What’s your background?
I grew up in NYC. I went to college at the University of Pennsylvania, followed by medical school at the Johns Hopkins School of Medicine. I then completed my dermatology residency and fellowship at Mount Sinai Hospital before joining the faculty full-time. I’ve been full-time on the faculty since 2009. My work is half medical and half cosmetic. On the medial side, my particular medical interest is in acne and rosacea, and on the aesthetic side, I do a lot of injectables and laser.
I’ve heard that the majority of acne patients are adult women. Is this true?
The biggest growing population of acne patients is adult women age 25 and older. There are three populations of these acne patients. There are women who had acne when they were teenagers and it never went away, or what we call, “persistent acne.” We have patients who had acne, it went away, and then it came back. We call this group “recurrent acne.” And lastly, we have patients who are experiencing acne for the first time in adulthood, which we call the “new onset” group. We don’t know exactly why adult women are getting more acne today than ever before, but it’s likely an interplay between genetic and environmental factors (be it diet, stress, or hormonal changes). And many women have been on birth control for a long time, and are just starting to go off it, which may unmask underlying hormonal sensitivities that lead to acne. Acne in adult women tends to differ from what we see in teenagers. The majority of the acne in adult women tends to cluster around the mouth and jaw line.
How does treatment differ in the three different groups?
The treatment tends to be the same. We use a variety of topical and oral medications, including some hormonal therapies (like birth control pills and spironolactone).
Are there any holistic ways women can treat their acne?
If you’re suffering from acne, there’s always something you can do about. You can start with a more holistic approach if that’s what your comfortable with. I would just say that If your at home treatments aren’t working, you should come in to see a dermatologist. The best thing you can do for yourself is to reduce your stress levels. Try yoga, meditation, exercise, whatever it is that you need to do to minimize stress. We know that stress leads to the stimulation of stress related hormones, which in turn stimulates your oil glands and can lead to breakouts.
What about diet?
You can also try modifying your diet. Start by reducing your sugar and starch intake. Elevated blood sugar levels can trigger acne. Also, cows milk, and particularly skim milk, is associated with acne breakouts as well.
Why skim milk, specifically?
It’s because skim milk has a higher concentration of sugar to fat (on top of the fact that the hormones from the lactating cow get transferred into the milk).
What else can people try at home before going to the dermatologist?
There are a couple of ingredients you can find over the counter to treat acne. The two most effective ingredients are Salicylic acid and Benzoyl peroxide. Salicylic acid is a BHA acid, and works by removing excess oil from the skin, as well as exfoliating dead skin cells. Benzoyl peroxide works by removing acne causing bacteria on the skin.
Does Benzoyl Peroxide get rid of the “good” bacteria too?
In short, we don’t really know. But you’re bringing up the skin microbiome, so let’s talk about that for a second. Generally speaking, your skin is crawling with microorganisms including bacteria that help the skin function optimally. And in conditions where there’s inflammation or disruption of the skin barrier, sometimes this microbiome (the collection of microorganisms) can become disrupted. Probiotic skincare and probiotic supplements can help promote a healthy microbiome. The idea is that if you can maintain a healthy diversity of microorganisms on the skin you can help promote healthy skin in general.
What do people often forget when treating acne?
A big misconception is that people with acne don’t need hydration. Skin hydration and skin oil are two separate issues. The fact is, you can be oily and acne prone and still be missing hydration. It’s absolutely necessary to take care of your skin barrier and maintain proper hydration even if you have acne. A disrupted skin barrier results in microscopic cracks in your outer skin layer, resulting in a loss of hydration and inflammation which can make your acne worse, and make treating acne more difficult.
How do you know if you have dry skin or dehydrated skin? I feel like I hear people talking about the two groups as if they’re distinct.
Generally speaking, dehydrated skin is skin that’s lacking hydration. Dry skin, on the other hand, is dehydrated skin in addition to some degree of skin barrier dysfunction (meaning that the outer layer of the skin isn’t working as it should be).
How can people treat acne scars at home?
The best way to treat acne home is to prevent it from developing from forming to begin with. Early, effective treatment is critical. If your at home regimen isn’t working within 2 weeks, make sure you go in to see a professional. Once a true “ice-pick” scar (a scar that has resulted in an indentation) has formed, it’s permanent. That’s because the scar is formed from irregular collagen production. At that point, you would benefit from coming in to see a dermatologist for a laser treatment. Lasers work by punching microscopic holes into the skin, creating a controlled wound. This then takes advantage of the skin’s natural ability to heal itself. The skin as a result produces new collagen which strengthens the skin’s foundation and can fill in any depressed acne scars. Discoloration and hyperpigmentation from acne is not permanent, but can be just as challenging to treat. Technically, they are more like “stains” on the skin. You can use skin brightening ingredients like kojic acid, niacinamide, Vitamin C and hydroquinone to treat the darker areas.
There’s been a lot of controversy around hydroquinone. Do you still recommend it to your patients?
I think that there has been no definitive data around the dangers of hydroquinone. I believe that it can be safe and effective when used appropriately. But ultimately, it’s a personal choice. You can get a 2% hydroquinone product over the counter, or a 2-6% with a prescription.
What does your skincare regimen look like?
My skincare regimen is actually pretty simple. I wash my face with the dove beauty bar for sensitive skin. Not all bar soaps are created equal; traditional bar soap contains harsh cleansing ingredients but the dove beauty bar is very mild and also very hydrating. After I shave, I use the L’Occitne after shave balm.
In the mornings, I use a moisturizer with sunscreen. I’m using the Aveno Positively Radiant SPF 30 at the moment. At night, I use a prescription Retin A.
I noticed you didn’t mention an antioxidant.
I use the
PCA Skin C&E Strength Max under my SPF when I remember too. I like this product because it’s anhydrous, meaning it doesn’t contain water which contributes to the stability of the formula. Sometimes I forget this step though!
What do you do to keep yourself grounded?
I work a lot. So when I’m not at work, I try to spend as much time with my kids as possible. I have a 7 year old and a 5 year old. So for me, my “self-care” time is really for my kids.
This interview has been edited for conciseness and clarity.
