High school, however stressful, is not usually life or death, but your body doesn’t know that, and it reacts as if it were.

Two side effects of increased cortisol are increased sebaceous oil production and increased inflammation in your skin. The result: big, red pimples in the middle of your face that make you now wish you were dead.

If you have painful, cystic acne bumps, then your dermatologist can inject the worst ones with steroids to reduce the inflammation and to flatten them out quickly — “Nurse! Give me a syringe with Kenalog. Stat!” (Who said I don’t do emergencies?) Steroid injections can, however, cause atrophy or dimpling in your skin, which can last for months — much longer than the original pimple.

• Spot treating acne is difficult at home. Tretinoin products such as Retin-A, Differin, or Tazorac do not work if applied to acne spots.
• You can pop a pimple; however, unless it has a white head, squeezing usually just makes a little pimple into a big pimple.
• Apply a spot acne treatment such as Neutrogena Rapid Clear Fight and Fade Gel. The mild acids in it help dissolve a pimple when applied directly.
• Use a spot cover-up or concealer that has salicylic acid in it. Yes, guys, it is OK for you to apply a dab of cover-up. Use your sister’s.
• If you have a little extra cash lying around (humor intended), then acne zappers like Zeno can help. They apply heat directly to the pimple killing the bacteria and hastening recovery. Or just use your iPhone, (I’m sure they will have an app for that soon, right?).

Remember that school is stressful, so eat well, sleep well (preferably not in calculus class), and exercise regularly. These will decrease your stress hormones and help keep you acne free.

Disclaimer: I did not receive any free products or reimbursement from any products mentioned in this post; these are my unbiased suggestions.

Photo: John Steven Fernandez

Argh! You cleaned out your high school locker years ago and now you have acne pimples on your jaw this morning. You’re not alone — 1 in every 5 women over 25 has acne.

Adult acne, in contrast to the teenage type, occurs more often in women. For some women, this is the first time they had acne; we call this late-onset acne. For other women, their acne never stopped from childhood into adulthood; we call this persistent acne. Many of my women patients have other names for adult acne, but they cannot be printed here.

It Must Be Hormones

We like to blame everything on hormones. In the case of acne, hormones contribute, but they are not the only factor. Stopping birth control pills causes a change in hormones and is  a cause for acne in adult women. Similarly, using progestin-only birth control pills affects hormones in such a way as to cause breakouts. Pregnancy is a time of dramatic hormone fluctuations and for some women, dramatic acne. Similarly, menopause can trigger outbreaks. Despite these known hormonal triggers, most women who have acne do not have hormonal imbalances (they are normal fluctuations in hormones). Foods or supplements that claim to balance women’s hormones don’t. So save your time and money, they won’t help your acne.

You Can’t Scrub Acne Away

Exfoliating to open pores can help, but only when done in moderation. Harsh scrubs or repeated microdermabrasion will irritate the skin and make acne worse. Instead, use mild chemical exfoliators such as salicylic acid or glycolic acid which are found in many women’s cosmetics and in acne treatments. Products that contain benzoyl peroxide also help to exfoliate and will treat adult acne.

Don’t Give Up Your Scharffen Berger Chocolate

Although myths of chocolate and pizza causing acne have been disproved, it is true that consuming cow’s milk (which contains hormones) as well as eating a diet high in carbohydrates (which causes inflammation) can contribute to acne. Eating chocolate once and a while, especially good chocolate, will not cause or worsen your acne.

Cosmetics Cause Acne

Many skincare products contain ingredients that clog your pores, triggering acne. Pantene shampoo as well as many hair conditioners have been known to cause this problem. Also, sunscreens are notorious for causing acne. If you notice that your acne is worse around your hairline or that it has flared since you started sunscreens, then try changing your products; it might be all you need to clear up your face.

Photo: Foundphotoslj (flickr)

Post written by Dr. Benabio Copyright The Derm Blog 2009

Everybody is talking about the blue light. It is the latest gadget for treating acne (and admit it, we LOVE gadgets).  But can you really treat acne by simply shining a blue light on your skin?

Acne is caused by bacteria that flourish in the pores of your skin. Clogged pores on your skin fill with oily sebaceous material. These warm, oily pits are breeding grounds for P. acnes, the bacteria responsible for acne. Overgrowth of the bacteria leads to inflammation and eventually (quite) noticeable pimples on your face.

Blue light therapy started as an office-based procedure only. Patients with acne would see their dermatologist for treatment. The physician would often apply a sensitizer to the skin called Levulan about 30 minutes before the procedure. Then the patient would sit in front of a blue light source called Blu-U for several minutes. This was repeated several times each week for about 6 weeks.

The therapy worked well. The sensitizing agent penetrated the skin. When treated with the blue light, it absorbed the energy from the light, killing the bacteria and frying the sebaceous glands, decreasing the oil production. It is, indeed, the ultimate dermatologist’s gadget.

So what’s the downside?

First of all, it is expensive. Each treatment costs about $200. A complete course of 8 treatments costs about $1,600. Although it is effective in improving acne, the results might not last, and you may need to continue treatments to keep your acne under control.

A second problem is that the Levulan sensitizes you not only to the blue light but to any light. As a result, you have to be extremely careful about sun exposure for 48 hours after your treatment. Failure to protect your skin after applying ALA can result in a serious sun burn.

A third problem is that the treatment hurts. The combination of the sensitizing agent plus the light treatment will give you a stinging sensation. For most people the treatment is tolerable, but some people find it too uncomfortable to stand.

We now know that light by itself actually kills bacteria; the bacteria produce a natural substance that is similar to the ALA. As a result, the bacteria absorb the blue light and are obliterated. Cool, huh?

Because the sensitizing agent is not necessary, you no longer have to go to the doctor’s office to get treated.  Several companies have developed hand-held blue light devices that you can use yourself at home (Woo-hoo, your own personal acne gadget!).

Recent studies have shown that blue light-only treatments are effective in treating acne. What’s the downside here? Again cost might be a factor. A hand-held blue light acne unit might cost about $250 to $300. 

The main problem is that you have to use it. In order for the light be be effective, you have to hold it against the skin for about 3 minutes everyday. That might not seem like much, but if you have several areas, like both cheeks and forehead to treat, then it could take about 10 minutes each day.

Considering that the average person brushes his or teeth teeth for just 46 seconds, 10 minutes is a long time. 

Photo: Freaksanon (flickr)

Many of my patients ask me about Proactiv. You know, the stuff that makes Vanessa Williams, Jessica Simpson, Kelly Clarkson, Sean Combs, Brooke Shields, Elle MacPherson, and Jennifer Love Hewitt beautifully blemish free. Patients want to know if Proactiv really works. I’ll address that here, but first, here’s a short intro on acne.

If you have acne, then you are like most people. Acne is common — about 85% of teenagers develop it and many adults, especially women, have acne in their 20’s, 30’s and even later. Proactiv is an acne treatment system, designed by two dermatologists, that uses non-prescription medications to clear up acne. It was designed with adult women in mind, but is used by millions of teenagers all over the world. Proactiv does not cure acne (nothing does), but it does work. Here’s how.

The basic Proactiv solution is a three part system comprised of a cleanser, a toner, and a lotion. There are several add-on products, but the acne treatment is in this three part system. In order to understand how Proactiv works, you have to first understand what causes acne.

Acne is a skin disease where red bumps, clogged pores, and tender cysts develop in the skin. It is sometimes painful and almost always embarrassing. The bumps you see on your skin today began about 2 weeks ago. Each acne blemish starts as a clogged pore. These pores are the opening of hair follicles. The skin cells at the surface of some of the pores do not shed normally. Instead, they stick together, clogging the pore. When the pore is clogged, the natural oils from the hair follicle accumulate in the pore, building up pressure and creating an airtight, warm environment for bacteria to grow. Bacteria build up in the blocked pore; as a result, white blood cells accumulate to attack the overgrown bacteria. The combination of blocked sebum, bacteria, and white blood cells (pus) lead to tender red bumps that we call acne.

The Proactiv system works to stop this process. The first step is to use a cleanser. The cleanser has tiny beads that help to physically exfoliate the dead skin cells, unblocking the pores. The cleanser also contains benzoyl peroxide. This is a powerful oxidizer that both exfoliates the skin as well as kills bacteria (similar to hydrogen peroxide).

The second step is to use a toner. The toner contains glycolic acid. This is a natural acid found in citrus fruits. It also works to exfoliate the skin and to unstick sticky-cells. It is a chemical exfoliant and compliments the physical exfoliant in the cleanser.

The third step is to use a repairing lotion. In actuality, it is another dose of benzoyl peroxide, now in lotion form. Again the benzoyl peroxide helps exfoliate the skin and kill the bacteria.

Although there are other anti-inflammatories, moisturizers, and botanicals in Proactiv, the main treatment is from the exfoliants and the benzoyl peroxide.

Proactiv is effective for many people with acne. The main reason why it works is because people actually use it. The system is designed to be used everyday and over your entire face. The whole concept is for you to be “proactive” about treating your acne. It is also a good product because the benzoyl peroxide, which is one of the most effective treatments for acne, is a mild strength, only 2.5%. At this strength, the benzoyl peroxide is mild enough to not be too irriating, but strong enough to treat your acne, especially since it is used in two products and applied twice a day.

Photo: Specialkrb Flickr.com

Tea tree oil is an essential oil that has antiseptic properties. It has been used as a natural antifungal and antibacterial agent. You might have heard that teat tree oil can help treat acne because it kills acne-causing bacteria. However, unlike benzoyl peroxide and retin A, there is not much evidence that tea tree oil is an effective treatment for acne.

There are only two published studies on the use  of tea tree oil for acne. The first was done about 10 years ago in Australia. It showed that 5% tea tree oil is comparable to 5% benzoyl peroxide. The tea tree oil took longer to work, but appeared to be less irritating than the benzoyl peroxide. The second study, which was done in Iran, showed that 5% tea tree oil was more effective than a placebo in treating acne. Comparing tea tree oil  to a placebo, which is essentially comparing it to non-treatment, is not the same thing as comparing it to another acne-fighting treatment. It’s likely that tea tree oil has some effect on acne but it has never been shown to be better than traditional acne therapies.

In contrast to other acne treatments, however, tea tree oil is an increasingly common cause of skin allergies. Like other fragrant oils such as balsam of Peru, tea tree oil can trigger an allergic contact dermatitis in people who are sensitive. This can range from a minor itchy rash to a full scale blistering eruption.

Tea tree oil is also toxic if swallowed. If consumed, even in small doses, it can cause reduced immune function, abdominal pain, diarrhea, drowsiness, confusion, or even, in rare instance, coma.  If applied in the ears, it can lead to hearing loss. It has been shown to be toxic to animals when applied to a large area of skin. Tea tree oil can affect hormones as well. One study published in The New England Journal of Medicine showed that repeated application of topical products containing tea tree oil (and lavender oil) could cause prepubertal gynecomastia, a rare condition resulting in enlarged breast tissue in prepubscent boys. Tea tree oil is not recommended for pregnant or nursing mothers.

Because tea tree oil is a naturally occurring substance, it tends to get good publicity, but it’s probably only an average or below average product for acne. Oftentimes people believe that since tea tree oil is natural, it must be safe and better for you than traditonal acne treatements. It’s not true. Remember, turpentine (a related tree oil that is used to strip paint) is also natural, but it doesn’t mean it’s good for you.

Photo: Shek Graham

Treating acne is expensive. You can spend hundreds, even thousands of dollars trying to get your face clear. Here is a simple, yet effective way to save money on acne medications.

All over the counter acne treatments work by using two basic ingredients –

1. An antibiotic to kill acne-causing bacteria and 2. A peeling agent to unclog your pores.

Proactiv® is a widely popular acne kit available by mail; it’s a nice combination of washes, toners, and lotions. If you can afford it, Proactiv is an effective treatment for mild acne. Its active ingredients are 2.5% benzoyl peroxide (the antibiotic) and glycolic acid (the peeling agent).

You can recreate the same acne therapy by buying the ingredients separately. For example, if you used CVS Acne Gel ($3.99) and Aqua Glycolic Toner ($12.28) daily you are using the same active ingredients as Proactiv. The only real difference is the cost:

Proactiv: $40 to $60 (depending on the extras)

Do-it-yourself-activ: $16.28.

Over a year you could save over $250. Remember that any acne therapy only works if you are “proactive;” that is, you must use it faithfully everyday for 2 to 3 months to see results.

Photo: Marissa Cap

It was a real dilemma. A patient of mine came to see me last week for acne. He is the star quarterback for one of the local high schools and is having a great season. At the same time that his passing-yards-per-game increased, so have the number of pimples on his face. Interestingly, his acne is confined to his chin and jaw.

So here is this handsome kid who is the new star on campus with big red pimples all over his chin. Could his acne be related to football?

It is. Acne is common in teenagers, over 80% have some acne during these years. While we have dispelled some of the myths, like eating greasy foods makes acne worse, there are things in a teenager’s life that can exacerbate the problem: in this case, football equipment.

There is a skin condition called acne mechanica that occurs in areas where the skin is occluded. This often happens under athletic equipment. It is common in high school athletes, especially hockey and football players. When solid or nonbreathable materials, such as pads or straps, rest on the skin, it occludes the pores. Heat and friction under the material makes the problem worse.

It can be improved by applying a breathable fabric such as cotton between the equipment and the skin. Treating the skin with mild exfoliants such as salicylic acid acne washes or with antibiotics like benzoyl peroxide washes can improve the acne. Sometimes oral antibiotics are needed to clear things up.

A similar condition to acne mechanica is folliculitis. This inflammation of hair follicles can be difficult to distinguish from acne; it is treated in the same way. Anytime you have an infection of the skin it important to see a physician — sometimes red, pus filled bumps can be a staph infection such as methicillin resistant staphlococcus aureus (MRSA). MRSA infections are not uncommon in high school athletes and can spread in the locker room or lead to more serious infections.

My patient put a cotton pad under his chin strap and took oral antibiotics. His acne is already better. So is his pass rating; maybe its just coincidence, but I don’t think so.

Post written by Jeffrey Benabio, MD
Copyright The Derm Blog 2008, All Rights Reserved

Photo: Edward Leger

A recent study published in the Journal of Drugs in Dermatology showed that rosacea can be exacerbated by cinnamon.

Rosacea is an acne-like condition seen in adults. It can take several forms, but commonly presents as pimples on the nose and cheeks. The study reports on a woman with mild rosacea who started taking oral cinnamon oil pills to treat her diabetes. Two weeks after starting the cinnamon pills, her rosacea became much worse.

When she stopped the cinnamon supplements, her rosacea improved. Interestingly, whenever she ate any type of cinnamon after this, her again rosacea worsened.

Using cinnamon to lower blood sugar and cholesterol levels has been growing in popularity. It’s thought that some properties of cinnamon might act like natural insulin in your body and might decrease your blood sugar levels. Clinical evidence for how effective cinnamon is at lowering blood sugar or cholesterol, however, has been minimal thus far.

Cinnamon certainly does act as a vasodilator, that is, it dilates blood vessels. As one of the main problems in rosacea is dilated blood vessels on the face, it’s likely that cinnamon could worsen these blood vessels and make rosacea worse. Dilated blood vessels can also lead to increased inflammation, which would also worsen rosacea.

This post is written by Jeffrey Benabio, MD

You might also like:

The Proper Way to Pop a Pimple

How Do Birth Control Pills Control Acne?

Are You Over-Scrubbing Your Face?

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