63-year old suffers from acne

DEAR DR. GOTT: I am 63 and have been plagued by acne since my teenage years. I have, however, found that a way to greatly reduce this problem is by not drinking milk, although skim or 1 percent may be OK. I also try to avoid other foods such as dairy products that are high in fat. I love dairy, but I do try to avoid the fat.

Thanks for your excellent column.

DEAR READER: Acne, while extremely annoying, is rather common, especially during the teen years. It becomes less common as we age. The condition is caused by an oily substance known as sebum that is produced by the sebaceous glands of the skin. The substance clogs pores that in turn attract bacteria causing the pores to become inflamed. [Read more...]

Acne can be difficult to treat

DEAR DR. GOTT: I am a 14-year-old female with acne on my back and arms that just won’t go away no matter how much I scrub, cleanse and moisturize. I was wondering if you have any suggestions to help me.
DEAR READER: While people of all ages can get acne, you are 14, and changes are occurring in your body. Many teenagers are susceptible to your very problem, and hormones might be the cause. Other possibilities are the use of birth-control pills (although some physicians might order the pill in an attempt to control acne), an overproduction of oil, a buildup of bacteria or an irregular shedding of dead skin. The condition is not caused by being dirty and, in fact, intense cleansing might even make matters worse. I am sure that your skin is sensitive. Scrubbing with a coarse washcloth or harsh soaps or astringents might further irritate the condition.
Wash the affected areas with a gentle cleanser, use over-the-counter lotions to dry up oil and kill bacteria, consider using tea-tree oil (which may produce mild skin irritations in some people), and speak with your doctor about supplemental zinc or brewer’s yeast. Beyond that, medical treatment might include the use of prescription medication, antibiotics, laser and light therapy or dermabrasion.

Cystic acne difficult to treat

DEAR DR. GOTT: My daughter is 18 years old. She has swelling in her left cheek that is now moving into her eye. Her dermatologist says it’s cystic acne. We tried tetracycline and erythromycin, to no avail. What can we do? Your help would be appreciated.

DEAR READER: Let’s start with some basic facts about acne. First, despite popular belief, acne can occur to anyone at any age but is most common in teenagers. Because of this, it is thought that hormones may play a role. For some women, the week prior to menstruation, pregnancy or starting/stopping birth control may also cause outbreaks.
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Did med cause skin condition?

DEAR DR. GOTT: While in Vietnam, I was taking a dapsone pill daily, as the Army suggested. Unknown to me, I had an allergy to the pill and became methemoglobinemic. I stopped taking the pill, but still have lichen planus on my legs and buttocks that comes and goes. I can go weeks with no trouble, then I have a breakout that will last for up to a month before clearing. I read that the dapsone could be the cause of the onset of the lichen planus. Can you tell me if this is right or wrong? Where can I find more information?

DEAR READER: Dapsone is commonly prescribed to treat dermatitis, herpetiformis (a skin condition that commonly appears on the elbows and knees), acne, infection and more.
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Daily Column

DEAR DR. GOTT:
I have a form of acne that is called hidradenitis suppurativa. Could you please tell me if there is anything that will clear this up?

DEAR READER:
Hidradenitis suppurativa is considered to be a severe form of acne that causes chronic skin inflammation. It is marked by the presence of blackheads and one or more tender lesions which often enlarge, break open and drain pus.

It commonly occurs around hair follicles and oil and sweat glands. It is frequently found in the armpits, anal area and groin. It can occur in any area where skin rubs together such as the inner thighs. It can affect one or several areas of the body.

Women are more likely to develop hidradenitis suppurativa. A family history of the condition increases the risk of developing it. [Read more...]

Sunday Column

DEAR DR. GOTT:
When I was 19, I had my acne burned off with X-rays. Twenty years later, it came back so I took tetracycline for thirty years. My acne didn’t disappear but started to change so my primary care physician sent me to a dermatologist. I was told that the acne was being replaced by rosacea.

I couldn’t tell the difference in the early stages of the transition. About a year later, however, the change was very apparent. At this point I was put on minocycline twice a day and have taken it for over six years.

My skin has always been very oily and I have inordinate amounts of seborrheic keratoses, some too big to freeze off. Now, if I stop my minocycline for three weeks, what looks like pus drips off my nose. Once I start the medication again, it takes another four months to get back to normal.

Is there any way off this treadmill? Like me, it’s old.

DEAR READER:
Rosacea is an increasingly common, chronic condition with about 14 million sufferers. It primarily affects the face but can also appear on the chest, scalp, ears and neck. It is generally characterized by redness on the checks, nose, chin or forehead. There are four types of rosacea, subtype 1 (flushing and persistent redness), subtype 2 (persistent redness with red bumps and pus-filled pimples), subtype 3 (thickened skin usually with enlargement of the nose) and subtype 4 (affects the eye, usually dry eye, tearing/burning, swollen eyelids, recurrent styes and more).

Rosacea has no known cause but it is believed that those with fair skin who blush/flush easily are at higher risk than others. It occurs in women more frequently. However, affected men tend to have severe or advanced cases. There is no cure but, with early treatment, it can be controlled.

Treatment generally starts with oral antibiotics and topical creams. These usually bring the condition under immediate control and is then maintained with long-term use of topical therapy. Some individuals may receive treatment with intense pulsed lights or lasers. Some may have visible blood vessels removed, nasal deformities from excess tissue corrected or doctors may attempt to reduce extensive redness.

If you would like more information, I recommend you visit the National Rosacea Society’s website, www.rosacea.org.

You also mentioned seborrheic keratoses. These are benign, non-invasive skin growths that usually develop around midlife or after. They generally appear as sharply margined, raised, yellow/light tan to black waxy or scaly oval lesions on the face, chest, shoulders and back. Because they are benign and harmless, you do not need to worry about them. They can be a nuisance if they are irritated or rubbed by clothing or are cosmetically unsightly. Your dermatologist may be able to remove or reduce the appearance of the larger lesions with other procedures, such as curettage (scraping) or electrocautery if they truly bother you. In some instances, two of the procedures will be used in conjunction (usually cryosurgery and curettage or electrocautery and curettage). Seborrheic keratoses have no known cause but may be related to sun exposure. Normally only one or two will appear over many years. See your dermatologist if the lesions start to bleed or if they appear rapidly because this may be a sign of skin cancer.

A dermatologist is your best bet. Ask him or her about possible treatment options and express your concerns about the current treatments you are receiving for your skin disorders. You may choose to go to another dermatologist for a second opinion. Your dermatologist appears to be handling your care very well. Good luck and let me know how this turns out.

Lack of sleep causes inflammation

DEAR DR. GOTT: I have noticed a direct correlation between lack of sleep and the eruption and/or proliferation of acne on my face. In fact, I have noticed that I experience a general feeling of being inflamed (breast tenderness, abdominal bloating and body aches) when I miss sleep or it is interrupted. I have found that taking a dose of ibuprofen will stave off the acne or the general feeling of inflammation if I know in advance I will not be getting adequate sleep.

Is this a bad practice? Is there anything I can do to arrest this process when those unavoidable interruptions occur? Is this an indication of a deeper, perhaps hormonal issue that can be treated?
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