New Findings Support the Rising Popularity of Spironolactone for Adult Acne

The inexpensive drug could be a safe and effective alternative to antibiotics.

Even though acne is usually at its worst when we’re in our teens and twenties, it’s one of the most common skin conditions in adults, too. As many as one in three women have facial acne in their thirties, and an estimated one in seven continue to struggle with facial blemishes into their fifties.

Many experts recommend considering systemic therapies if topical medications aren’t working or if the acne is causing scars. But that usually means antibiotics, which can be less than ideal for a few reasons.

“Not only is antibiotic resistance a problem, but antibiotics can affect the gut microbiome with unwanted consequences,” says Abigail Waldman, MD, the clinical director of the Mohs and Dermatologic Surgery Center at Brigham and Women’s Hospital and a dermatologist at Mass General Brigham, both in Boston.

For women with a certain type of acne, one alternative has been an inexpensive drug used to treat high blood pressure called spironolactone. Used “off-label” for the skin condition, the drug blocks certain hormones that can cause acne. Men aren’t prescribed spironolactone for acne because of the side effects; men have developed breasts while taking the drug, according to the American Academy of Dermatology.

Largest Randomized Controlled Trial to Look at Spironolactone for Acne

Now results from the first large-scale clinical trial to look at the effectiveness of spironolactone in treating acne, published on May 16 in the British Medical Journal, add support for the inexpensive generic drug.

“Spironolactone has been gaining popularity [as a treatment for acne], and I think this randomized controlled trial with over 400 participants will help. The previous randomized controlled trials were with fewer than 40 women,” says Dr. Waldman, who was not involved in this study.

“Because spironolactone has been generic for many years, there is less financial incentive to conduct large, multicenter placebo-controlled trials in acne patients,” says Lindsay Strowd, MD, an associate professor of dermatology at Wake Forest University School of Medicine and a dermatologist at Atrium Health Wake Forest Baptist, both in Winston-Salem, North Carolina. Dr. Strowd was not involved in the new research.

After 3 Months of Treatment, Women Saw Significant Improvement in Their Acne

The UK study included 410 women older than 18, with an average age of 29, who had acne that had persisted for more than six months, and for whom oral antibiotics would have normally been the next treatment. Half were randomly selected to take spironolactone, while the other half were given a placebo.

For the first six weeks, the spironolactone group took 50 milligrams (mg) a day, and then the dose was increased to 100 mg per day until week 24.

The women were asked to complete questionnaires on their acne and quality of life relating to the condition at the start of the trial and then at 12 and 24 weeks into their treatment.

“The results showed that the women taking spironolactone saw a significant improvement in their acne after 12 and 24 weeks compared to those on the placebo,” said the lead author, Miriam Santer, PhD, a professor of primary care research at the University of Southampton in England, in a press release.

Spironolactone Could Offer an Alternative to Antibiotics for Many Women

“A significantly higher proportion of people also reported that they felt satisfied that their skin had been helped compared with those receiving placebo, and any side effects were uncommon and very minor. These results show that spironolactone could offer an alternative to antibiotics for many women with persistent acne to use alongside topical acne treatments,” she said.

“The findings also showed a significant objective reduction in acne at 24 weeks. This was a well-designed study, and I think it was reassuring that few side effects were noted, with headache being higher in the treatment group,” says Waldman.

What Kind of Acne Responds to Spironolactone?

Spironolactone is used for a very specific type of acne caused by hormonal imbalance in women, says Waldman. “This acne presents on the jawline, neck, and chest,” she says.

Usually, spironolactone is a second- or third-line treatment after topical medications such as benzoyl peroxide, topical retinoids, and oral antibiotics, says Waldman. “Often it is prescribed with an oral contraceptive, which increases its potency and prevents pregnancy complications while on the medication,” she says.

Spironolactone shouldn’t be used during pregnancy or if you’re trying to get pregnant because of its effect on hormones, and so women must be willing to use contraceptives while on the medication, she adds.

Antibiotic Resistance Is One of the Biggest Threats to Global Health

Spironolactone use for acne in the United States is very common, and its popularity has risen as dermatologists have become more conscious of antibiotic resistance. There has also been a push to minimize long-term use of oral antibiotics for acne treatment, says Strowd.

Antibiotic resistance happens when germs like bacteria or fungi no longer respond to the drugs designed to kill them, according to the World Health Organization (WHO).

Antibiotic resistance is one of the biggest threats to global health, food security, and development today, per the organization. Although there are many health situations where antibiotics must be used, it’s important to avoid using them unnecessarily, because it can contribute to antimicrobial resistance.

Contact us today at our Bakersfield dermatology office to schedule an appointment for a acne evaluation.

Unlocking the Layers of Psoriasis: Beyond Skin Surface

Familiar Names, Uncommon Condition

Do any of these (somewhat unusual) names sound familiar to you? Humira, Stelara, Cosentyx, Embrel, and Otezla? It’s probably because you’ve seen ads for them. With so many commercials (and celebrities) talking about “clear skin” you might think everyone needs it!

The skin condition those medications, and many others, are designed to treat is psoriasis. It affects 3% of the population, so while we don’t all need it, millions of Americans suffer from it. It’s considered an “immune-mediated disease,” which means a disease with an unclear cause related to the dysfunction of the immune system, according to the National Psoriasis Foundation®.

The Immune System and Psoriasis

Normally, skin cells grow and then fall off in about a month. When you have psoriasis, the immune system doesn’t work properly, causing T-cells to attack the body and prevent skin cells from shedding. Instead of coming off, they pile up in raised “plaques” or scales on the skin.

Don’t Be Fooled by Appearances: The Many Types of Psoriasis

If you think red, itchy, or flaky skin is psoriasis, it might be. But in fact, many skin conditions look similar. That’s why getting an exam from a dermatologist is the quickest way to the best treatment (versus buying an over-the-counter treatment that may or may not treat the outward symptoms).

List of Psoriasis Types

• Plaque psoriasis: Raised, thicker skin in patches, covered with scales; typically on the scalp, elbows, knees, or back.
• Scalp psoriasis: Thin or thick psoriasis on the scalp, can spread to nearby areas like the ears or neck.
• Nail psoriasis: Yellow-brown spots on the nails or tiny potholes, weak or separated nails.
• Guttate psoriasis: Small, scaly spots, often seen in children after an infection like strep throat.
• Inverse psoriasis: Shiny, smooth patches in areas where skin touches skin, like under the arms or in the groin.
• Pustular psoriasis: Painful pus-filled blisters and thicker, scaly skin, often on hands and feet.
• Generalized pustular psoriasis: Rare and serious, shows up as dry, red, and tender skin followed by pus-filled blisters.
• Erythrodermic psoriasis: Life-threatening, noticeable areas of skin that look burned.

What Causes Psoriasis?

While the specific cause is unknown, medical professionals agree it’s genetic. If someone in your family has it, your chances of getting it too are higher. As with many health conditions, you can have a genetic predisposition but never “trigger” the disease itself.

Known Triggers to Avoid

• Stress
• Injuring the skin (cuts, sunburn)
• Infection
• Certain medications, including lithium, prednisone, and hydroxychloroquine
• Smoking or chewing tobacco
• Heavy alcohol use

Psoriasis Treatment Options

• Topical medications
• Injections of biological medications
• Oral therapy with immunomodulators and anti-inflammatory medications
• Phototherapy
• Laser treatment

Contact us today at our Bakersfield dermatology office to schedule an appointment for a psoriasis evaluation.

The Role of Moisturizers in Acne Care

Acne can wreak havoc on your skin, leaving it feeling oily and uncomfortable. Surprisingly, a moisturizer could be the missing piece in your acne care routine. If you’re undergoing any of the following acne treatments, incorporating a moisturizer might be just what your skin needs:

• Benzoyl peroxide
• Salicylic acid
• Adapalene, tazarotene, or tretinoin
• Isotretinoin (a prescription treatment for severe acne)

These treatments are known to dry out and irritate the skin. However, using a moisturizer daily can help your skin better tolerate these medications.

A moisturizer can also be a savior when your skin feels parched, especially during the cold winter months.

Dehydrated skin can trigger an overproduction of oil, which can lead to more breakouts. A well-chosen moisturizer can prevent your skin from becoming excessively dry and irritated.

Why Dermatologists Include Moisturizers in Acne Treatment Plans

So, what type of moisturizer is ideal for someone with acne-prone skin? Look for products with these labels on the container:

• Oil-free
• Non-comedogenic
• Won’t clog pores

When you spot these descriptions, it’s a good sign that the moisturizer is unlikely to exacerbate your acne.

When should you apply moisturizer if you have acne? The rule of thumb is to use it when your skin feels dry. Dermatologists recommend incorporating it into your daily routine, especially after cleansing, as it helps lock in much-needed moisture.

Sealing in Moisture for Healthy Skin

After washing your face, leave some water on your skin before applying moisturizer. This can be a game-changer in maintaining skin hydration.

Now, when can you expect to see results? Studies show that most patients experience a reduction in acne between 4 to 8 weeks after starting to use an acne-friendly moisturizer. These studies typically involve patients following a comprehensive acne treatment plan, including acne medication, cleanser, and moisturizer, all carefully chosen by dermatologists.

If you’re still skeptical about introducing a moisturizer into your acne care routine, it might be time for a chat with a dermatologist. Schedule an appointment and Bakersfield dermatologist Dr. Raskin will provide personalized advice on how to effectively clear your acne and develop a tailored treatment plan.

Is there a Risk in Skin Tags?

Skin tags, those small flaps of skin that often emerge in areas prone to friction like the neck, underarms, and face, are a common occurrence, with most individuals experiencing at least one during their lifetime.

For those dealing with skin tags, Dr. Raskin, a board-certified dermatologist in Bakersfield provides in-office solutions to safely remove them. Dr. Raskin offers insights into the nature of skin tags and whether they warrant concern.

Understanding the Origins of Skin Tags
Skin tags are benign growths, appearing as small skin bulbs atop stalks. While they can affect anyone, they are more prevalent among middle-aged individuals, both men and women alike.

The exact cause of skin tag formation remains unclear, although they might develop when thicker patches of skin trap clusters of excess collagen and blood vessels. This can stem from friction within skin folds or genetic predisposition to skin tag development.

Factors Contributing to Skin Tag Formation Several factors can increase the likelihood of developing skin tags, including:

• Obesity
• Pregnancy
• Diabetes
• High cholesterol
• Hypertension (high blood pressure)
• Human papillomavirus (HPV) infections
• Hyperinsulinemia (excess insulin levels)

For some individuals, skin tags could potentially signify heightened insulin resistance, atherosclerosis (hardened arteries), polycystic ovary syndrome (PCOS), or cardiovascular issues.

When Skin Tags Pose Problems
Typically, skin tags are harmless and require no removal for health reasons.

However, Dr. Raskin might recommend skin tag removal if they bleed, become entangled with clothing or jewelry, grow excessively, display multiple colors, or cause persistent irritation. Some individuals also opt for removal due to self-consciousness related to the appearance of these growths. Consulting with Dr. Raskin can help determine whether skin tags should be removed.

To arrange a diagnostic evaluation for skin tag removal, contact our dermatology office today to  schedule an appointment.

Living with Eczema: Insights from Dr. Raskin in Bakersfield

Dealing with atopic dermatitis, commonly known as eczema, is a daily challenge for many individuals. Approximately 30% of the American population grapple with eczema, which can make it difficult to navigate the day and achieve restful sleep while contending with the persistent itching and discomfort it brings. Dr. Michael Raskin, a dermatologist practicing in Bakersfield, wants you to recognize that there are practical strategies to effectively manage this chronic skin condition and regain control over your daily life.

Exploring Diverse Approaches
It’s important to recognize that eczema manifests differently in each person. Adopting a comprehensive approach to minimize the frequency and intensity of symptoms can offer sustained relief. Given that eczema lacks a single causative factor, there isn’t a one-size-fits-all solution. Therefore, it’s advisable to consider a range of strategies to optimize your quality of life despite eczema’s presence.

Identifying Personal Triggers
Eczema often follows a pattern of flare-ups triggered by various environmental factors and substances, including:

• Sun exposure and hot weather
• Excessive sweating
• Irritants like fragrances in lotions, soaps, and perfumes
• Laundry detergents and clothing materials
• Stress
• Allergens and microbes
• Severe cold weather
• Texture of fabrics

Being attuned to specific triggers empowers you to avoid or modify situations to minimize their impact on your condition.

Developing Tailored Approaches
Should you discover a skincare regimen that effectively reduces eczema flare-ups, itching, and irritation, it’s wise to stick to it diligently. Alternatively, if a prescribed medication proves most effective, adhering to the treatment regimen is crucial. Self-care practices contribute significantly to managing and alleviating uncomfortable symptoms.

Cultivating a Positive Mindset
Engaging in relaxation techniques like meditation, yoga, or mindfulness exercises can divert your attention from the itching and irritation of eczema. Guided imagery, in particular, offers a mental escape, proving beneficial, especially if stress exacerbates your symptoms.

Exploring Natural Alternatives
Embracing natural remedies like coconut oil or sunflower oil can provide soothing and moisturizing effects without the irritants present in cosmetic products. Experimenting with such remedies may offer relief from itching and redness. Establishing a routine involving these natural options can become integral to your daily skincare regimen.

While essential oils and aromatherapy might be less suitable due to potential skin irritation, it’s important to note that eczema management isn’t uniform. Finding approaches tailored to your specific condition is key.

If managing eczema symptoms has been a struggle, know that you’re not alone.  Reach out to Bakersfield dermatologist Dr. Raskin and schedule an appointment today.

Cystic Acne: The Worst Form of Acne

The most severe type of acne is called cystic acne, in which deep and very inflamed acne develops on the face or other parts of the body. The breakouts may be large and can leave unsightly scars. These acne bumps or cysts appear under the surface of the skin and are filled with fluid and often painful.

What causes it?
All types of acne are primarily caused by too many dead skin cells in the pores, overactive oil glands, or a proliferation of acne-causing bacteria. Minor acne blemishes develop when a pore wall breaks near the skin’s surface and leaks infected material into the surrounding area. If a pore wall similarly breaks deeper under the skin’s surface, more severe blemishes can form. If the infected material leaks into adjacent pores, cysts may develop. This most severe kind of acne is usually not related to things like poor cleansing or making poor diet choices. Some people are just more prone to cystic acne than others. It has also been shown to have a genetic element, with parents who had cystic acne more likely to pass severe acne down to their children.

Can it cause scarring?
Because cystic acne damages healthy tissue, it is very common for scars to form in the skin. The best way to limit scarring is to stay on top of treating this type of acne. It is also important to avoid popping or picking at acne cysts, which will likely worsen the breakout and lead to skin damage and scarring. Many patients with this form of severe acne struggle with the embarrassing appearance of breakouts and the lingering effects of scars. This is another reason to get professional treatment from a skilled dermatologist like Dr. Bernard Raskin in Bakersfield.

How is cystic acne treated?
Strong medications are almost always required to adequately treat cystic acne, so seeing a professional is a vital element of treatment. Systemic medications that circulate throughout the body instead of just focusing on one part are a common choice for handling cystic acne. Some of the most frequently prescribed treatments include:

• Oral antibiotics
• Oral contraceptives for women
• Corticosteroid injections
• Accutane
• Surgical skin incision to access and drain the cyst

In can be difficult to gain control of cystic acne, so patients should remember to be persistent and follow the physician’s instructions carefully. Several treatment combinations may be necessary to find the right method for each individual patient. Working closely with your experienced dermatologist is the best way to successfully treat cystic acne.

Schedule an appointment today in our Bakersfield dermatology office.

Age Spots vs. Sun Spots: What’s the Difference?

Many people use the terms “age spots” and “sun spots” interchangeably, but they are not the same thing. While both are related to the sun, they have different causes and treatments. In this article, we’ll take a closer look at age spots and sun spots, and how to tell the difference between the two.

What are Age Spots?

Age spots, also known as liver spots, are flat, brown or black spots that appear on the skin as we age. They are usually found on areas of the skin that have been exposed to the sun, such as the face, hands, and arms. Age spots are caused by the overproduction of melanin, the pigment that gives our skin its color.

What are Sun Spots?

Sun spots, also known as solar lentigines, are similar to age spots in appearance, but they are caused by sun exposure. Sun spots are usually lighter in color than age spots, and they can appear anywhere on the body that has been exposed to the sun.

How to Tell the Difference

The easiest way to tell the difference between age spots and sun spots is by their location. Age spots are usually found on areas of the skin that are regularly exposed to the sun, while sun spots can appear anywhere on the body. Additionally, age spots are usually darker in color than sun spots.

Treatment Options

If you are concerned about age spots or sun spots, it is important to see a dermatologist. Dr. Raskin of Bakersfield Dermatology can provide a thorough examination and recommend a treatment plan tailored to your individual needs. Treatment options may include:

• Laser therapy
• Cryotherapy
• Chemical peels
• Topical creams

Prevention

The best way to prevent age spots and sun spots is by protecting your skin from the sun. This includes wearing sunscreen with an SPF of at least 30, wearing protective clothing such as hats and long-sleeved shirts, and seeking shade during the hottest parts of the day. Avoiding tanning beds and other sources of UV radiation is also important.

Conclusion

Age spots and sun spots may look similar, but they have different causes and treatments. If you are concerned about any spots on your skin, it is important to see a dermatologist. Dr. Raskin of Bakersfield Dermatology can provide expert care and treatment options tailored to your individual needs. Remember, prevention is key when it comes to protecting your skin from the sun.

If you are looking for more information about skin cancer prevention and treatment, visit the Bakersfield Dermatology website.

Acanthosis Nigricans – What is It?

Granuloma 101

Granulomas are small areas of inflammation in tissues of the body that develop in response to various types of irritants, infections, or foreign substances. They are clusters of immune cells, such as macrophages, that gather together to surround and contain the irritant. Here is a closer look at the causes, symptoms, types, and treatments of granulomas.

Causes
Granulomas can form in response to a variety of factors, including infections, inflammation, autoimmune diseases, and exposure to certain substances. Some of the most common causes of granulomas include:

• Infections such as tuberculosis, fungal infections, and leprosy
• Autoimmune diseases such as sarcoidosis and Crohn’s disease
• Exposure to foreign substances such as talcum powder or silicone
• Chronic inflammation due to conditions such as rheumatoid arthritis or inflammatory bowel disease

Symptoms
The symptoms of granulomas vary depending on the location and cause of the granuloma. In some cases, granulomas may not cause any symptoms at all. However, common symptoms of granulomas include:

• Skin lesions or bumps
• Coughing
• Fatigue
• Shortness of breath
• Weight loss
• Joint pain or stiffness
• Abdominal pain or discomfort

Types of Granulomas
There are several types of granulomas, including:

• Tuberculoid granulomas: These are caused by tuberculosis or other mycobacterial infections and are characterized by a central area of caseation necrosis surrounded by a layer of immune cells.
• Foreign body granulomas: These develop in response to foreign substances that are not able to be broken down by the body, such as talcum powder or silicone.
• Sarcoid granulomas: These are characteristic of sarcoidosis, an autoimmune disease in which immune cells cluster together in the lungs, lymph nodes, and other organs.
• Granulomatous vasculitis: This is an inflammatory condition that affects the blood vessels, causing granulomas to form around the vessel walls.

Treatments
The treatment of granulomas depends on the underlying cause and the severity of symptoms. Some treatment options include:

• Antibiotics or antifungal medication for infections
• Steroid or immunosuppressive medication for autoimmune diseases
• Surgical removal of foreign bodies
• Injections of corticosteroids into the affected area to reduce inflammation and promote healing

In some cases, granulomas may not require treatment and may go away on their own. If you have symptoms of a granuloma, it is important to seek medical attention to determine the underlying cause and appropriate treatment plan. Schedule an appointment with Dr. Raskin today!

Battling Boils

Boils, also known as furuncles, are painful and inflamed lumps that form beneath the skin. They are caused by an infection in a hair follicle or oil gland. Boils can occur anywhere on the body, but are most commonly found on the face, neck, armpits, buttocks, and thighs. In this article, we will discuss the causes, symptoms, types, and treatments for boils.

Causes of Boils
Boils are most commonly caused by the bacteria Staphylococcus aureus. This bacteria normally lives on the skin and in the nose, but can enter the body through a cut or break in the skin. Boils can also be caused by other types of bacteria, such as Streptococcus pyogenes.

Other factors that can increase the risk of developing boils include:

• Poor hygiene
• Diabetes
• Weakened immune system
• Friction from tight clothing or shaving
• Exposure to harsh chemicals
• Certain medications, such as steroids

Symptoms of Boils
Boils typically start as a red, painful bump that gradually increases in size over a few days. They can range in size from a pea to a golf ball, and may be accompanied by a fever or general feeling of illness. As the boil grows, it may develop a white or yellow center, which is pus that has accumulated under the skin. The skin over the boil may also become tender and swollen.

Types of Boils
There are several types of boils, including:

1. 1. Furuncles: single boils that occur on the skin and are typically caused by Staphylococcus aureus.
   2. Carbuncles: clusters of boils that are often larger than furuncles and can be very painful. Carbuncles are more likely to cause a fever or other systemic symptoms than furuncles.
   3. Cystic acne: deep, painful, and inflamed cysts that occur on the face, neck, chest, and back. These cysts are caused by blocked hair follicles.

Treatments for Boils
Most boils will heal on their own within a few weeks. However, there are some treatments that can help alleviate the pain and speed up the healing process. These treatments include:

• Applying warm compresses to the affected area for 10-15 minutes several times a day.
• Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, to alleviate pain and reduce inflammation.
• Keeping the affected area clean and dry to prevent further infection.
• Taking antibiotics if the boil is severe or if there are multiple boils.
• In rare cases, a boil may need to be drained by a healthcare professional. This involves making a small incision in the skin and draining the pus out of the boil.

Preventing Boils
There are several steps you can take to prevent the development of boils, including:

• Practice good hygiene, such as washing your hands regularly and showering after exercise or heavy sweating.
• Avoid sharing personal items, such as towels, razors, or clothing.
• Avoid tight clothing that may cause friction on the skin.
• Treat any cuts or breaks in the skin promptly with antiseptic to prevent infection.

Boils can be painful and uncomfortable, but they are usually not a cause for serious concern. Practice good hygiene and take steps to prevent the development of boils to keep your skin healthy and free of infection. Most boils will heal on their own within a few weeks, but if you experience any symptoms of a severe infection or if the boil does not heal, it is important to seek medical attention. Call our Bakersfield dermatology office to schedule an appointment.