Are you frustrated with your acne?

Do you feel like your ‘beating your head against the wall’ with your current acne treatment?

There are different reasons why people get pimples. It may be that you have one of the less common reasons for pimples.  Getting the right diagnosis and adding a specialized treatment medicine may finally clear up your acne.

In my practice, patients with pimples usually have one of the following problems:

1. Acne Vulgaris, the most common form of acne
2. Pityrosporum Folliculitis, which is also really common
3. Staph. Folliculitis, which is really an infection
4. Gram Negative Folliculitis, which happens because of acne treatment medicines

This sounds really complicated, but it’s actually not. The important point is that if you have one of the ‘folliculitis’ acne conditions, you need different treatment to clear up your pimples. If you think you have one of these forms of acne, talk with your doctor about getting the right treatment.  What you need to know:

Acne Vulgaris

This is the most common reason for pimples and it’s what we all think of as acne.  People with acne vulgaris have both blackheads and pimples, usually around the nose, cheeks and chin as well as the forehead.  The pimples may gradually spread to the neck and back.  As this form of acne worsens, the pimples and blackheads get bigger and more numerous.  In this type of acne the skin is usually really oily.

Acne vulgaris responds to the standard acne treatments.  Topical acne treatment products aim to unclog the blackheads in the pores and kill the acne causing germ p. acnes. If over the counter products don’t work, doctors add stronger prescription products and oral  antibiotics that basically do the same thing.  Really bad cases of acne vulgaris may be treated with the powerful drug Accutane.

Pityrosporum Folliculitis

Pimples and clogged pores happen with this form of acne too, but they are in different areas of your skin and they look different than in acne vulgaris.

The pimples and clogged pores usually start on the forehead, the nose and along the jaw line.  There are often little pimples on the neck at the hairline and in the little indentation below the ear.  They also happen on the chest and back.

The key points are that there are often millions of little pimples and clogged pores on the forehead and many of the clogged pores are covered over by skin instead of open like blackheads.  The pimples on the chest and back are really bright red almost like a bug bite and they either itch or are really tender.  There may even be pimples or dandruff on the scalp.

You’re more prone to this type of acne if you or your family members have a history of allergies or asthma.  You’re also more likely to get pityrosporum folliculitis if you’re often really sweaty, like if you’re an athlete or you live in a hot climate.  That’s because this type of acne is due to an overgrowth of normal skin yeast germ called pityrosporum and the germ grows really well on sweaty, oily skin in predisposed people. We all have this yeast germ in the pores on our face and upper body.  Sweating and having a genetic predisposition (people with allergies and asthma) promotes the growth of the yeast, which then causes the pimples and clogged pores.

Obviously, treatment needs to kill the yeast and regular acne medicines don’t.  My favorite treatment for pityrosporum folliculitis is pyrithione zinc in the form of soaps and cleansers. I like Noble Zinc Soap for the face and OTB SKIN Medicated Cleanser #2 for the back, neck, chest and scalp.  It’s also important to use medicines that unclog the pores such as benzoyl peroxide, glycolic acid or salicylic acid.  My OTB SKIN Acne Kits for the face and the back include these ingredients.

Staph Folliculitis and Gram-negative Folliculitis

These are skin infections and require prescription oral antibiotics that specifically kill these types of germs.

Staph. folliculitis is caused by the staphylococcus bacteria that causes impetigo.  25% of everyone you know carries this germ on their body.  Most of the time it doesn’t cause any problems, but it can.  One of the skin problems looks like acne with pimples and white heads.  This can occur anywhere on the body, including the usual acne vulgaris places on the face and back.  Any break in the skin including injuries, or your acne lesions, can become infected with staph.  When pimples become infected with staph. they get really big and are much more sever than normal. Regular acne treatments don’t work against staph.  Your doctor needs to do a culture of your pimples (a test for the bacteria) to tell if you have a staph. infection and then prescribe the correct antibiotic.  Ask them to do this if you’re not getting better on your acne treatment.

Gram negative folliculitis is the strangest of all these conditions.  It happens when doctors do such a good job of killing the p. acnes bacteria with topical or oral antibiotics that this germ moves into the pores and starts causing pimples.  What I see in patients with this problem is that their pimples (not their blackheads) all of a sudden get really bad in spite of being on antibiotics. The gram negative germ is not killed with the acne antibiotics and needs to be treated by different types of antibiotics that we don’t usually use to treat acne.  This is one of the most common reasons that acne patients come to see me after being treated by another doctor.  It’s easy to fix if you know to look for it.  It’s one of the reasons I try to get my acne patients off both oral and topical antibiotics as soon as possible.

Remember, this information is intended to be educational, giving you a better understanding of the range of acne problems that affect the skin so that you can have a valuable discussion with your doctor of skin care professional.  It isn’t intended to give a specific diagnosis or treatment for your skin problem.

If you found this post helpful, you may also like to read:

Dermatologist’s Tips for Dry Flaky Skin on Your Face and Scalp

Photo attribution: Elaine with Gray Cats

Dry, itchy, scaly skin on your foot may indicate that you have a foot fungus infection, more commonly called athlete’s foot.  This highly contagious fungus infection is common and not limited to athletes.

Athlete’s Foot Fungus Infection may show up as:

• excessive dry skin or thick skin on the soles of your feet
• a painful crack between some of your toes
• an itchy, scaly rash on part of your foot
• small blisters on your foot

Foot fungus may involve both of your feet, just one foot or just a small part of your foot skin.  Sometimes people with the athlete’s foot fungus have  excessively smelly feet because of the fungal infection.

Anyone can get foot fungus infections, but you’re at higher risk if you have:

• excessively sweaty feet
• wear hot enclosed shoes that make your feet sweat
• share shoes with other people who may have athletes foot (example bowling shoes or ice skates)
• share a shower with people who may have athletes foot (like at the gym, in a fire station, or even family members with athletes foot or nail fungus)

The athlete’s foot fungus lives on the outer layer of your skin and does not enter deeper into your body.  It is the same fungal germ that causes jock itch, most nail fungus infections and ‘ring worm’ infection (not a real worm) of the scalp or body.  It is highly contagious!

My Treatment Recommendations for Athlete’s Foot Fungus Infection

1. Apply over the counter antifungal cream with either terbinafine or clotrimazole twice a day for 2 months to treat an active infection.  Don’t stop before 2 months regardless of how fast the antifungal cream product claims it works.  That’s because these creams need to be applied for the full time that it takes for you to grow new skin on your feet, and that’s 2 months typically.
2. Dust your shoes with Zeasorb AF athlete’s foot powder every time you wear them during the 2 month treatment phase and for 6 months after your feet are cured to prevent a recurrence.  Discard shoes that are really old, worn out and that may harbor lots of fungal organisms.
3. Disinfect your home shower during your treatment period by spraying or washing the floor with a dilute bleach solution made of 1 part bleach to 9 parts water.  Of course wear gloves and keep the bleach solution out of your eyes.

General Foot Care Recommendations to Help Prevent You From Getting A Foot Fungus Infection

• Always wear thongs or sandals in public or communal showers like at the gym.
• Wash your feet and between your toes with soap every day.  Use a wash cloth or exfoliating cloth like the Salux cloth to remove excessive dead skin that can harbor the fungus.  If you use a communal shower like a gym shower, do this right before you exit the shower.
• Dry well between your toes after bathing using a towel.  If you are highly susceptible to foot fungus infection you should also blow dry between your toes because the athlete’s foot fungus loves to grow between damp toes.
• Keep your toenails trimmed short so that you can keep this little space between your nail and your toe skin clean, dry and inhospitable for the fungus.
• Always wear cotton socks in closed shoes to absorb sweat and that allow your feet to stay dry.
• Wear shoes that ‘breath’, meaning don’t wear plastic/synthetic enclosed shoes made from nonporous material that prevents evaporation of sweat.
• Dust your shoes with Zeasorb AF powder if you are excessively susceptible to athlete’s foot, if you have excessively sweaty feet or if you often wear hot enclosed shoes.

If you found this information helpful, you may also want to read some of my other posts:

Dermatologist’s 3 Simple Steps for Soft Sandal-Ready Feet by Spring

Dermatologist’s Tips for Dry, Flaky Skin on Your Face and Scalp-Tis the Season For Seborrheic Dermatitis

Pandemic of Dry Hands; Hand Sanitizers, the Swine Flu and Tips to Save Your Hands

Photo Attribution: aussiegall

I found this spot on someone who came into my office for something else.…  He saved his life by letting me do a full skin exam.

He didn’t really want a full skin exam or think it was necessary.  He made the appointment because of some spots on his face that were bothering him and his family.  He’d had a lot of sun exposure over the years and I think his primary physician may have also said that at he should see a dermatologist.  My rule of thumb is that I STRONGLY encourage every fair skinned person over 40 who has lived in the sun belt to have a full skin exam.  Many patients decline.  This gentleman didn’t and his decision saved his life.

This melanoma was on his thigh.  In spite of having a large diameter, the melanoma was not invading into the deeper layers of his skin.  We removed it and he should be fine.  Statistically, it’s unlikely to come back….. Full skin exams save lives.

Yesterday I removed another early melanoma that I found on the back of a different patient.  This woman came in especially for a full skin exam because she had a family member who had had a melanoma.  My patient had questions about some of her moles but couldn’t see the subtle little mole on her back that caught my attention.  It was small and light brown, but didn’t match her other moles.  She wisely agreed to have me remove it for testing, which showed an early melanoma.  Like the gentleman above, we caught it early and statistically she should be fine.  Because this mole was on her back, she would not have been able to notice it until it had grown quite large, and thus more invasive.  This patient saved her life by requesting a full skin exam.

The Skin Cancer Foundation recommends that everyone have their doctor examine their skin every year.  People at higher risk for skin cancer should seek out a physician who’s really good at skin cancer detection like a dermatologist or a primary care physician who is good at doing skin exams.  It doesn’t matter what your ethnicity is or how dark your skin is naturally.  Every skin type can get skin cancer.

In addition, everyone should do self skin exams on a monthly basis.  The Skin Cancer Foundation has guidelines for self skin exams.

People are often shy and decline full skin exams, even in the dermatologist’s office.  Don’t be.  Do your monthly skin exams.  Have an annual exam.  Ask your doctor about your level of risk for skin cancer.  Get a plan to catch skin cancer early.

Need motivation? Read the Skin Cancer’s Statistics on skin cancer-their compelling!

Get ready for spring sandals now!

For many of us, the rough, thick skin on our heels  looks like it belongs on an elephant?  It’s hard to hide cracked, thick heels in sandals and you CAN fix them before spring.

Reclaiming your baby soft feet is easy when you have the right tools for the job.  All it takes is strong exfoliation.  A pumice stone alone doesn’t cut it if you have really thick foot skin.  You need CHEMICAL EXFOLIATION AND PHYSICAL EXFOLIATION to get your feet back into sandal-ready shape.

• Chemical exfoliation means using a skin care product that softens and dissolves the thick skin so that you can actually get somewhere when you try to file it off.  The best product for thick, rough heel skin is Glytone Heel and Elbow Cream*.  This is a seriously strong glycolic acid cream that’s a miracle for rough feet!
• Physical exfoliation is what you do when you file or scrape off your rough thick foot skin. The best foot scraper is the PedEgg, which you can get at www.PedEgg.com.  You could also use a foot file like the pedicurists use, or a pumice stone.

Dr. Cynthia Bailey’s 3 Steps To Treat Thick, Rough Skin on Your Feet

1. Soak your feet in warm water, or take a warm shower for 10-15 minutes.
2. Rub the rough skin off your feet using the PedEgg or a foot file while your feet are wet.  Rub off as much rough skin as possible without hurting your feet.
3. Apply Glytone Heel and Elbow Cream while your feet are still damp.  Towel dry your feet, but you need to apply the cream while they are still damp.  Apply the Glytone Heel and Elbow Cream liberally to the thick areas, including the toes and nail beds if needed.  Put on a clean pair of cotton socks and leave them on for at least 8 hours.

Depending on how thick your foot skin is, this process can take between one week and several months for all the thick, rough skin to come off of your feet.

If irritation develops, let the skin heal before you resume the treatment

Once you have soft, smooth skin on your feet, repeat this process as necessary to maintain the results.  Some people find that once their feet are soft again, they can maintain the results by switching to my Anti Aging Body Rejuvenation Kit products and treating their feet when they treat the rest of their body skin in the shower.

Having baby soft feet that invite a foot massage is easy, and they look so much better in sandals!

*  Glytone Heel and Elbow Cream is a 30% glycolic acid cream and is REALLY strong.  If used in any manner other than I’ve stated above it WILL be too strong and irritate/burn your skin.  It works beautifully for thick skin on the feet, but even though Glytone markets it for elbows, only the thickest, roughest elbows need this strong glycolic acid product. Because Glytone Heel and Elbow Cream is so strong, I do not sell it directly to customers on my web site.  I will sell it by phone if you call my office at 707 829-0937 during the normal business hours (Pacific Time).  This enables us to be sure that you have read this information and understand that you are buying a very strong (and very effective) professional grade glycolic acid skin care product.  You can also order it directly from large retail sites like Dermstore.com without this precaution.

If you found this post helpful, you may also want to read:

Essential Winter Skin Care: 2 Simple Tricks To Healthy Winter Skin

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Chapped Lips: The Remedy Depends On The Cause

Pandemic Of Dry Hands: Hand Sanitizers, The Swine Flu And Tips To Save Your Hands

Making Sense Of The Vitamin D Dilemma And Sun Exposure

Photo Attribution: Sean Dreilinger

Winter weather is hard on all of your skin, including your lips.

If your lips are chapped due to the weather they will improve when you moisturize them with a simple, but high quality lip balm. Unless you’re a big time lip licker, or constantly out in harsh weather (think fishermen and skiers), your lips should respond to lip balm. If your lips don’t heal with consistent use of a good lip balm, you could be allergic to a food or to your lip care products; find the allergen and heal your lips!

I see a lot of patients with chapped lips. Before they’ve seen me, they’ve tried numerous chapped lip remedies, all without improvement. When I see that both the top and the bottom lips are chapped, I suspect an allergy as the cause. In my practice, the most common lip allergens are:

1. Citrus: This includes the twist of lemon in your beverage, drinking orange juice, eating an orange etc. This is my lip allergen. I get chapped lips every time I squeeze lemon in my water or use it generously on food. I have citrus trees and love using the fruit. I know to expect dry, scaly lips after ingesting citrus and because I love the fruit I do it anyway. I can lessen the chapping by wearing Ceralip (see below) as a barrier, using a straw if I’m drinking the citrus and washing my lips soon after the exposure.
2. Mint: Mint is in many products including gum, breath mints, dental products etc. I have a patient whose chapped lips were caused from regularly drinking mint tea.
3. Cinnamon: Cinnamon products are less common but there is cinnamon in some dental products, teas and beverages. One of my patients developed dry lips from the cinnamon in Good Earth’s Original Flavor herb tea, which is loaded with cinnamon.
4. Lip balms: Many ‘healing’ lip balms designed to treat chapped lips actually contain well intended allergens that you can be allergic to. The product I see the most problems with is Bert’s Bees Lip Balms, but there are many other products patients bring me that are loaded with allergens. The common lip product allergen ingredients include vitamin E (tocopherol), rosemary, eucalyptus, mint, lanolin, non mineral sunscreen ingredients as well as the fragrance and flavors in the lip products.

If your chapped lips are due to an allergy, they become chapped within a few days after exposure to the allergen, and can take a week or more to heal. If you think that you may have chapped lips due to an allergic reaction, try avoiding the allergens that I listed above for a month. Moisturize your lips with a simple, low allergen product. My favorite is Ceralip, which is why I sell it at OTB Skin Care. Other options include pure shea butter (L’Occitane has a nice Mini Pure Shea Butter tin with 100% pure shea butter). You can also try plain vasaline, but it’s irritating to some people. When your lips have healed, retest just one of the allergens. If your dry lips reoccur you have your answer.

If you found this post helpful, you may also want to read:

Essential Winter Skin Care: 2 Simple Tricks To Healthy Winter Skin

Dermatologist’s 3 Simple Steps for Sandal Ready Feet by Spring

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Pandemic Of Dry Hands: Hand Sanitizers, The Swine Flu And Tips To Save Your Hands

Dermatologist’s Tips For Dry Flaky Skin on Your Face and Scalp-Tis the Season for Seborrheic Dermatitis

Making Sense Of The Vitamin D Dilemma And Sun Exposure

Photo attribution: