It’s amazing how many options have arrived in the world of skincare and acne in the last 10 years.  It’s daunting even for someone who has been dealing with troubled skin for years.   For new sufferers,  the marketing mayhem must be completely overwhelming.   

For those who trust my opinion based on this website and video gallery,  I’m going to clearly organize the pros and cons of all the popular treatment routes in an effort to minimize the clutter and aimless internet research.   

 

Let’s start with the more common options…

 

1)   Simple Benzoyl Peroxide and Salicylic Acid Regimens:   (infomercial products, drug store kits, basic online regimens)

Pros:  

-Easily accessible and relatively inexpensive.

-Decent success rate for mild, non-persistent acne. 

-a good first choice if there is minimal destructive inflammation.

 

Cons:

- weak success rate for more aggressive and persistent cases

-weak success rate at bringing “Total Inactivation”,  even in the milder cases.

-Because of the cultural popularity of these regimens,  individuals with moderate to severe acne will fail these products for long periods of time.   Since time=scarring, one major con of these regimens is that they distract people who urgently need a more advanced solution.  The hype will confuse someone into thinking it “should” work even when it’s not working.  (hype is a powerful force.)    **This is the biggest con of these regimens.

 

Bottom Line:   Convenient simple fix for less stubborn cases.  If failing on these topicals for long periods of time,  the worst decision possible is to keep at it, hoping and waiting without seeking better assistance.

 

 

2) Dermatology Standards of Care:   (Rx. Retinoids, Topical Antibiotics, Glycolic Acid, and Benzoyl Peroxide)

Pros:

-Relatively inexpensive if you have good insurance.

-Decent success rate for mild and mild/moderate non-persistent acne. 

-a good first or second choice if there is minimal destructive inflammation.

 

Cons: 

-Frequent uncontrolled irritation 

-weak success rate for more aggressive and persistent cases

-weak success rate at bringing “Total Inactivation”,  even in the milder cases.

-weak availability if seeing a dermatologist for a specialized opinion.  (long waits to see the doctor.  It’s a real problem when time = scarring)

-Again,  for more aggressive cases, the waste of precious time moving through a dermatologist’s set algorithm for acne is time that an Acne patient sometimes can’t afford. 

**If your doctor has left you heavily inflamed for months on a Rx topical program,  you have a real problem that needs to be corrected.  (time = scarring)

 

Bottom Line:  This possibility is a fine first option.  Don’t be scared by other people failing and don’t be overly sure it will work.  If unsuccessful after 4-6 weeks,  ask the same doctor exactly what is going wrong with your case.  If they don’t have the needed energy for this conversation,  find a more caring doctor.

 

 

 

3) Dermatology Standards of Care:  (Oral Antibiotics)

Pros:  

-Relatively inexpensive if you have good insurance.

-Decent short term success rate for decreasing inflammation

 

Cons:

-mediocre overall success rate for chronic acne problems

-Gastrointestinal side effects are common

-Antibiotic resistance

-Normal flora is affected all over body.  (yeast infections, etc.)

-fear and stress of taking real pills every day for years. 

-difficult to maintain results without long term use.  

 

Bottom Line:  Good for short term assistance of bringing down inflammation.  Mediocre long term solution.  I see oral antibiotics as a optional adjunct only to speed things up and minimize scarring while active. 

 

 

4) Dermatology Standards of Care:  (Rx Hormonal Therapy, Birth Control Pill, Anti-Androgens, etc.)

Pros:

-Varied success in some stubborn cases

-Paid for by most insurance

 

Cons:

-Not consistently effective.  Often times more time is wasted with trial and error.

-Long term use often needed to maintain control

-Hormonal medications have real short term and potential long term side effects.

-This treatment route has caused the new misconception of “Hormonal Acne”     The confusion creates more pessimism for patients seeking other options. 

 (see the misconceptions category)

 

Bottom Line:   This option is ok to try if you don’t mind being on long term hormonal medications.  If results aren’t being seen in the first 1-2 months,  don’t continue hoping and waiting.  Ask the same doctor about your progress or find a doctor that cares much more about your overall result.

 

 

5) Dermatology Standards of Care:   (Oral Isotretinoin, Accutane, Roaccutane, etc.)

Pros:

-Effective,  even for stubborn cases

-Short term and some long term remissions possible from one course.

-Convenient usage,  less work.  (just take the pill) 

-Covered by health insurance

-Specialist is present for emotional surveillance.

 

Cons:

-Lethal side effects are possible and the risk vs. benefit is weighed with all usage.  (acne itself can be emotionally lethal as well.)

-Requires strict blood testing to prevent dangerous complications.  

-Requires women to not get pregnant under any circumstance.

-Emotional side effects have been reported and are feared by new patients.

-Not a cure.  Despite the optimism that has been created over the years,  there is a significant percentage of complete and partial relapse.

-Short term skin dryness, discomfort, and dramatic aesthetic problems with the skin during treatment can cause real emotional wounds.

-Long Term skin sensitivity and flushing are less well-know side effects that have haunted many prior users.

-Potential for Massive Intitial Purging stage that destroys and permanently scars skin in a way that would not have happened through other treatment options.

-Multiple courses increase the risk for all known side effects,  especially the long term sensitivity problem.

-Because the hype,  those who fail Accutane mistakenly believe that they are “untreatable”   

 

Bottom Line:  For stubborn, resistant moderate to severe acne, this drug is still one decent option because of it’s ease of use and reasonable expense to those with insurance.  Many people can be treated with little energy expended by one practitioner.  It’s a crude and socially efficient way of achieving a goal.  It needs to be emphasized that  this medication is not the only option for tough, severe cases.  While the lethal consequences are very rare, it should be pointed out that lifetime skin sensitivity and a massively scarring “purge” are very common.  As you watch the video gallery here,  you may learn for yourself that this drug is no longer the best option available, regardless of the severity.  

 

 

 

6) Dermatology Standards of Care:   (Lasers and Light therapy for Active acne)

Pros:

-can rapidly bring down dangerous inflammation  (not always)

Cons:

-extremely expensive

-weak overall success rate despite high cost.

-not an effective long term solution

-Distracts patients from seeking better options. (time=scarring)

 

Bottom line:  These treatments are far too expensive and far too ineffective to be recommended to anyone.  I have met countless young souls who have spent in excess of 6,000 dollars on laser treatments only to be left with a full face full of acne.  I would only recommend this treatment if your practitioner has the confidence to promise complete long term results with a money back guarantee.   

 

 

 

 

7) Aestheticians  (Facials, microdermabration, Acid Peels)

Pros:

-immediate sensation of improvement.  

-effective temporary results for blackheads and plugged pores.

-professional exfoliation helps gain some short term control.

 

Cons:

-weak overall success rate for chronic stubborn acne.

-weak success rate at bringing “Total Inactivation”,  even in the milder cases.

-expensive when used in a “series” of treatments

-not enough medical expertise for massive severe cases.

-manual manipulation of the skin can aggravate a fragile acne condition turning mild cases into aggressive severe cases.

 

Bottom Line:   These services are good adjuncts to a preventative program that is actually working.   The patient conversations in these offices is often clouded by theory and imagination rather than clinical evidence.   Try to weed through the language and anecdotal theory to get to the good stuff…..     professional, skilled pimple popping, general skin care, and exfoliation.   Persistent moderate and severe acne patients have a significant risk of failure with these protocols.

 

 

 

8 )  Holistic and Alternative Treatments:   (Food Restriction Strategies)

Pros:

-typically safe unless too extreme

-increases overall body consciousness and general health

-it can be fun.  (decreasing stress helps all chronic conditions)

 

Cons:

-very weak overall success rate as a solo treatment.

-distracts patients who have more aggressive cases from quickly seeking better options.  (time=scarring)

-propagates fear and obsessive-compulsive tendencies, thus causing more stress which worsens any chronic condition.

 

Bottom Line:   This is an emotional topic.  We’ll keep this bottom line simple with the clear understanding that I always recommend conscious eating to optimize the function of every cell in the body.  That being said,  this treatment option for acne is better used as an adjunct to another more direct program.  On the downside,  this strategy can easily distract patients from more powerful alternatives and cause harm indirectly by using up precious time and energy.  

 

 

 

9) Holistic and Alternative Treatments:   (Gastrointestinal cleansing)

Pros:

-general health benefits are possible

 

Cons:

-very weak overall success rate as a solo treatment

-diarrhea caused by aggressive cleansing is very dangerous to the ano-rectal area and commonly causes chronic hemorrhoidal conditions.  

-distracts patients who have more aggressive cases from quickly seeking better options.  (time=scarring)

 

Bottom Line:   Think twice about this option as many people have become “hemorrhoid patients”  directly from this therapy.   If done much more gently,  this route can be used as an adjunct to help out with all chronic inflammatory conditions.  Not recommended as a primary treatment for chronic acne. 

 

 

10)  Holistic and Alternative Treatments:   (Extra Vitamins and Nutritional Supplements)

Pros:

-easy availability

-increases overall body consciousness and general health

 

Cons:

-very weak long term success rates. 

-Gastrointestinal side effects are common.

-improvement in the first few days is impossible to distinguish from a real placebo effect.  (When i say placebo,  I don’t mean people think they are getting better.  Rather, I mean they are actually getting better from the stress reduction induced by the confidence in their new supplement.  Unfortunately, this effect does not last long.)

-completely distracts patients who have more aggressive cases from quickly seeking better options.  (time=scarring)

-can turn into an obsessive-compulsive hobby that eventually causes a real stress on the body.  Stress makes all inflammatory conditions worse.

 

Bottom Line:  Taking a multivitamin everyday can help balance one’s overall nutrition.   Be observant of the manic and obsessive risks of this hobby that can eventually cause disharmony, emotional imbalance, and unwellness.  Supplements can be used as an adjunct for prevention as long as they don’t distract from the primary treatments.  Not recommended as a primary treatment because precious time wasted causes physical and emotional scarring.  (**this is the main side effect of all weak anecdotal acne treatments.)    

 

 

11) Holistic and Alternative Treatments:  (Chelating agents, Acupuncture, Healing Teas, Herbs, and Homeopathy)

Pros:

-helps general wellness and stress.

-decreased stress can partially help acne.

 

Cons:

-completely distracts patients who have more aggressive cases from quickly seeking better options.  (time=scarring)

 

Bottom Line:   My mom is an acupuncturist and a great healer of many chronic conditons.    That being said,  this route is not the fastest and best route for healing acne.  This route causes real damage by distracting patients and wasting time that could have been used to inactivate the inflammation.

 

 

 

12) The Acne Practice  (in-office program)

Pros:

-Experiencing a 100% success rate with all levels of acne.

-No oral medications needed. 

-initial improvement occurs in 24-48 hours which both reassures patients and minimizes scarring.

-Proven Results in the largest high resolution acne gallery ever seen.  (built in less than 2 years in a private practice)

-”Total Inactivation”  is achieved and proven in HD video.

-Strong doctor/patient relationship helps the emotional healing that is necessary with this chronic condition.

-Extremely fast success for both acne and dark marks.   (helpful for an upcoming special occasion)

-No massive initial outbreak as seen with other options.

-no bleaching of clothing as seen with other topical preparations.

-effective for patients with any type of skin allergy  (benzoyl peroxide, etc.)

-effective regardless of prior failure. (accutane, lasers, hormone treatment, etc.)

-effective for pregnant patients.

-guaranteed results.

-Free initial consultations.

 

Cons:

-relatively expensive compared to less advanced programs.

-The office is only in New York at this time.

-requires good communication skills.

 

Bottom Line:   If you spend an hour watching the 50+ videos, you will realize the this practice is completely new and unique.  Anyone who lives in proximity to midtown manhattan and has failed many acne treatments should consider coming in for a free initial consultation.

 

 

13)  The Acne Practice   (Long Distance and Home Versions)

Pros:

-brings the exact original products from The Acne Practice to locations all over the world.

-initial improvement noticed in 24-48 hours.

-amazing success rate for those patients and clients who know how to repeatedly ask for assistance.

-rapidly enlarging home version gallery helps people enter with confidence.

-less expensive than the original program.

 

Cons:

-still relatively expensive compared to less advanced programs.

-communication is by email and therefore miscommunication is a risk.  (by phone in the long distance program)

-requires good reading comprehension.

-requires clients to initiate the conversation which is difficult when shrouded by anxiety and depression.

 

Bottom Line:  These extended programs are intended for a certain type of client.   One who is a good communicator and knows how to repeatedly ask for assistance when needed.   The success rate for those who communicate properly is extremely high.

 

 

 

Hope this helps….!

be well, 

-Dr. Neal

 

 

 

©2009   “Pros and Cons: (an organized overview of all treatment options)”     by   Dr. Neal Schwartz

Many people email me asking,  “My case is not nearly as big as some of the cases here,  do you think this will work for me also?”

If you have had chronic mild or moderate acne for many years,  you have likely partially improved on many products only to relapse back to the prior condition within days to weeks of the exiting improvement.  The repeated excitement of the improvement followed by the predictable relapse can cause a manic-depressive type of emotional reaction that eventually will tear at the core of anyone’s soul.   This repeated yo-yo effect can cause many people to make new “conclusions” about their skin and about moderate acne in general.   One popular misconception is the idea that large cystic acne is easier to treat than impossible,  resistant,  chronic mild cases.

Placing one’s skin in a special “untreatable” category is the same victimizing mentality that is seen by many people who are suffering from anything.  I guess it eases the pain temporarily to assume your case is “special.”   It likely gives people the needed break from the constant struggle.

If anyone tells you that resistant mild or moderate acne is too tough to beat,  have them look at this video I made for you.   This very nice and intelligent patient has both the physcial and emotional marks of a chronic sufferer who has tried very hard to control this problem.   His prior failures were of no fault of his own.  He used products and pills from the doctor and over the counter,  followed directions perfectly, and maintained a good lifestyle.

He’s a great person and a great example of how chronic, resistant, annoying moderate acne can be completely inactivated. Make sure to watch it in high quality and take special note of his tone of voice and the emotional transformation that follows the physical changes.

Here’s the video:

FAQ: The next common question I hear is,     “Will your acne bootcamp program work for a little while and then fail like the rest??”

The answer is No.

If your are having any setbacks or relapses,  you will simply send an email with the details of your current situation.

I’ll be here,

-Dr. Neal

©2009    ”Resistant Moderate Acne…. an emotional spiral.”     by  Dr. Neal Schwartz

    For the past several decades, doctors have been prescribing topical and oral medications for acne and telling people to patiently “wait” for results.  ”I’ll see you again in 3 months”,  is usually the last thing you’ll hear when leaving the doctors office.  While some mild cases will clear up with a single prescription and a smile,  more stubborn cases do not always go as planned.  It is often told to patients coming in, “Your acne will take 6 months to one year to clear up.”   This prognosis is dangerous for many patients because they find themselves in a “Hoping and Waiting” pattern like when they eagerly waited to get their driver’s license.  Unlike other milestones though, real psychological damage can be done when a year has passed and, despite perfect compliance, they are the same or even worse.

        As you can see from several of our case studies,  moderate acne can be cleared in weeks and severe acne can be cleared in a few months when treated properly.  Why then, do many doctors still tell patients 6-12 months??    It is simply the passing forward of the “standard of medicine” from generation to generation.  As you can see from the videos, the standard isn’t always the most effective.  Commonly used topicals like prescription retinoids, benzoyl peroxide,  and antibiotics have ruled this field for decades.   When and more importantly, if at all successful, this treatment concept can take several months to a year.

     How do you know if you should patiently “wait” or change up doctors??   This really becomes a critical question because, on the other end,  many people also make the mistake of switching up before giving their treatment a chance at all.     How can you decide what to do???

Here’s how:   Rather than asking random people what they think you should do,  simply ask your doctor if he or she thinks you are on the right track.  If you can’t get in touch with your doctor after several attempts or feel like he or she really doesn’t care whether you get better or not,  then it’s time to switch.  

 

 

 

 

©2008 Acne Misconception #5 (”It takes 6 months to 1 year to clear up Moderate or Severe Acne”)    by Dr. Neal Schwartz

 

    The biggest misconception about acne is the idea that it is a simple problem. Decades of acne marketing with a smile have mislead the public to believe that acne is something you can “just” fix with a small tweak in your washing or nutritional routine. I always encourage my patients to try any simple acne program sold on the market, only to get an idea of how this condition is not as simple as it seems.

    I often get worried when I hear people give others acne advice with a breezy tone that sounds like this:   “All you have to do is just………”            With persistent acne, there is no “just” do this or that.  It can be very stubborn and very complicated.

    We created this program to handle the complexity of persistent Acne.  All possible scenarios can be handled in a new tone that sounds more like this: “Pay attention, this is not a simple problem to defeat. However, although it is powerful, it can ALWAYS be beaten.”  I give online support with all our programs to specifically address the stubborness of this chronic condition.

 

 

 

©2008 “Acne Misconception #4 (”For Acne, all you need is to just…..”)”   by Dr. Neal Schwartz

“Hormonal Acne”

The idea of “Hormonal Acne” is a newer misconception that has spread quickly among physicians and female patients alike.

When encountering severe acne, there is always the thought of hormonal alterations causing such a breakout. The differential diagnosis includes increased androgen secretion from benign growths, malignant tumors, and hyperactive glands. Fortunately, there are accurate blood tests and imaging studies that can detect such hormone imbalances. If still questioned, the tests can be repeated at a later time.

Real hormone issues combined with the widespread knowledge that oil glands respond to androgens in general, has many patients and doctors believing they are treating a “newly discovered” variant of acne called “Hormonal Acne”, which has normal bloodwork but distict acne characteristics and locations. This line of reasoning has since been solidified by the fact that hormone altering medications have been shown to help some cases of acne in varying degrees.

**Before I make a point about this emotional subject, I’d like to refer to the video gallery and note that the vast majority of the female patients in the gallery had worsening symptoms with menstrual periods.  Afterwards, they completely cleared up and stayed clear without any direct or indirect hormonal treatments.

Question:

If all women have SIGNIFICANT hormone fluctuations before and during their menstral periods, why do only some women have monthly breakouts….???

The answer is because some people are in a State of Acne Proneness while others are not. The hormones are better viewed as “gasoline” poured on a “fire” The acne prone skin itself is the fire and should remain the focus of treatment if all hormone levels prove normal in a simple blood test.

Bottom line: While Hormonal treatments have been used with varying success in this battle, Acne is still simply just “Acne”   (Just like it was in the 60’s……)

This post may be off-putting to some people……  Here’s why:

I’ve observed that women over 25 with chronic acne find it easier to accept their condition under the veil of “Hormonal Acne”.   Maybe it sounds better than “plain old acne”,  Maybe it just doesn’t make sense to have a “teenage” condition throughout adulthood.  Maybe they are sure they have hormonal acne because all other treatments failed except hormonal therapy.  Maybe they locked into this “diagnosis” simply because their physician told them, “You have hormonal Acne”

The stubborn nature of acne has many people desperately searching for a new diagnosis.  If you look hard enough, you’ll find something else besides “plain old acne” to pin this problem on.  The truth is that the diagnosis of acne is far easier than the successful treatment of it.

Here’s the story as I see it…..,     All acne prone skin responds poorly to hormone changes.  Acne prone skin is the problem, not the hormones.  Any successful hormonal treatment that works is simply minimizing a major aggravating factor.  This is a fine treatment option for those who don’t mind taking long term hormonal therapy for their skin.

What about the Acne prone skin?? ……you may ask….

It’s always changeable over time…..  We’ll discuss the misconception of Acne-prone skin as an affliction vs. the temporary state of acne proneness in a separate post.

This topic may be confusing to those who are strongly convinced they have “hormonal acne.”  When all the videos are watched closely, you can see that the women on here are completely transformed without any hormonal treatment whatsoever.

©2008  ”Hormonal Acne” by Dr. Neal Schwartz

       You’re a special person.  With all your quirks, your strengths, your history, and your troubles.  Your skin however, is not special.  Regardless of how intolerant of products, or how  heavily oily or reactive it gets…,  it’s still not special.  Your skin’s current state of unwellness is not unique in any way whatsoever.  Millions of people all over the world have suffered from juicy acne bumps, oil slicked faces, red faces, post-oral isotretinon sensitivity, dry irritation, and oily irritation.  The moment you think your skin is “special”, is the moment you stop looking for answers and stop asking for assistance.  This mistake can potentially cause a lifetime of needless suffering.  

 

 

©2008 “My Skin is Special”  by Dr. Neal Schwartz

      Genetics does indeed have a large influence on one’s capacity to fall into a State of Acne Proneness.   The oil gland’s behavior pattern and distribution can vary greatly between and within all ethnic groups.  However, the idea of Genetics being the “cause”  of acne bears great potential repercussions because at this time, our genetics are not changeable.  So it would  stand that if acne is primarily cased by genetics, and genetics are not changeable, then acne is also not changeable!?   The video gallery has already proven otherwise demonstrating that the conversation of genetics and acne is one of mistaken pessimism and is unimportant in the treatment of this condition.

 

©2008 “Genetics and Acne”  by Dr. Neal Schwartz