The Proper Way To Pop A Pimple

There is a right way to pop a pimple; take it from me, I do this professionally. If done improperly, you could turn a minor blemish into a full-blown pimple crisis. If done correctly, you could eliminate that spot in 72 hours. Here are 10 tips to properly pop a pimple. Continue reading “The Proper Way To Pop A Pimple”

Skin Care Myths: Always Apply Antibiotic to a Wound

We are a germaphobic society. This is partly for good reason; MRSA, an aggressive staph infection, lurks everywhere, and we are constantly on watch for some deadly bird flu to descend upon us. Continue reading “Skin Care Myths: Always Apply Antibiotic to a Wound”

Skin Care Myths: Antibiotics Make Your Birth Control Pill Less Effective

birth-control-pills.JPGA young woman who I saw in clinic this week was on birth control pills for contraception. She had acne and I suggested we start minocycline, an oral antibiotic, to treat her. “Won’t that stop my birth control pill from working?” she asked. Good question. Continue reading “Skin Care Myths: Antibiotics Make Your Birth Control Pill Less Effective”

Over the Counter Wart Treatment Not as Cold as Mine

OK. There’s cold. Then there’s really cold. Growing up in Providence, RI, I can remember waiting for the school bus on frigid January mornings. Some days, it was zero degrees. I can tell you, when it’s zero degrees out, a 30 degree day feels balmy.

It’s the difference between cold and really cold that matters when it comes to treating warts.

A recent study in the Journal of American Association of Dermatology explored the difference between over the counter wart freezer and the one that we use in dermatology clinics. They found that the coldest the over the counter product could achieve was -4° F (-20º Celsius). Pretty cold.

But the liquid nitrogen used in dermatology clinic was colder than -148º F (-100º Celsius), the lowest the sensor could measure — much colder than the over the counter version!

I am sure your wart will be able to tell you the difference.

Bacteria Secretes Sticky Glue, Causing Acne

sticky gum

Propionibacterium acnes (P.acnes) is the bacteria found in acne. A new study in the Journal of the American Academy of Dermatology has shed some light on how it wreaks its damage.

P. acnes lives in a biofilm, an aggregation of bacterial organisms and sticky extracellular substance, that allows it to stick to the wall of the hair follicle. This sticky substance also causes the skin cells to stick together, limiting their ability to shed. These stuck-together skin cells (keratinocytes) then block the hair follicle, forming a keratin plug and trapping the natural oils (sebum) below the surface. When the pressure from this trapped oil builds up, a pimple is born. The acne bacteria then live happily encased in their protective biofilm, trapped in the follicle.

This is why combination therapy is most effective against acne; if you don’t break up the keratin plug on the skin’s surface, then antibacterial medications cannot penetrate and won’t work.

Proactiv® works by employing a mild acid to break up the plugged pores and an antibacterial to kill the P. acnes. Prescription acne therapy works similarly. I often prescribe a retinoid, like Retin-A, to break-up the keratin plugs and an antibiotic, like benzoyl peroxide or clindamycin, to kill the bacteria.

Unfortunately, even with the appropriate combination therapy, it still takes up to 12 weeks to clear up your acne. On the up side, if you follow this regimen daily, you really will see results.

Burkhart, CG and Burkart, CN. Expanding the microcomedone theory and acne therapeutics: Propionibacterium acnes biofilm produces biological glue that holds corneocytes together to form plug. J Am Acad Dermatol 2007;57:22-4

Photo credit: FCC, xcaliber

Itchy Henna Tattoo


A patient of mine presented last week with an itchy tattoo. He had been on a cruise and had this temporary henna tattoo placed on his right arm. A few days later when everyone else’s tattoos were fading, his got darker and became itchy. The redness and itching became much worse over the next week. What happened?

My patient is allergic to para-phenylenediamine (PPD).

PPD is a coloring that is used in permanent hair dyes. It is also sometimes added to henna to create a dark color, or “black henna,” for temporary tattoos.

Contact dermatitis is a delayed type hypersensitivity reaction; it’s the same type of allergy that occurs after exposure to poison ivy or poison oak. It takes 1-2 days to develop the rash from an allergen, and the response can last weeks.

If you are allergic to hair dye, then you should be weary of getting a henna tattoo. PPD can also been found in printer inks, black rubber, and photodevelopers.

What is more problematic (especially for those studying for the derm boards) is that PPD can cross-react with sundry other things, causing an identical allergic reaction. These include PABA sunscreens, azo dyes (found in fabrics), benzocaine anesthetics, and sulfa drugs.

My patient was treated with topical corticosteroids and the itchy rash resolved. Some patients actually need oral steroids to treat this; consult your physician if you think you are having an allergic reaction to your tattoo.

And don’t get a tattoo that you wouldn’t want your dermatologist (or mother) to see.