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Recent Acne Article in Elle Magazine


The Best Tips for Clear Skin

From toothpaste to tretinoin, we’ve tried it all. Here, the country’s top dermatologists weigh in on what really works to get a flawless complexion.

By Fiorella Valdesolo  |  December 01, 2011


  I confess: I have canceled plans because of acne—occasionally even because of one lone pimple (usually a vexing shade of eye-catching scarlet and raised enough to cast its own shadow, but still). And I am not alone in my overreaction. Something about acne manages to drive the sanest among us to extreme measures. Even with a universe of products available nowadays to address it, we still turn to a cocktail of homegrown remedies and self-surgery to try to eradicate it—such as the fashion editor friend of mine who uses Monistat cream (yes, the yeast-infection treatment) as a weekly face mask, or the street-style darling I know who admits she spot-treats with Pepto-Bismol. But why raid other drugstore aisles when there’s a whole row specifically dedicated to acne?

 Because we’re desperate. “The conventional acne treatment for teenagers is to dry them out and get rid of the oil,” says New York dermatologist Dennis Gross, MD. Although we have less sebum as we age, the oil we do have turns into a pore-clogging glue. “With adult acne, it’s a problem with the oil chemistry. As hormones change, oil does too­—becoming more viscous. And as it flows through the gland and out through the pore, it gets stuck.” Sometimes, products designed to strip away oil just exacerbate acne by increasing inflammation. “Plus, when skin is dry, dead cells flake off, further blocking pores that already have a problem, leading to more acne.”

 Rather than blasting skin topically, many derms are tinkering with the hormonal precursors that lead to breakouts. During the teen acne years (between the ages of 12 and 18), the hormone Insulin-like Growth Factor 1 (IGF-1) peaks; it “decreases as people reach their twenties and may account for the decline in acne in many people,” says NYC dermatologist Kavita Mariwalla, MD. “But at the same time there are plenty of other hormonal irregularities that cause adult acne.” For example, progesterone spikes each month when we ovulate. “Progesterone, more than estrogen, resembles testosterone, and that’s the one that seems to be more villainous when it comes to stimulating and driving the sebaceous glands,” says dermatologist David E. Bank, MD, of Mount Kisco, New York.

 The hormonal cascade released when we’re stressed is another acne agitator. “Your adrenal glands that sit right above your kidneys secrete cortisol and trigger your fight-or-flight response,” says New Jersey–based Jeanine Downie, MD. “When you’re stressed, your adrenal glands are secreting more cortisol, which can pack on pounds around the waist and lead to more significant amounts of hormonal acne.” So stress leads to acne, which, in turn, leads to even more stress—it’s a vicious cycle.

 While facialists have bashed dairy for decades, clinical studies have only recently established a link between milk consumption and acne. “Milk contains testosterone precursors, which cause increased sebum production,” says New York dermatologist Francesca Fusco, MD. “What’s fascinating is that one study found that of all milk, skim milk has the strongest correlation with acne. We’re not sure why, but some hypothesize that skim milk has less estrogen than whole milk.”

 And switching to organic milk won’t remove your exposure: “All milk naturally contains androgens and IGF-1,” Mariwalla says. “There’s no such thing as hormone-free milk. Plus, milk contains sugar, a lactose, so it stimulates insulin.”

 Another recent study suggests that following a low glycemic index diet—that means one with less refined sugars, carbohydrates, and sugar-containing foods—may result in fewer acne outbreaks. “As the glycemic index goes up, it affects insulin production and all the hormones,” Fusco says. “They are all in a delicate balance—your female hormones are in balance with your thyroid hormones, which are in balance with your insulin. When you have more in one area, it’s like a domino effect on the others.” Since the dietary acne provoker may vary for every person, New York dermatologist Ellen Marmur, MD, recommends keeping a food diary outlining what you eat in the days before a breakout to determine what your triggers are. “Then you start a very slow reentry, introducing one new item, like dairy, every six weeks to see what happens on the skin,” says Marmur, who believes that it takes just 48 hours for what you eat to show up on your face. “So you can look back two days ago and figure out what you were eating,” she says. “It may not be the same foods for you as it is for me. Personally, when I eat chocolate, I’ll break out 48 hours later.”

 Historically, the premier hormonal mediator has always been the birth control pill, which works by replacing the hormones your ovaries are producing with synthetic varieties that won’t stimulate those pesky sebaceous glands as much. But this doesn’t have to be your first line of defense. Marmur points out that while the Pill may clear up acne, it can also provoke another unsightly reaction: melasma, a noticeable discoloration of the skin that she says is on par with acne in her practice as a top complexion complaint. If you do opt for the Pill, figure out an exit strategy first. “Birth control pills can be very effective. But eight or nine times out of ten, when you stop them you are right back where you started,” says Bank, who’s a big fan of the controversial Accutane, the prescription-only vitamin A–derived pill, because it continues to work after you stop using it. “Accutane is still, hands-down, our most effective, lasting antipimple medication,” he says. “My Accutane-treated patients are among the happiest and most grateful patients.” Although an Accutane prescription comes with significant FDA regulation (because of possible birth defects, patients have to agree to use two forms of birth control and undergo regular pregnancy tests during treatment and for one month after), most of the derms we interviewed believe it to be worth the trouble. Downie calls Accutane “the be-all end-all for really bad cystic acne,” and Mariwalla says it is “phenomenal”: “After you stop the medication, many people have a durable response for many, many years.”

 Gold-standard topical acne fighters such as retinoids, benzoyl peroxide, and salicylic acid remain the solutions most frequently name-checked by our dermatologists; what’s new are the streamlined formulas, delivery systems, and accompanying ingredients. “Old medications are being revived by novel combinations,” says North Carolina dermatologist Zoe Draelos, MD. She cites prescriptions like Ziana, a blend of the antibiotic clindamycin and the retinoid tretinoin, and Epiduo, which contains another retinoid, adapalene, plus benzoyl peroxide.

 “BenzEFoam short-contact cleanser is a great new vehicle for benzoyl peroxide,” Bank says. “It’s a mousse formulation that you leave on the skin for a couple of minutes and then wash off, so you don’t have to keep it on all night, which can be drying.” Though there has been some trepidation about benzoyl peroxide because of its ability to spike free radicals, no studies, according to Mariwalla, have shown that they are wrinkle-causing. “Actually, in the case of benzoyl peroxide, we have one of the few times when free radicals can help you,” Mariwalla says. “In the skin, the peroxide part dissociates and kills the bacteria that’s causing the acne, stopping the inflammatory process.”

 Although, as Marmur notes, it takes only two days for a pimple to crop up, you need to give any topical preventive measure 42 days to kick in. “The lifespan of a pimple is about six weeks, so that’s the magic number for how long you should give a product before you give up,” she says. “The biggest mistake people make, besides picking at a pimple, is giving up on products too early. It’s like driving a car—you don’t want to make any rapid changes.”

 As far as picking goes, it’s hard to resist the lure of the magnifying mirror, that evil contraption that turns every pore into a crater. But while it may appear that your clogged pores number in the thousands, many of those little dots, particularly on the nose, are entirely normal hair follicles. Resist the urge to squeeze; leave extractions to the professionals. “If you have a well-trained medical aesthetician working under the auspice of a derm, they can use acne extractors or microneedles to actually get in there for the more difficult whiteheads,” says Neil Sadick, MD, who shares his Park Avenue office space in New York with facialist Luzinete Ripardo, famed for her incredibly thorough (“almost OCD,” says one fan) pore cleanses. (And for emergency spot reduction, the best cure is a shot of cortisone from the doc.)

But the most major advancement may come thanks to gene research, such as that done at P&G’s Miami Valley laboratory in Ohio. A team of researchers led by Rosemarie Osborne, PhD, recently developed an innovative combination of a topical antimicrobial (sodium dehydroacetate) and vitamin B (niacinamide) that was shown, in double-blind independent clinical studies, to reduce sebum production significantly (both can be found in the new Olay Pro-X Clear line). What next? “The biggest genomics breakthrough relative to acne is understanding why some of us get acne and others don’t,” Osborne says. “This type of research will lead to more customized solutions for acne-prone skin in the near future.” For longtime acne sufferers, that sounds akin to a quantum leap—one that just may help ensure that we never have to turn to toothpaste as a skin care treatment again.

Popular Off-Label Options

Advil: “An [oral] ibuprofen can help with red, inflamed pimples but not whiteheads or blackheads,” Fusco says.

Aspirin: “It’s a salicylate,” Mariwalla says, “so you can make a little paste of it and apply to a pimple.”

Benadryl: According to Fusco, “Benadryl can be beneficial for only one subset of acne: acne rosacea.”  

Hibiclens: This antibacterial all-purpose cleanser is “good for folliculitis­—infection of the follicles that looks like acne,” Mariwalla says. “But it’s too drying for the face.”  

Monistat: “For people who have little tiny pimples that are often a form of yeast, not typical bacterial acne, Monistat is actually good,” Marmur says. “No matter what, it won’t hurt you—it will just function as a moisturizer.” 

Pepto-Bismol: “The main active ingredient in Pepto is bismuth subsalicylate,” Mariwalla says. “While some people think that the benzoic acid, an inactive ingredient, will make red marks fade away, the results are iffy.”

Top Blemish Blasters

 An AHA-glycolic complex in La Roche-Posay Effaclar Serum tightens pores; Sampar Pure Perfection Prodigal Pen rolls on eight pimple-fighting essential oils; Olay Pro-X Clear Sulfur Mask absorbs oil; banish blemishes around the clock with the a.m./p.m. formulas in Kate Somerville 24 Hour Pimple Punisher; blue LED therapy plus gentle vibration makes Tända Clear+ (an at-home light device) a non-irritating acne solution; (Malin + Goetz) Acne Treatment zaps zits with 10 percent sulfur; lycopene found in Yes to Tomatoes Acne Roller Ball Spot Stick controls oil production. 


Pacific Dermatology & Cosmetic Center welcomes 2012

A New Year, A New You!

Pacific Dermatology & Cosmetic Center would like to wish all of you a Happy New Year! And with a New Year, comes our excitement to share with you our 3 newest additions; Xoemin, from the makers of Radiesse… the laser-hair removal system of all systems, the Lightsheer DUET…and last but certainly not least, an upgrade to our current laser, the Vbeam Perfecta!

“In keeping with our core mission to stay on the forefront of skin rejuvenation and treatment advancements, we are delighted to offer these new products” says Dr. Jennifer Reichel, founder and Medical Director of Pacific Dermatology & Cosmetic Center and a leading MOHS and Cosmetic surgeon.


Pacific Dermatology & Cosmetic Center is one of the first 100 Dermatology practices in the US to receive and begin injecting Xoemin, a promising new Merz Aesthetics product. Xoemin works just like BOTOX. You could call it a “pure injectable” because it doesn’t contain some of the complex proteins.

The United States Food and Drug Administration (FDA) approved Xoemin July 21, 2011 for the temporary improvement in the appearance of frown lines between the eyebrows. It is also often used to temporarily erase crow’s feet and even the vertical platysmal bands often called “turkey-neck” folds on the neck.

“But most important, Xeomin is LESS expensive. We are able to offer it for 20% less than BOTOX therefore making the Bank A Vial only $10 a unit” says Dr. Reichel.

For more information about Xoemin or to schedule a consultation to see if Xoemin is right for you, please call 206-859-5777.

LightSheer DUET

For those who are tired of unwanted hair and have been waiting for a laser with little to no discomfort, this is the laser for you! LightSheer 800 nm diode lasers were introduced in 1998 and have long been considered the ‘gold standard’ in terms of permanent hair reduction and reliable, low maintenance technology over time. The NEW LightSheer Duet is capturing clinical interest and support for its revolutionizing approach to laser hair removal.

Vbeam Perfecta

We just bought the newest Vbeam laser! The Vbeam Perfecta is the most trusted pulsed dye laser and the most advanced. This laser has a proven track record of safety, reliability, and efficacy. And, the Perfecta has less risk for bruising and is more powerful than its predecessor. Thanks to cutting edge technology, the Vbeam Perfecta is the gold standard. Here are just a few things we can treat with this amazing laser:

• Rosacea
• Port Wine Stains
• Dilated Blood Vessels
• Spider and Cherry Angiomas
• Stretch Marks
• Keloid Scars
• Superficial Leg Veins

The physicians and skin care specialists at Pacific Dermatology & Cosmetic Center look forward to helping you make 2012 your best year yet! Whether your needs are cosmetic or medical, call 206.859.5777 to schedule your appointment today.

Restylane Gets FDA Approval for Lips

Restylane Gets FDA Approval for Lips

Posted Thursday, October 13, 2011 by Brenna Fisher, Deputy Editor

Earlier this year, we reported that the Food and Drug Administration’s General Plastic Surgery Devices Advisory Panel had recommended Restylane for lips. Just this week, that recommendation received approval from the organization.

Previously approved to treat moderate to severe facial wrinkles and folds, including nasolabial folds, the hyaluronic acid filler has now been officially approved for lip augmentation. Although used “off label” in the lips for years, Restylane’s official sign off means the product is now indicated for use in the lips to improve volume and shape. Also, because hyaluronic acid boosts natural collagen production, patients using the product will benefit from that as well. Currently the product is indicated for lip augmentation in patients older than 21.

Worried about how larger lips might look on you? Inquire about doing a series of plumping injections over time, which allows more control over the final shape and size.  Call the doctors at Pacific Dermatology & Cosmetic Center at 207-859-5777 for your cosmetic consultation.

The "Eyes" have it....and we have the "Latisse" to prove it!

These Lashes Are Real, I Swear

These Lashes Are Real, I Swear

Correct me if I am wrong, but recently, I've noticed everyone's trying to fake it. What is "it" exactly? Good question, whether it's Los Angeles, Scottsdale, New York or Miami, there isn't a whole lot people aren't trying to fake. But I digress.

The "it" I'm referring to is, especially as we age, full, voluminous lashes. Lashes so thick and black they'd make Kim Kardashian blush. Doll-like lashes.

Extensions are always an option. Eyelash growth enhancers will give you a one up.  Here are two fabulous options that both promise and deliver fabulous results in as little as 8 weeks.  The one and only FDA approved--Latisse--which can be found at Pacific Dermatology & Cosmetic Center, often at a great discount, and the other is Obagi's Elastilash--also offered at Pacific Dermatology & Cosmetic Center.

But if you're looking for a quick blast of drama, a flirty flash of lash—a fantastic mascara can work wonders. So without further adieu, here are two new mascaras to keep an eye out for:

MAC False Lashes Extreme Black Mascara ($19)
Part of the Fall 2011/Winter 2012 MAC lineup, this intensely black mousse-like formula creates the illusion of costly extensions.

Noir G de Guerlain Mascara ($49)
Launching January 2012, this formula will curl and lengthen lashes, and stimulate the production of keratin, according to WWD.

So Long, Crow’s-Feet

So Long, Crow’s-Feet

They crop up for a variety of reasons: Age-related collagen loss, smoking, squinting and sun damage are likely culprits. They can appear when you’re in your 20s…or may hold off until you hit your 40s. Regardless of when these fine lines start creeping from the corners of your eyes to your temples, they are sure signs of aging and skin damage. But you can combat them a variety of ways.

Injectables. Botox and Dysport offer a two-part solution for crow’s-feet in that they smooth the wrinkles by halting the physical movement (like squinting), therefore preventing them from forming in the first place. This is why many women are opting to start injectables in their 30s. Injectables can’t help sagging skin, like a droopy brow, but are often used in conjunction with browlifts or eyelid surgery to ensure an overall more youthful eye makeover.

Laser resurfacing. To fix the changing texture of the skin around the eyes, a skilled physician may administer fractional CO2 lasers to ablate the top layer of skin, where the damage exists. This prompts the body to development new collagen, which supports the skin, creating a more youthful, plumped look. It takes several weeks to heal, but these types of lasers are ideal for significantly reducing the appearance of crow’s-feet.

Topical solutions. Use sunscreen daily to protect from future damage. We particularly like the extra tinting and matte finish of Skinceuticals Physical fusion UV Defense SPF 50.  To slough away dead skin cells a few times a week we love Clarisonics Mia, you choose the color, it does the work for you.  And finally opt for an eye cream, such as Skinceuticals AOX serum or A.G.E. Eye Complex.

Now is the time to take care of your skin, no matter what your age


  • As featured in Peoples Stylewatch September issue Under “Best Serums For…UV Protection,” C E Ferulic is “A powerful combo of anti-oxidants prevents sun damage and improves skin tone.”
  • As featured in Fitness magazines September issue Phyto+ featured as a go to product for reducing brown spots, dark patches and fine lines that result from constant sun exposure on hands. “To help fade dark patches, try…a gel with botanical lighteners, such as kojic acid and arbutin, both found in SkinCeuticals Phyto +.”

It's a must have and we have it!

I am thrilled and excited to share the placement from the October 2011 issue of Allure, featuring its highly-anticipated “Best of Beauty” Awards, in which SkinCeuticals Phloretin CF wins the award for “Best Anti-Aging Treatment: Antioxidant.”

Want beautiful skin? We have the answer....Clarisonic!

My Path to Perfect Skin

It had been months since I could remember when my skin looked glowing and even. My skin was red, blotchy, oily in places yet super dry in others. Every day that I looked in the mirror I was...


A Big Congratulations To Dr. Reichel!

We congratulate Dr Reichel on being promoted by the University of Washington to Clinical Associate Professor. Her promotion is based on her involvement with teaching the Dermatology Residents and the Dermatology Surgery Fellow. In addition, the promotion is also based on her national recognition as a speaker at skin cancer and cosmetic surgery meetings. She is scheduled to give a talk on "How to Build and Manage a Cosmetic Dermatology Practice" at the next annual American Society for Dermtologic Surgery meeting.

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Thank you for choosing Pacific Dermatology & Cosmetic Center, we look forward to providing you with the very best skin care.