Hey Everyone,

I’m starting a new video series this week call “Dr. Neal’s Opinion” which will address any and all things I am passionate about including chronic ailments, healthcare, wellness, cultural issues, and anything else I feel strongly about.


The first episode voices my firm stance on the prescription drug Oral Isotretinoin, commonly known as Accutane.

©2012 “Dr. Neal’s Opinion: “Accutane” by Dr. Neal Schwartz

There is major conflict going on in the world of acne treatment that is driving patients more crazy than the condition itself. I’m referring to the repeated lack of confidence a patient has for their chosen practitioner.
The real problem is that this lack of confidence is often times justified and makes sense when you consider the amount of failure currently going on in the world.

In order to preserve the minds of the many continuing sufferers, I want to do another pro and con list specifically regarding Board Certified Dermatologists. I will make a new blog category today organizing these pro and con lists to help people get their heads around what is going on in the world of acne treatment. My intention with these lists is to prevent patients from being baffled by what is going on in the offices they choose. I want everyone to understand the reality of the medical world we live in and work wisely from within the confines of this reality.

Pros of seeing a Board Certified Dermatologist:

1) They are legally and ethically held accountable:
This aspect immediately makes going to see a real doctor completely different than taking irresponsible advice on a blog site. Doctors have an accountability that is monitored by the state government, their specialty associations, and their peers. They are held to a high standard of “First doing no harm”
For this reason, seeing a real doctor is a relatively safer move.

2) Powerful Remedy Options: A good dermatologist has the ability to quickly blast old bumps with injections, lasers, aestheticians, antibiotics, and creams. With this extended arsenal, a dermatologist is the best place to go if you have one large rogue bump that needs to be fixed fast.

3) Credentials: There is no doubt that your dermatologist is more knowledgeable regarding the anatomy, physiology, statistics, and science of skin than any other practitioner you will ever run across. The amount of hours, meetings, competitive testing, and speaking on the topic is far more extensive than any patient can ever imagine.
For this reason, doctors who have been in practice for many years are true experts in the field, having spent tens of thousands of hours at their craft.

4) Some really do care: Although they get a bad rap, some dermatologists are still very passionate about helping acne sufferers. It may take a few tries before you find one you can connect with on an emotional level.

Let’s look at the other side to break down why so many patients are losing their minds in this system.

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    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