1. I keep hearing mixed things about the connection between diet and acne (e.g., avoid greasy foods and chocolate). What’s the current consensus in the dermatology field about whether diet contributes to acne?

I admit that it seems that every few years medical thought on a variety of subjects flip-flops, sometimes doing a 180-degree reversal. So, I cannot say that in one, two or 10 years, scientists won’t change their current thinking that diet has little effect on acne.

However, for more than the past quarter of a century, the consensual contention in the medical community is that diet — particularly chocolate, fried foods and nuts — doesn’t cause acne or aggravate the condition in someone who is predisposed to it.

That being said, there’s mounting evidence that hormones found in cow’s milk, particularly skim milk, can trigger acne, and in many cases simply cutting out or cutting down on milk and other dairy products has helped certain people with controlling their acne. One of my sons, who had a difficult case of acne, was able to control outbreaks by limiting his intake of dairy products.

Iodine-containing foods and products, such as fish and iodine-containing multivitamins, may also flare acne in those with an inherited tendency to acne. Otherwise, in the limited research done to date, there’s little to support that avoiding chocolate and fried foods helps to control acne.

As to why some people break out almost immediately when consuming these items, there’s at least one plausible explanation. If the person has grown up in an environment where it’s been thoroughly inculcated that consuming these kinds of foods leads to acne, the stress, anxiety and guilt that are engendered by doing so can trigger the release of a cascade of hormones that may be the actual trigger(s) of the flare up. This could explain why the breakout is often so immediate after ingestion and long before the foods have been adequately broken down and digested and capable of triggering any reaction.

2. Can taking vitamins protect against acne or help treat it in any way?

Vitamins consumed in ordinary amounts have little effect on the course of acne. Mega doses of vitamin A, however, can be beneficial by decreasing the abnormal clumping of skin cells with the pores that contribute to whiteheads and blackheads and diminishing inflammation.

Before the introduction of Accutane (which is a vitamin A derivative), dermatologists sometimes recommended high doses of vitamin A for their patients who had difficulty controlling their acne.

But vitamin A, when consumed for prolonged periods in very high doses, can have serious side effects on the mucous membranes, bone, liver and the heart and shouldn’t be taken for acne or any other condition without the advice and supervision of a physician.

3. There are many topical products on the market that claim to reduce the appearance of acne scars, such as Mederma and Scar Zone; are these products helpful or just hype?

Mederma, a topical onion skin extract, has been used for several years for improving the appearance of old scars or preventing the formation of new scars. While not overwhelming, there’s some recent evidence that its use over several months may help to improve the appearance of some scars.

Similar claims for a host of other products — which generally contain some form of silicone applied topically (along with sunscreens, aloe, hydrocortisone, antioxidants, etc.) or in silicone sheets — have also been made during the past few years.

Although the jury isn’t in on any of these products, one thing is clear: there are currently far more effective, in-office methods for treating all kinds of scars, including acne scars and traumatic scars, that take only minutes to perform, have little associated downtime and may improve some scars dramatically.

These include microchanneling (microneedling), dermaspacing, CROSS and manual dermasanding. For a detailed discussion on these techniques and others, check out the Skincare-news.com interview I gave on the subject not long ago.

4. I’m a woman in my later 20s with dry skin and occasional acne; what kind of topical treatments can I use that won’t dry my skin out further but keep blemishes away?

Most young people with acne complain of oily skin. And while shiny, greasy-looking skin may be the source of embarrassment, there’s an upside. Since almost all of our current acne therapies tend to dry out and irritate the skin a bit, acne sufferers with excessive oiliness are better able to resist the drying effects while benefiting from the therapy.

On the other hand, those with dry skin have a tougher time. Here’s what people with dry, sensitive skin can do to minimize irritation:

• Wash gently with mild cleansers designated as "sensitive skin cleansers."
• Avoid the use of abrasive scrub sponges and even wash cloths.
• Use tepid (rather than hot) water.
• Cleanse no more than twice daily
• Lightly pat the skin dry, rather than vigorously towel drying.
• Wait at least 15 to 30 minutes before applying any topical anti-acne medications (common OTC treatments typically contain salicylic acid or benzoyl peroxide). Wet skin acts to heighten the drying effects of these medications. So, it’s always best not to cut corners and wait the required 15 (better 30) minutes before applying them.
• In the case of acne topicals, more is usually not better. In fact, a little generally goes a long way. Applying heavy globs of medication not only doesn’t look nice, but wastes money and increases the risk of irritating skin, particularly with dry, sensitive skin.

5. Can a diet with a low glycemic index actually help to protect against acne?

As I mentioned earlier, at least for the present, the link between diet and acne remains iffy at best. There’s recent preliminary evidence, however, to suggest that some people with acne may actually do better by adhering to a low glycemic diet. Since a diet with a low glycemic index is certainly better for promoting overall good health, I have no objection to making this part of an overall anti-acne regimen.

6. I’m experiencing more acne during menopause than I did as a teen! Why is that and what can I do?

Adult acne, or more accurately, rosacea, is a condition that can affect individuals anytime between the ages of 20 and 60 (and even beyond). Acne vulgaris, so-called "teenage acne," and acne rosacea, adult acne — while they both may cause pimples and pustules — aren’t the same condition. In fact, they’re genetically distinct problems.

Acne vulgaris is characterized by the presence of whiteheads and blackheads (closed and open comedones), in addition to pimples and pus-heads. Rosacea, too, may give rise to red papules and pustules but without the presence of comedones. It may also be associated with the development of "broken" blood vessels (telangiectasias) on the cheeks, excessive flushing, irritation of the eyelids and overgrown oil glands, none of which are seen with teenage acne. It’s clearly a distinct condition and having escaped teenage acne isn’t a guarantee of escape from adult acne.

Rosacea sufferers typically have very sensitive skin, easily irritated by all kinds of personal hygiene products, cosmetics and topical medications, making treatment difficult.

A trial of over-the-counter anti-acne medications usually leads to excessive dryness and little improvement in the breakout. For this reason, consultation with a dermatologist is the best, fastest, and in the end, the most economical?way to deal with this problem.

7. What professional treatments work for acne (e.g., chemical peels, lasers)?

The mainstay of professional acne therapy is topical agents, particularly those containing vitamin A derivatives, such as Retin-A, Tazorac and Differin and benzoyl peroxide gels. Oral antibiotics can be used in more severe cases.

In cases of nodular, cystic and scarring acne that haven’t responded to aggressive oral antibiotic and topical therapy, oral isotretinoin (Accutane) has proven quite successful, although this agent requires strict doctor supervision. Due to the risk of birth defects, this medication isn’t permitted in women who may become pregnant.

Other therapies that may be helpful in selected cases include the use of chemical peeling agents, such as glycolic and salicylic acid peels, intense pulsed light (IPL) and photodynamic therapy with either blue light, red light or a combination of the two.

In my opinion, none of these therapies is a stand-alone treatment. They serve best to supplement the treatments already mentioned and may also be helpful for periodic maintenance to prevent flare-ups.

8. Many articles talk about the importance of minimizing stress to achieve and maintain clearer and better-looking skin; does stress really play that integral of a role in skin health?

Stress has long been labeled the causative culprit in so many diverse skin conditions (as well as non-dermatologic illnesses). But, it's only recently that we’ve begun to better understand the link between stress and disease.

Stress, or "nervous tension," can have a profound effect on the production of hormones, like catecholamines and cortisol, which can then impact the immune system dramatically and in turn affect our skin and overall health. Put another way, while stress may not be the direct cause of skin and health problems, it can severely aggravate them.

Stress doesn’t cause acne or rosacea, but many sufferers will attest that they have breakouts when they’re under pressure — such as studying for exams or under deadlines at work — or even coping with good stresses, like planning their wedding.

Curiously, anti-anxiety drugs and antidepressants haven’t proven useful for preventing or dealing with these flare-ups. For some, meditation and biofeedback techniques have been useful and are certainly worth a try.

But, for the moment, professional topical and oral treatments are the most effective way of managing flare-ups triggered by any cause.

9. Today, there’s a wide array of over-the-counter anti-aging creams that claim to promote collagen and elastin production, reduce wrinkles, firm the skin and improve discoloration. It’s tough to tell if this is just advertising or accurate. In general, what can (and can’t) anti-aging products do?

A good rule of thumb is that if it sounds too good to be true, it probably is. That would apply to most of the claims made for all kinds of anti-aging preparations, particularly for over-the-counter cosmeceuticals.

Tretinoin, alpha hydroxy acids, beta hydroxy acids and L-ascorbic acid have the strongest scientific underpinnings for their use on the skin. A host of other agents, including topical hyaluronic acid, antioxidants, DMAE and all kinds of peptides, have their advocates, but to date their purported benefits have far more marketing hype than scientific proof.

The problem is that the skin is such a magnificent barrier that it prevents the absorption of these compounds down to where they’re needed in the dermis, limiting their value.

There’s growing support that the use of in-office techniques, such as microchanneling (microneedling) — which creates tiny, temporary, imperceptible channels in the skin — and iontophoresis — which uses a mild electric current — may improve the transport of all kinds of topical agents across the skin barrier, increasing their efficacy.

Recently, I’ve begun employing these techniques successfully in my office for improving the penetration and effect not only of all kinds of substances for anti-aging and anti-wrinkling, but for improving scars, eliminating stretch marks and promoting hair growth.

I also make available to my patients a home-use microchanneling roller that can be combined with an at-home routine that helps to maintain the benefits obtained with in-office treatments.

10. I just turned 51, but I still get blackheads; what kind of topical treatments do you recommend to treat and prevent this kind of acne?

Over-the-counter preparations containing benzoyl peroxide or salicylic acid may be helpful for mild cases. In general, however, the use of retinoids (like Retin-A, Tazorac, Differin) is most effective for dealing with and particularly preventing the formation of blackheads and whiteheads.

When there’s a lot of clogging, I usually perform microdermabrasion followed by a professional cleaning and the application of a glycolic or salicylic acid peel and then prescribe the above for at-home maintenance.

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To learn more about cosmetic dermatologist Nelson Lee Novick, M.D., F.A.A.C.S., F.A.A.D., please visit his bio.