Acne is one of the most common of all skin problems. It affects most teenagers to some degree and even more adults. Acne shows up as whiteheads, blackheads, pimples and deep painful bumps that look like boils. Acne most commonly occurs on the face but can also appear on the neck, back, chest and shoulders. It is estimated that as many as 80% of people between 12 and 25 years of age suffer from acne. While in most people, acne clears up after few years, many suffer from permanent scarring of the skin. Even when there are few physical marks left, the emotional ones can be devastating.

Acne problems are commonly faced by many young adults and teenagers today. Some people develop acne even at forties and fifties. According to Dr. Rothfeld at NYC Dermatology acne is believed to develop due to various factors like hormonal imbalance, sebum secretion, hereditary factors, and food habits.

There are many treatment options for adult acne problems, but it is not mandatory that everyone gets cured. Dermatologists prescribe medicines taking skin care into concern. In many cases, blood and urine tests are taken, to test for any underlying causes. Severe acne patients are given antibiotics and very severe adult acne patients are treated with laser surgery, considering the seriousness of the problem. People suffering from acne should consult board certifed dermatologists like Dr. Gary Rothfeld and then undergo treatments that are suitable to them.

Acne treatments are always done on the basis of severity of condition. Mild acne problems can be treated with topical products containing benzoyl peroxide, salicylic and glycolic acids. Some persistent acne patients may require systematic antibiotics like tetracycline, erythromycin, and acutane. New methods like chemical peels and lasers are also included in the treatments to eradicate pimples and the marks present.

Comedo Extraction
Sometimes removing comedones proves beneficial. To extract whiteheads and blackheads, dermatologists use a sterile pen-sized device. This procedure should only be performed by a dermatologist.   Patients’ attempts to extract comedones and drain cysts by squeezing or picking, can lead to worsening of the acne, scarring and infection. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other bacteria. Dr. Gary Rothfeld, a board certified dermatologist at NYC Dermatology performs this procedure personally. 

 In many cases, acne cannot be cured completely, but can definitely be controlled in almost every case. Some basic steps need to be followed by adults. They should always touch their face gently, even when washing. Their diet should be as healthy as possible, and they should avoid oily or greasy foods whenever possible. Men should be careful while shaving using electric or ordinary razors, as these can negatively affect acne.

When pimples arise, the need to flatten them out and squeeze is understandable. Unfortunately though, this may lead to short and long-term problems such as persistent redness, large brown stains (hyperpigmentation) and scarring (loss of skin substructure). Stains and scars are often confused by patients – stains are pale or brown flat marks whereas scars can be seen as indentations or pock marks in the skin. It’s now recognized that scars can also develop from small as well as large lumpy pimples.

For both scars and stains, the best treatment is avoidance - that is, preventing the acne in the first place or at least treating it early and avoiding picking or squeezing the spots.

To treat acne and prevent new scars from forming, you should remember:

• You should get help for your acne as soon as you notice it as early treatment minimizes the severity of acne and the risk of scarring
• Effective acne treatments are available
• You can control and cover the visible lesions and avoid embarrassment

Types of Acne Scars

It is common to have stains and mild scars from acne. Stains will generally improve with time and can be helped to improve more quickly with skin care treatments such as topical retinoids, alpha-hydroxy acids and therapeutic exfoliating facials. For many of those with mild scars, they may not even be aware of it – some of these may improve over time. However, severe scarring may be more difficult to treat.

There are a number of types of scars caused by acne.

• Ice pick scars - Deep pits, that are the most common and a classic sign of acne scarring.
• Box car scars - Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
• Rolling scars - Scars that give the skin a wave-like appearance.
• Hypertrophic scars - Thickened, or keloid scars.

Acne Scar Treatment Facts:

• Ideally, acne should be quiescent or controlled before treating scars
• Treatments for scars depend on the specific scar type
• Treatment also depends on your skin type.
• Embarrassment from is most often due to facial scars – effective treatment can lead to an improvement in self-image and confidence
• Scars on the chest and back will also respond to  intralesional steroid injections. For Acne Scars on the Face: Skin Fillers/injectables: Materials are injected into the depressed area of the scar to elevate it to the level of the normal surrounding skin. This treatment is best for scars with smooth shoulders such as thumbprint or rolling scars. Evaluating whether individual scars will respond to fillers is easily done by placing slight tension at the scar edge – if this improves the appearance of the scars, fillers will help. There are temporary and permanent fillers - examples are: Artecoll®, Zyplast®, Restylane®, and HylaForm®, and Cosmoplast. At NYC Dermatology by board certified dermatologist Dr. Gary Rothfeld customizes every patients' therapy on an individual basis.

Non-ablative collagenosis:

New laser and radiofrequency devices are being evaluated for enhancing collagen formation in deeper skin layers without damaging the skin surface. It is possible that these treatments may also prove useful in acne scarring.

 Photorejuvenation:

Using laser or broadband visible light, 5-6 treatments that are performed every 3-4 weeks. This treatment improves mild acne scarring by causing new collagen formation.  Dr. Rothfeld at NYC Dermatology performs these procedures.

Fraxel laser approved for acne scar treatment

 Resurfacing:

a) Ablative Laser Treatments: - Laser resurfacing (CO2 laser, Erbium Yag laser): These resurfacing lasers remove the surface layer of skin and cause a zone of heat injury. The healing process allows for reformation with younger less scarred skin and deeper layer of new collagen formation.

b) Dermabrasion: - This is a mechanical procedure in which a rapidly rotating wire or brush is used to strip off the surface irregularities of skin. Felt by most experts to be the most effective primary treatment for extensive scarring, it can be used in conjunction with fillers and excision