Yes, it’s real. Being on a progestin only contraceptive like the Mirena IUD can trigger hormonal acne. Yes, the type of acne that can hound you even though you’re in your 20s, 30s or 40s etc and even though you thought you had said goodbye to acne forever. Yes, the type of acne that shows up as pesky red uncomfortable bumps of your chin and jawline. Yes, the type of acne that can leave a little blemish – maybe a pink or dark spot – even when it goes away. Yes, the type of acne where maybe you have one bump that just keeps coming back — like a bad teen movie sequel – Parts I, II, III and more.
So what should you do?
You could have your physician remove your IUD and that could help your hormonal acne. However, that’s not a practical option for everyone. After all, there’s a reason you chose to have it placed in the first place. There are practical benefits to having an IUD after all.
You could also see your dermatologist. Most of the time, we are able to “treat through” the hormonal effects of the Mirena IUD. We can tailor your acne treatments to your acne. This may involve a medication called spironolactone which helps address hormonal acne. We may use other meds in combination with spironolactone or even choose a different med all together.
So in short, don’t despair! If your Mirena comes along with a tag-along called acne, it may be time to see your dermatologist (or get your Mirena removed)!
Differin (adapalene) gel is now available over the counter. This is great news since it means you no longer need a prescription for it. Also, the prices over the counter (e.g. at your local Walgreens or CVS) have been quite reasonable. Or you can purchase online also.
So what is Differin (adapalene) used for?
Differin is marketed for acne. It can be used in combination with other products or on its own depending on the type of acne you have and the severity of your acne. It is also particularly good for comedonal acne (eg whiteheads or blackheads) which other types of medications might not address.
Differin is also a topical retinoid and as such it may be helpful for reducing appearance of wrinkles, and helping with skin texture and pigmentation issues. (You may have heard of using retinols for anti-aging.) There are a lot of topical retinoids out there though so definitely consult with your dermatologist if you’re wondering whether Differin is right for you.
Are there side effects to using Differin?
Any medication has potential side effects. Most commonly, people will report dryness, redness, or flaking. This is actually to be expected to a degree. We recommend spacing out use to every other night or mixing with some moisturizer if you need to. Your skin tends to get used to the medication after a month or so. You may also need to take it easy on other products you are using (eg benzoyl peroxide or salicylic acid which can also be drying and irritating)
Also, if you are pregnant or trying to get pregnant, you should discuss with your obstetrician before using this medication (it is still a medication after all!) Many/ ?most will recommend that you stop your topical retinoid.
Spironolactone is an oral medication that is used to treat hormonal acne. Although it is often thought of as a blood pressure medication, it is also effective for hormonal acne. Hormonal acne manifests in women as acne that has a predilection for the jawline and chin. Additionally, the acne often flares before periods. Patients with polycystic ovarian syndrome (PCOS) often have hormonal acne as well. Do you have hormonal acne? If so, talk to your medical provider. There are side effects and contraindications to this medication so it’s important to discuss whether this medication is appropriate for you. Additionally, don’t be surprised if the effect of the medication does not kick in immediately. It may take a few months or further dosage adjustments to see an effect!
Whether it’s a need to do chores involving water, due to one’s occupation, or just a habit, frequent handwashing can lead to irritated skin of the hands. The hands become dry and stripped of their natural protective oils. Irritant dermatitis is the name of the rash which often ensues from frequent handwashing — it is a type of rash that occurs as a result of direct physical, mechanical or chemical trauma from an outside culprit. The most frequent culprit is handwashing. Between the soap and the water, the damage is done. Skin becomes dry and rough, and can become variable degrees of pink/red.
So how can you prevent irritated hands from frequent handwashing?
– First, if it’s not necessary, then don’t wash your hands. This is not to mean that you should not wash your hands when they are dirty or soiled. You should! Handwashing is important in preventing spread of germs. However, if you find yourself excessively handwashing, figure out if you can cut back.
– Although hot water helps cleanse the hands more readily of microbes, they can also strip the skin’s oils more readily. Depending on how germy your hands are, you may considering using lukewarm or cold water to wash as opposed to hot water.
– Limit the amount of time you are washing. Do not wash for an excessively long time.
– Pat dry instead of rubbing dry.
– Follow up with a moisturizer.
– If all else fails, see a medical professional such as a dermatologist for help. If your rash is particularly bad, prescription medicated creams or ointments may be helpful.
We’ve previously discussed the use of skin protectants and ointments for irritated skin such as eczema skin. One of my favorites is Vaniply ointment. One frequent complaint I hear from patients about ointment is that it leaves the skin and clothing sticky and goopy, and that it’s difficult to apply. Vaniply is somehow much smoother and much easier to spread. It also doesn’t leave that really sticky feel behind.
Vaniply is made by the same company that makes Vanicream. All of their products are meant to be hypoallergenic. Specifically, Vaniply is free of fragrance, preservatives, lanolin, parabens, formaldehyde, formaldehyde releasers, sulfates, gluten, and chemical irritants. Patients with eczema are more likely to develop contact dermatitis so it’s good that Vaniply has taken out all the above offenders.
So what does Vaniply contain? 1% dimethicone, C30-45 alkyl methicone, C30-45 olefin, hydrogenated polydecene, microcrystalline wax, polyethylene, silica dimethyl silylate
What are the uses of Vaniply?
It can function as a skin protectant — serving as an extra barrier between the skin and the outside world. As such, you can use it over chapped lips, hands, feet, and elsewhere. You can also use it in areas that develop a rash from constant moisture (think babies’ bottoms or skin folds). It helps “seal” in the water content of the skin, so you could use it as part of the “soak and smear” method if you’re trying to hydrate the skin and then trap the moisture in (e.g. for those with eczema). It can also be used as part of the wet wrapping procedure (again, often used in eczema patients).
Vaniply is “kid friendly” and has also received the National Eczema Association Seal of Acceptance.
The Bamboo Bubby Bag is a sleep sack made of bamboo and cotton designed for babies with eczema. The material is stretchy and is relatively lightweight, so dress your child accordingly inside the sack depending on the weather. The Bamboo Bubby Bag features covered sleeves which can fold over to shorten the length of the sleeves. Because of the adjustable sleeves, they can accomodate small babies of about 6 months old up to 6 year old toddlers.
Here are some things I like about the Bamboo Bubby Bag:
– The stretchiness of the material makes for easy on and off. This is important as when an eczema child is tired and needs to rest, the scratching often starts. You don’t want to spend all day trying to get on your mittens, gloves, scratch sleeves and then your sleep sack, etc.
– The sack accommodates a wide age range. Eczema clothing and accessories can be expensive and this can last you a long time. Just be sure to take care of your sack in order to preserve its longevity.
– The double zipper means easy diaper changes.
– There’s a hole in the back to accommodate placing your baby in the stroller or car seat. If you’re taking a long car ride and can’t constantly monitor your child’s hands, this is a nice benefit.
The cost is currently $79.95 and you can buy it through the company’s website. You can also get it with the ScratchMeNot Flip Mitten Sleeves for a total of $89.95. I recommend you line dry the sack as noted in the care instructions, so you may want to invest in two sacks.
One of the most frequent growths that brings patients into the office are seborrheic keratoses. Frequently mistaken for moles, they are most commonly brown “stuck-on” growths that can occur essentially anywhere on the body. They tend to arise in adulthood and have a likely genetic inheritance. Most of my patients refer to them as barnacles, nuisance growths, age spots, or “moles.”
So now the important question… how do you get rid of them?
Seborrheic keratoses can be frozen off by a process called cryotherapy, scraped (curetted) off, cut out (not usually optimal), or burned off with an electric needle if small. If they are pretty flat, lasers can be used to remove them as well. Be careful how you get them removed though. I have seen patients left with bad darkening or lightening of the skin as well as scarring after removal. As with most cosmetic procedures, it’s best not to be tan in general during the procedure as that could increase risk of pigmentary change of the skin. If you are concerned about a particular growth or interested in removal, schedule an appointment with a dermatologist who can evaluate the growth to 1) make sure it is indeed a benign growth, and 2) counsel you on the best way to remove the growth.
The AD RescueWear RescueSuit is a body suit made of soft stretchy Tencel (R) that covers your baby or child neck down. Conceived by eczema mom Beth Scott, it is designed as an aid for wet wrapping for eczema, and can also be used for dry wrapping. It features fold over mitts to cover the hands when needed as well as fully enclosed feet. The neck down full coverage is important in providing a protective layer from scratching.
The Tencel (R) fabric is excellent for gently hugging your child’s skin. Traditionally, parents have used tight fitting cotton pajamas for wet wrapping. However, I have yet to find cotton pajamas which are able to fit a child’s body as well as this RescueSuit. Additionally, the wet cotton pajamas end up heavy, bulky and bunchy when used for wet wrapping. This RescueSuit molds to the body so that the damp fabric is right next to the skin and really is superior for wet wrapping. Another benefit I have found of the body molding RescueSuit is that bulky diapers do not rub against thighs as much — this sort of rubbing can incite eczema and itch.
This suit can also be used for dry wrapping and worn day to day. It is an added protective layer to protect the skin from scratching and because of the body molding fit, can easily fit under outer garments.
The AD RescueWear RescueSuit is very helpful for those of you whose children benefit from wet wrapping. Watch the YouTube demo on how to wet wrap with the RescueSuit. You may have to practice a couple of times to become as adept at putting the suit on as the mom in the video.
The AD RescueWear RescueSuit retails at $105. You may want to have a couple on hand as they are delicate and should be air dried flat, so that would cost a couple hundred dollars. The suit costs significantly more than cotton pajamas, but at the same time, they are actually designed for wet and dry wrapping. Check out the AD RescueWear website as well as The Eczema Company’s website to look for sales and promotions.
All in all, as a dermatologist and eczema mom, I found the AD RescueWear Rescue Suit to be a helpful item to have and would recommend it to other parents of children with eczema.
For the month of March, use the code DERM10 to receive 10% off from The Eczema Company.
The ScratchMeNot Flip Mitten Sleeves are a unique way of protecting little ones’ nails and fingers from damaging their own skin, hair and nails. An alternative to traditional mittens, they are worn like a shawl over the child’s normal clothing. The ends can flip open or closed. When closed, the exterior of the mitten is silk. When open, the exterior of the mitten is cotton. The shawl part of the sleeve is a blend of organic bamboo viscose, organic cotton and lycra. They are available for babies and children ranging from 3 months to 6 years old.
These sleeves are useful for babies and children who scratch themselves, especially those with eczema or atopic dermatitis, or other skin issues. They are also useful for children who pull out hair or have a habit of nail biting. The ScratchMeNot Flip Mitten Sleeves were designed by eczema mom Andrea Thomas and it shows.
I really like these sleeves and here’s why:
– The external silk mittens are gentle on skin. I have yet to find baby and kid mittens that are made of silk. The traditional mittens and flip sleeves attached to onesies are cotton. Silk is much smoother and decreases the amount of damage rubbing can do to the skin. Even rubbing with cotton can lead to thickening (what we call “lichenification” in dermatology) which can worsen the skin condition and itch.
– These sleeves stay on. The mitten portion is attached to the shawl portion. Babies and kids are really good at getting traditional mittens off. These stay on.
– They are easy to flip open and closed. This is important because you aren’t going to just flip them closed and leave your child that way all day. There are often predictable times when your child will scratch skin, pull hair or bite nails — e.g. when she/he is tired or fussy, during diaper changes, at night when her/his inhibition is decreased, etc. In anticipation of these times, you can close the mittens. The rest of the time, you can keep the mittens open. This may also decrease your anxiety over whether you child won’t have enough open mitten time to learn how to use her/his fingers and hands.
– They are easy to get on and off. The shawl part is a mix of bamboo viscose, cotton and lycra. It has just enough stretch so that you can put it on easily, but not so loose that your child can work her/his way out of it.
– They are relatively affordable. There are so many products that target parents of eczema babies and kids. Some of them are very costly. These are relatively affordable and there are often deals through the ScratchMeNot website or The Eczema Company.
As a dermatologist and eczema mom myself, I give these ScratchMeNot Flip Mitten Sleeves 5 stars.
DermBytes readers get 10% off at the ScratchMeNot website with the code: Dermbytes.
By Jodi LoGerfo, MSN, APRN, BC, FNP-C
“Yay! More zits,” said no one ever, upon waking up in the morning and looking in the mirror. Acne can cause a lot of anxiety and even depression depending on how bad it is. The good news is there is help and you are not alone.
Actually, acne vulgaris is the most common skin disorder in the United States and nearly 85 percent of all people have had acne at some time during their lives, according to statistics from the American Academy of Dermatology. Acne most often begins during teen years (as we can all attest), but can follow into adulthood. It occurs most often on the face, chest, and back which are areas that have a large number of oil glands.
Acne lesions are caused by a combination of overactive oil glands that produce oil, along with the build-up of dirt and bacteria and irregular shedding of dead skin cells. Contrary to popular belief, acne is not caused by chocolate or dirt or eating greasy foods. Although there is a link between the amount of oil produced in the skin and acne, the amount of oil is not created by food. Instead it is caused by changing hormone levels like those during puberty or cyclical hormonal changes in a female’s menstrual cycle.
How a simple pimple forms
When an oil gland opening (called a pore or hair follicle) becomes clogged with skin’s natural oils, dirt, dead skin cells and bacteria, a comedo forms. We often call those blackheads (open comedo) or whiteheads (closed comedo). Additionally, the surrounding skin can respond by becoming red and inflamed, appearing as small red pimples (pustules or papules) or it can get infected and cause deeper, large and more painful nodules and cysts. These larger, deeper cysts and nodules can cause scarring, so you always want to get treatment from a dermatologist to avoid permanent pits and discoloration.
How you can make pimples worse
While you can’t “cause” your own acne, there’s lots you can do to make it worse:
- Oily, moisturizing products, cosmetics and many sunblocks can further clog up pores causing excess oil to get trapped. Look for formulas that say, “non-comedogenic” on the label, which means, “non-pore-blocking” or use cosmetics that are oil-free.
- Heat, humidity and excessive sweating amplify skin inflammation. Be sure to wash off excess sweat, dirt and oil after excessive activity, especially after exercising or in the summer months.
- Picking or squeezing acne lesions with fingernails or other objects causes acne to look worse and may result in further infection and deeper, permanent scarring. Lesion removal (called acne surgery) should only be done by a medical professional.
How your dermatologist tries to stop your acne in its tracks
There are various approaches dermatologists use for effectively treating acne. Often, we use a combination of methods at the same time to attack acne in different ways. These include:
- Acne Surgery (including corticosteroid injections) performed in a dermatologist’s office to extract blackheads and to open and drain whiteheads. This helps prevent pustule and cyst development, which are the main causes of acne scarring. Inflammatory lesions (pustules, pimples and cysts) are often injected with low potency cortisone to decrease inflammation and help an acne lesion disappear quickly. These intra-lesional injections also help decrease the remaining discoloration that can occur when acne is resolving.
- Isotretinoin, an oral prescription medication can permanently help severe or troubling cystic acne (you may remember it by the brand name Accutane®) or poorly responsive acne that improves less than 50% after 6 months of combined traditional treatment. About 85% of patients treated with isotretinoin see permanently clear skin after just one treatment course.
- Chemical peel (e.g., TCA) is a non-toxic chemical (trichloroacetic acid) that is applied to the skin. It has been used for over 20 years and works by drying up the top layers of skin cells, causing them to peel off. The old skin is removed and a new undamaged layer is revealed.
- Oral antibiotics can help manage the severity and frequency of acne outbreaks. There are a number of oral antibiotics used depending on the type of acne you have.
- Topical lotions, creams or gels containing benzoyl peroxide, antibiotics (e.g., clindamycin and erythromycin) or salicylic acid are known to kill bacteria, unplug pores, exfoliate and decrease inflammation.
- Topical retinoid medications help other acne medications absorb better, have an anti-inflammatory effect and also speed up cell turnover so pores can’t clog. These include Retin-A® (tretinoin), Differin® (adapalene) and Tazorac® (tazarotene).
- Laser or light treatments (e.g., Blue Light, Infrared Light) are designed to target and eliminate acne-causing bacteria and decrease inflammation.
- Androgen blockers (e.g., spironolactone) have been used in acne for years. They decrease the amount of oil that is produced by oil glands and are also effective in those female patients who also have excess hair growth.
- Oral contraceptives have been shown to improve acne by normalizing hormonal spikes and reducing testosterone and progesterone, the hormones responsible for hormonally-induced acne. This may be especially helpful in women with acne along with menstrual irregularities or hirsutism (facial hair growth).
How you can help your acne regimen work better
- Read and follow any label, package or doctor’s instructions exactly for any acne product or medication you are using. If medications are to be applied at different times of the day or in a particular order, follow the regimen exactly because that’s how it is designed to work.
- Treat the acne-affected area (e.g., face) entirely, not just individual pimples (don’t spot treat), so the medication can prophylactically prevent future breakouts.
- Never pick, pop or squeeze your pimples because that often causes more damage to the pore resulting in permanent scars, pits and discoloration. A dermatologist can offer you acne surgery done properly by a medical professional in the office.
- Keep your hands (and the bacteria on your hands) away from your face. Constantly touching your face can cause more infection to inflamed, irritated or open skin.
- Reduce the amount of oily face makeup. Try to use a makeup that is oil-free and always wash it off at night before going to sleep.
- Gently cleanse the acne-affected area; scrubbing inflamed skin (whether from acne itself or as a side effect to acne treatment) can be more irritating.
- Use a cleanser your dermatologist recommends for your specific skin type twice per day and use warm (not hot) water.
- Avoid using over-the-counter alcohol-based astringents, which strip your skin of it’s natural oils, and stick to only products and medications your dermatologist recommends.
- Avoid excessive sun exposure as many acne medications (including Retin A®,oral antibiotics and isotretinoin) make your skin more sun-sensitive. Always use a non-comedogenic, broad spectrum sunscreen recommended by your dermatologist daily to prevent your acne lesions from becoming darker and pigmented.
- The most recent research on acne and inflammation found that people with acne (and more severe acne at that) had lower levels of antioxidants in their bloodstreams and that both oral and topical antioxidants can potentially be used in treating acne. That means a more nutritious diet of fruits and vegetables is more important to acne patients than we thought, and can only help.
Finally, acne treatment regimens usually require 6-8 weeks of treatment before results are noticeable. Don’t give up and stop treatment if you do not see faster results and don’t stop treatment if you notice some preliminary clearing. After 8 weeks, if you see no improvement, your dermatologist will adjust your treatment or suggest different therapies to try.
Keep it up!
Jodi LoGerfo, MSN, APRN, BC, FNP-C is a Family Nurse Practitioner
Board-Certified in Family Medicine and Dermatology at the Orentreich Medical Group in New York City. She runs a patient Question & Answer blog at Orentreich.com/blog.