Acne vulgaris is so common that many children in the street could correctly diagnose it. Skin is an accessible organ, particularly the skin on the face. Although acne is often very distressing to those with it, it is not life-threatening, so many people never seek the services of a professional to treat this problem. When a person is trying to DIY acne treatment, most are aware of the warning, however, not to "pop pimples," "pick zits" lest they develop scars.
In the dermatologist's office, however, we often perform a procedure called acne surgery, in which we extract the plug, or puncture and drain acne lesions resulting in a reduction of pain, less risk of scarring and faster clearing of acne. Acne is a essentially a plumbing problem, and like plumbers, your dermatologist may need to physically clear the drain in order to help the acne go away. Patients sometimes perceive us as "picking their zits" when we do extractions as part of their acne treatment. But remember the warning, "Don't try this at home." A trained professional knows the difference between an acne lesion that would respond positively to extraction and one that should be left alone. A professional knows the right techniques to use to get the best outcome and not scratch up the surrounding skin. In addition, it is physically easier to have someone else do this procedure correctly than to try to do it on ourselves.
Perhaps the risks aren't the same as trying to take out your own appendix, but to get the best outcome when if comes to treating acne, a board-certified dermatologist is your partner in achieving beautiful, acne-free skin.
Even people who are disciplined sun protectors miss areas when they are following the advice to use an sunscreen with and SPF of 30 or higher with UVA protection. Before you head to the beach, on that hike, sailing, or just that walk down the street on day to be spent out in the sun, pay special attention to avoid sunburns and sun damage on theses areas:
1- scalp- people who are balding, who have fine hair, or who part their hair in the middle should consider applying liquid sunscreen to the exposed areas of the scalp or wearing a hat or scarf. Sunburns, or even skin cancers such as melanoma can occur on this area.
2- ears- Whether your ears stick out a little or a lot, they are out there, vulnerable to sun exposure. Make sure to protect them.
3- lips- Lip balms with spf, or opaque lipstick, may be in order if you are out in the sun
4- neck- The neck, particularly the back of the neck, often becomes very sun damaged in the unwary
5- the upper chest- Photoaging on the chest, and increased risk of skin cancer, often make the person who has been so meticulous about facial care, look weathered.
The coming July 4th weekend brings to mind the topic of patient empowerment. When one reads about “patient empowerment” in the media, it often refers to technologies that make it easier for patients to directly contact the doctor or the health facility. It often refers to a texting app or a messaging portal. The idea that having a variety of communication tools and direct access gives the patient more power and therefore better health outcomes. Ironically, this isn’t always true.
Technology is not our power. Technology is a tool we can use to express our power. Sometimes it helps us get the results we want. Sometimes it doesn’t help. Many of the modalities that are promoted as providing “patient empowerment” ironically give patients a false sense of powerlessness and unexpectedly damage the doctor-patient relationship.
An example would be the patient who is using an app to text her doctor about an insurance issue. The technology promises that the patient is “empowered” because she has this direct and instant access. It is implied that the doctor’s response, and resolution of the issue, should also be immediate. Many times, however, instant solutions are not in store.
Just because a message can be sent to a doctor immediately does not mean it can be responded to immediately. A doctor in the middle of a patient care visit may choose to respect the patient in front of her by not interrupting his visit by responding to a text message. After hours, the doctor may not have access to the resources to address the non-urgent issue. If the message had been sent to the office or during office hours, it would have been more quickly addressed. Even if the doctor is addressing the issue immediately, the response may not be immediate, as he or she may need to consult other parties to resolve the matter. A patient who doesn’t understand this may get unnecessarily offended.
The resolution of a patient concern is also sometimes delayed because the technology encourages patients to “engage” with their doctors, instead of the appropriate parties (i.e. insurance companies or pharmacies), about matters over which the doctor has no authority. “Is my prescription ready?” “Why do I have a deductible?”
Technology is a great servant but a terrible master. Sometimes it helps patients get what they want. Sometimes it delays them getting what they want. It’s also important to consider that sometimes it is introduced into the health care process not to empower the patient but to empower technology companies and administrators to more efficiently capture patient communications for data collection businesses—at the expense of the efficiency of the patient’s care. Make sure the technology you use can give you the results YOU want.
Power comes from within you…there’s no app for that.
Hair loss, or alopecia, has a number of causes. The cause may have to do with genetics, ethnic background, diet, lifestyle, grooming practices, underlying health problems, local scalp problems and more. Some types of hair loss are reversible. Some types are not. How one treats hair loss depends on why one has it. It is for this reason that it is important to correctly diagnose what kind of hair loss someone has before one embarks on a treatment plan.
As the diagnosis and treatment of skin, hair and nail problems is the foundation of dermatology, a board-certified dermatologist is generally the most experienced in caring for people with hair loss. Some causes of hair loss can be determined with history and physical examination. Sometimes, however, even a hair expert needs more information. This is when a punch biopsy of the scalp is helpful. By taking a pencil-eraser sized piece of skin from the affected area of the scalp, and sending it to an experienced dermatopathologist who looks at it under the microscope, a more accurate diagnosis can sometimes be obtained. Getting a scalp biopsy is particularly helpful when trying to diagnosis scarring alopecia, which is permanent hair loss. Sometimes, even for an expert, it is challenging to know which of several conditions is causing scarring alopecia just by looking at it.
Do you want to know more about hair loss? Listen to Dr. Strachan's interview with Modern Aesthetics magazine: http://modernaesthetics.com/series/modern-aesthetics-journal-club/video.asp?f=diagnosis-and-management-of-hair-loss
Many patients come seeking help regarding dark spots on their faces that they sometimes refer to as scars. They are surprised to learn that their primary problem is acne and that, technically, these marks are not scars but what we refer to as post inflammatory hyperpigmentation.
Acne is a common skin condition that starts with a keratin plug in the hair follicle. The body can react to this plug by mounting an inflammatory response, with redness and swelling, much like it might to a splinter in the skin. In people with dark skin, or skin that tans easily, the body's response with making extra pigment leaving a dark mark. In people with lighter skin inflammation appears as redness or erythema. Although acne can cause scars, neither the dark marks, nor the red marks, made by acne are scars. True acne scars occur when the inflammation is more severe causing destruction of tissue or an abnormal healing response causing thickening of tissue. Discoloration caused by acne is generally temporary. Scars, however, are permanent, although they improve over time.
Another way to distinguish discoloration caused by acne and scars caused by acne is to compare them to a tee shirt. If one were to spill wine or coffee on a white tee shirt, this would be the equivalent to post inflammatory hyperpigmentation (dark marks) or persistent erythema (pink marks). These marks could generally be removed. If one were to tear the fabric of the tee shirt and then patch it up, this would be like an acne scar. The hole would be gone but the texture would not be the same.
Either way, the best way to treat and prevent dark marks, red marks and scars from acne is to treat the acne.
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Dr. Dina D. Strachan, MD
Dr. Strachan (pronounced 'strawn'), the director of Aglow Dermatology board-certified dermatologist who specializes in medical and cosmetic dermatology.
Visit Dr. Strachan's Vivacare page
to learn more about the conditions she treats and the services she offers, from Acne to Zyrtec.