Acne in Virginia, Washington D.C. and Maryland

Acne, or Acne Vulagris, is a common skin condition affecting teens and young adults ages 11-30. Acne usually appears on the forehead, chest, upper back, shoulders, and face. It can vary depending on the individual, and for some people, acne can lead to emotional distress and cause scarring on the skin. A sudden onset of acne in older adults can be a sign of an underlying medical condition that should be addressed.

Causes of Acne

We all have pores all over our skin, which consists of a hair follicle and a sebaceous gland that produces an oily substance known as sebum. Sebum is great for keeping hair healthy and protecting our skin from losing water. During puberty and with certain hormonal abnormalities pores can enlarge and produce more sebum. Sebum also helps create a comfortable environment for bacteria that live on the skin. When a pore becomes plugged due to excess sebum and dead skin cells it can become infected with bacteria. Inflammation and pus may result underneath the skin, giving rise to acne.

Factors known to Aggravate Acne

• Aging
• Certain foods
• Chronic stress
• Family history
• Dead skin buildup
• Skin produces too much oil, which clogs the pores
• Hormonal changes
• Certain medications
• Excess friction or pressure on the skin
• inflammation of the skin
• Presence of bacteria (P.acnes) in pores

Is it a white head or a black head? Classifying comedones

WHITE HEAD:  Hair follicle that is plugged and congested and encapsulated under the skin.

BLACK HEAD:  Hair follicle that is plugged and congested but exposed to air resulted in brown color.

Diagnosing Acne

Blackheads

Blackheads are non-inflammatory, small, dark pigmented lesions on the surface of the skin. Their dark color comes from the open pore being exposed to air.

Causes

• Increase in oil production
• Puberty
• Sweat
• Oil based cosmetics
• Humidity
• Medications

Treatments

• Cleansing twice daily with acne face wash
• Routine mechanical and chemical exfoliation of dead skin cells
• Switching to mineral based makeup
• Healthy diet
• Topical products with salicylic acid, benzoyl peroxide and glycolic acid

Papules

Papules are small, hard, tender, red dome-shaped bumps that have managed to push deeper into the skin.

Treatments

• Cleansing twice daily with acne face wash
• Routine mechanical and chemical exfoliation of dead skin cells
• Switching to mineral based makeup
• Healthy diet
• Topical products with salicylic acid, benzoyl peroxide and glycolic acid
• Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)

Pustules 

Pustules are similar to papules except that they contain a whitish-yellowish fluid inside of them. The white fluid, or pus, is a result of your body’s immune response trying fight off the bacteria that has entered the follicle. They mostly occur in areas of the body that are oilier, like the face and neck, they are often inflamed and sensitive to touch.

Treatments

• Do not POP the acne
• Cleansing twice daily with acne face wash
• Routine mechanical and chemical exfoliation of dead skin cells
• Switching to mineral based makeup
• Healthy diet
• Topical products with salicylic acid, benzoyl peroxide and glycolic acid
• Oral prescription medication: Antibiotics, Accutane
• Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)

Nodules

Nodules are small, hard, yet painful acne lesions under the surface of the skin. When bacteria gets trapped in the pore and becomes infected, the infection is carried on underneath the skin, causing redness and swelling.

Treatment

• Do not POP the acne
• Cleansing twice daily with acne face wash
• Routine mechanical and chemical exfoliation of dead skin cells
• Switching to mineral based makeup
• Healthy diet
• Topical products with salicylic acid, benzoyl peroxide and glycolic acid
• Oral prescription medication: Antibiotics, Accutane
• Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)

Cysts

Cysts are the most severe type of acne, they are hard, painful lesions under the surface of the skin. They form from the complete blockage of the pores causing inflammation and infection. Cysts can form anywhere in our body where there are hair follicles, typically because of hormonal changes in a person. They are a type of acne that is known to bring emotional distress and insecurities because of the skins’ appearance.

Treatments

• Cleansing twice daily with acne face wash
• Routine mechanical and chemical exfoliation of dead skin cells
• Switching to mineral based makeup
• Healthy diet
• Topical products with salicylic acid, benzoyl peroxide and glycolic acid
• Oral prescription medication: Antibiotics, Accutane
• Topical prescription strength retinoids medication: Adapalene (Differin), Tretinoin (Retin-A), and Tazarotene (Tazorac)
• Oral contraceptives

Before & After Photos

Treatment Options for Acne

Topical Treatments

Topical creams and serums are designed to decrease sebum production and to increase dead skin cell turnover. Topical products that contain salicylic acid, glycolic acid or benzoyl peroxide, can reduce breakouts by decreasing and removing excess sebum. Topical retinoids, such as tretinoin and tazarotene, help remove dead skin cells and reduce inflammation. 

Isotretinoins

Isotretinoin is a class of vitamin A derived medications that have the ability to target every step responsible for acne pathogenesis: inflammation, sebum production, abnormal keratinization and colonization with Propionibacterium acne. 

Accutane

Accutane is a prescription medication indicated for recalcitrant and/or severe acne. Recalcitrant acne refers to acne that has not responded to multiple other therapies, including antibiotics. Severe acne is when many red, tender nodules (bumps or lumps) form in the skin – this type of acne can lead to permanent scarring. Accutane works to prevent the development of acne lesions by shrinking the sebaceous or oil glands in the skin to prevent the development of clogged pores. Treatment with Accutane typically lasts 4-5 months of monthly visits with laboratory monitoring a few times during treatment. It is important to note that Accutane has been associated with serious side effects including birth defects. For this reason, treatment is monitored through the iPLEDGE program (can link to website). However, the most common side effects are skin redness, dryness and peeling, dry eyes and dry mouth/chapped lips and occasionally, nose bleeds. It is important to see a board certified dermatologist to determine if you are a candidate for this treatment and to provide careful monitoring during treatment. While on Accutane, other treatments with laser, microneedling, and some other cosmetic surgery are contraindicated. 

Chemical Peels

At The Naderi Center we offer chemical peels specifically designed for patients with acne. The VI Purify peel contains a combination of Benzoyl Peroxide, Kojic acid, Hydrocortisone, TCA, Salicylic Acid, Retinoic Acid, Phenol, Vitamin C and a proprietary mineral blend. The VI Purify peel is a light chemical peel that targets acne, large pores, pigmentation irregularities and discoloration. This light peel has little downtime but has proven to improve skin clarity and acne scarring. We also offer a variety of TCA concentration peels for both spot treatment and total face treatment of acne and acne scarring.

Steroid Injections

Steroid injections are done to treat nodular and cystic lesions. These injections improve appearance, decrease pain and shorten the course of the acne lesion. Often times these treatments are done if the patient needs to quickly remove an acne lesion for an upcoming special event. Additionally, if it is felt that the acne lesion may leave a bad scar, steroid injection can help to minimize this scar formation. Steroid injections however may also leave a depression in the skin.

Comedone extractions

Mechanical comedone extractions are also options that may help to improve skin clarity, preferably done by a dermatologist to decrease the possibility of scarring and further acne damage. A special comedone extractor is utilized to remove the acne lesion.

Antibiotics

Antibiotic therapy of acne is one of the older tools that often times dermatologist would use to help treat acne. Typically antibiotics such as erythromycin, doxycycline, clindamycin are given for a course of 2-3 months to fight the acne causing bacteria. This therapeutic modality is falling out of favor in light of new research that shows antibiotic therapy helps create antibiotic-resistant bacteria. Even when antibiotics are used they are never used as the sole modality for improving a patient’s acne.

Hormone Therapy

If it is felt that your acne is hormonally regulated, your physician may prescribe a form of oral contraceptives that can help regulate the hormones that are stimulating acne production. They may also suggest you start on a birth control to regulate your androgen type hormones. Currently the FDA has approved the following birth control for treatment of acne: Ortho Tri-Cyclen, Estrostep, and Yaz.

Light Therapy for Acne Treatment

Based on clinical observations and research studies it has been noted that patients’ acne improves after exposure to natural sunlight. The exact mechanism for this observation is still uncertain however we think that light-based therapies do help to decrease the Propionibacterium acnes levels and decrease the size and activity of the pilosebaceous glands. The blue light spectrum specifically, is agreed upon as being the most effective at reducing bacterial levels as well as having an anti-inflammatory effect on the skin, specifically the keratinocytes. At The Naderi Center, we offer blue light therapy for our acne patients. The treatments are typically performed once a week for a series of 6-8 weeks. Patients are also placed on a topical skincare regiment to complement the light therapies.

Medical Grade Skincare

At The Naderi Center we offer our patients only medical grade skincare that are more effective than over the counter products in fighting acne.

ZO SkinHealth

Designed by Dr. Zein Obagi, ZO SkinHealth has developed an acne treating protocol that is utilized effectively at The Naderi Center to help our patients clear their acne.  These products when used correctly and based on clinical protocols are designed to:

• Slow sebum production
• Exfoliate skin cells to unclog pores
• Tighten pores
• Neutralize bacteria-causing acne breakouts
• Reduce redness
• Revive dull looking skin

Specific product recommendations for acne include:

Exfoliating Cleanser 
Exfoliating Polish 
Complexion Renewal Pads 
Sulfur Masque Acne Control
Enzymatic Peel
Exfoliation Accelerator
Correct + Conceal

Acne Specialist, Dr. Alexandra Snodgrass

Board Certified dermatologist, Dr. Alexandra Snodgrass is extremely knowledgeable and skilled when it comes to the acne treatment and prevention. Dr. Snodgrass approaches each patient as an individual and tries to develop a treatment plan that is customized for their lifestyle and goals. Not all skin types are the same, therefore, not all acne is the same. Whereas one individual’s acne can be managed with topical skincare and light treatments, another may need to be placed on Accutane. Dr. Snodgrass has extensive training in many invasive as well as non-invasive treatment options that can help you once and for all clear your skin of acne.

Schedule your Acne Consultation

Known as a leader in skincare and cosmetic procedures, The Naderi Center has been serving patients in the Virginia, Maryland, and Washington D.C. area for more than 10 years. The Naderi Center is known for being the source of physicians and surgeons that are specialized in their realm and scope of practice. Patient’s come to The Naderi Center when they want an expert on the procedure or condition they are trying to improve. Contact one of The Naderi Center’s two offices for more information, or to schedule your acne treatment consultation. A patient coordinator can be reached at our Reston, Virginia office at 703-481-0002 and at our Chevy Chase, Maryland office at 301-222-2020.

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