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FAQ - Acne

FAQ - Rosacea

1. Is my acne caused by the food I eat?

Acne is caused by a number of factors including: hormones, bacteria, and genetics. Diet does not appear to play a major role in acne, although there is increasing evidence in the last few years that a low glycemic diet and reduced dairy intake may be beneficial for some patients. If you notice that eating certain foods consistently aggravates your acne, then reducing intake of these foods makes good common sense.

2. Will I outgrow my acne?

Approximately 90% of teenagers will develop acne and most will outgrow their acne, but some acne can persist into adulthood or even develops in an adult with no previous history. Our dermatologists can assess your acne and determine what treatment plan would be most beneficial for you. Your options include non-prescription products and if necessary, topical and/or oral medications such as antibiotics, oral contraceptives, or isotretinoin (Accutane). Various procedures may speed improvement, such as microdermabrasion & silkpeel dermalinfusion, chemical peels, Blu-U or laser/light therapy.

3. I have been prescribed an antibiotic pill for my acne. My pharmacist tells me that because I am on an oral contraceptive pill, that the birth control will be less effective as a result of adding the antibiotic. Is this true?

The number of birth control failures presumably due to antibiotics is extremely low. In fact, the birth control pill itself is only 92-99.7% effective as a contraceptive and the reduction in efficacy as a result of antibiotic addition is minimal at best. If you are concerned, then a second form of birth control (e.g. condom) can be added while on the birth control which would also be protective against sexually transmitted diseases.

4. How do I improve my dull complexion?

Various prescription or physician-grade creams can be somewhat helpful, though for better results, chemical peels, microdermabrasion, medical-grade or oxygen facials, or broad band (BBL) or intense pulse light (IPL) are required.

5. How do you treat deep and extensive acne scarring on the face?

Fractionated laser resurfacing (e.g. ProFractional laser) is one of the best treatments for deep and extensive acne scars. Chemical peels and microdermabrasion are less effective (less deep) but are also an option. Creams or topical treatments are unlikely to be very helpful.

6. What are the benefits of Silkpeel DermalInfusion?

If you are looking for a skin treatment that delivers immediate results, won't take hours out of your busy schedule, and will leave you with noticeably better skin in under 30 minutes, then SilkPeel™ Dermalinfusion™ is one of the best procedures offered today. Similar to microdermabrasion, The SilkPeel™ Dermalinfusion™ System combines non-invasive exfoliation with deep delivery of patient-specific solutions directly to the skin without the use of crystal or other chemical exfoliants. SilkPeel™ is exclusively offered through facilities with medical directors on staff, and isn't available at a typical day spa or salon. The procedure is non-invasive and even soothing; delivering the results you want without harsh chemicals or uncomfortable treatments. When you get a SilkPeel™, you won't have any downtime, and don't have to worry about dealing with irritated or inflamed skin. Within about 30 minutes, SilkPeel's wet exfoliation leaves your skin silky smooth, hydrated, bright, and full of the youthful, healthy glow that we all desire.

7. Are the creams & other products that the Toronto Acne & Rosacea Centre sells any better than what I can buy over the counter?

Most certainly yes. The creams, lotions, and other products sold at Toronto Acne Centre are physician/medical grade and not available over the counter. They have been rigorously reviewed and selected by our Dermatologists. The concentrations of various antiaging ingredients (e.g. glycolic acid, vitamin C) and their delivery system is superior to over the counter products, and we provide sunscreens and other products that are the least likely to cause irritation or allergy, and at various price points to fit your budget.

8. My skin is very oily, do I still need to use a moisturizer?

Yes, even those with oily skin need a daytime moisturizer with a minimum of SPF 15 and a non-oily nighttime moisturizer. A deficiency of moisture will typically lead to an overproduction of oil which can worsen your condition.

9. At what age is it recommended to introduce daily skin care products?

Adolescence is a great time to begin a daily skin care regimen. The introduction of a gentle cleanser, sunscreen moisturizer in the morning and nighttime moisturizer will assist in maintaining healthy skin, preventing the onset of certain skin conditions and helping to form beneficial habits, such as daily SPF/sunscreen application.

10. What creams, lotions, shampoos and products should I be using on my skin?

Every skin type is different, so speaking to your Dermatologist is always an excellent idea to receive a personal assessment, recommendation, and sometimes a prescription. Generally speaking, protecting yourself from the sun through sunscreens, hat, sunglasses and sun avoidance during mid-day hours is one of the best things you can do to minimize sun damage, aging, and risk of skin cancer. Moisturizing your skin with a non-comedogenic cream for the face is important, and exfoliating once or twice a week depending on your skin type is also beneficial. Cleansing your face with a mild soap, or more preferably a cleanser (e.g. Alyria, Revaleskin, SwissTec, Spectroderm/jel, Cetaphil, Toleriane etc) is a great way to wash your face without irritating or overdrying it; once a day is usually sufficient, although if you're oily or do lots of sports/sweating, then twice a day is recommended. Acne-prone skin benefits from face washes or products containing salicylic acid, benzoyl peroxide and/or sulfur, though prescription treatments from your Dermatologist are often required as an adjunct. Various anti-aging preparations are available and beneficial, including: glycolic acid, vitamin C, vitamin A/tretinoin (retinoids), matrixyl, coffeeberry extract etc. At Toronto Acne Centre, we offer physician-grade products to our patients that have been extensively studied for efficacy and safety, as well as prescription creams that can be beneficial.

11. Do I really need to take care of my skin?

Definitely since your skin is the largest and most visible organ of the body. Our skin acts as a shield protecting our insides from external stresses such as infection, allergens, temperature change and environmental factors (e.g. sun, pollution), and can show manifestations of underlying health problems. Our skin is an important part of our appearance as it can reveal age, sun damage and overall health.

12. Is the Toronto Acne & Rosacea Centre accepting new patients?

We are always accepting new patients into our practice and typically can see new patients within a few weeks, and often much sooner. We also keep a waiting list for patients if cancellations occur prior to your scheduled appointment time.

13. Do you treat children?

We treat anyone and everyone with skin!; we treat men and women, children, elderly, pregnant patients, and all skin colours and skin types.

14. Are any acne treatments specifically for people with darker skin?

There are no acne treatments that are specifically developed for dark skin. Acne treatments are as safe and effective on dark skin as on light skin. Topical retinoids are a particularly important treatment in darker skin types because it helps both the acne, as well as the acne blemishes ("post-inflammatory hyperpigmentation"). Chemical peels & microdermabrasion are similarly a particularly useful option in darker skin types to help both the acne and blemishes. There are also topical preparations containing vitamin C, azelaic acid, salicylic acid or glycolic acid that can be helpful with these blemishes. Our Toronto skin specialists have extensive experience treating a multi-ethnic and diverse population, so you'll be in great hands.

15. Now that my face is clear, can I stop using my acne creams?

Stop if your dermatologist says it is okay to stop, since in some cases, especially when acne occurs in the teenage years, the acne can flare when treatments are stopped. You may want to try weaning or reducing the frequency of application to say every other night to see if this maintains your skin in good shape, and eventually you will be able to determine the least frequency of application that keeps your skin calm and beautiful.

16. If I wash my face twice per day, why do I still get acne?

Acne is not caused by dirty skin, and so washing alone is not sufficient to clear up or prevent acne. Washing is a helpful thing to do as it removes excess surface oils and dead skin cell. It is important to wash gently, as over scrubbing or rubbing aggressively will make the skin more red and irritated. Washing the skin once or twice per day (depending on how oily you are, whether you wear makeup or not) with a gentle cleanser and lukewarm water is ideal. Since acne is caused by numerous factors including genetics, stress, and hormones, specific acne treatments recommended by your dermatologist are often required as well.

17. Will stress cause acne?

Acne is caused by a number of factors including genetics and hormones, although stress certainly plays a role by increasing cortisol levels. As best you can, try to find ways to reduce your stress, be it by going for long walks, meditating, doing yoga, or simply discussing your feelings with friends and family. At the same time, having lots of acne is embarrassing and can cause stress itself, and so clearing up your acne may in fact reduce some of your stress.

18. Will getting more sun improve my acne?

Many people with acne will in fact improve in the summertime as a result of ultraviolet light, likely due to specific wavelengths of light in the red and blue spectrum. Only a modest amount of sunlight is required for improving acne, as we don't want to start worrying about sunburns, wrinkling and early aging, or skin cancer. Since many acne treatments (e.g. topical retinoids, oral antibiotics, isotretinoin/Accutane) also make an acne patient sun sensitive, only modest sun exposure is advised if trying to improve your complexion.

19. What's the difference between acne and rosacea?

Acne typically begins during puberty, around age 10-13 and is often related to increasing testosterone levels and hormonal fluctuations. It is characterized by blackheads and/or whiteheads (comedones), and sometimes red papules and pustules, affecting the face, and/or chest, back, and shoulders. Acne affects all skin types and both genders, affecting 80-90% of teenagers at some point.  Rosacea on the other hand typically begins in the 30-50 year range, and more often affects women and fair-skinned persons, especially those of Celtic or Eastern-European background. Rosacea is exclusive to the face and doesn't involve the trunk. Rosace involves persistent redness and dilated blood vessels, and sometimes papules and pustules, though very rarely blackheads or whiteheads. Seldom, a person can have both conditions. Your dermatologist is the best person to get you the right diagnosis and treatment plan.

20. Are there any good treatments for acne scarring?

Acne scarring treatments include topical creams that contain vitamin A or glycolic acid which provide modest benefit, with no downtime, no discomfort and minimal cost. For more impressive results, medical-grade chemical peeling and infusion-based microdermabrasion can provide better benefit with minimal downtime, minimal discomfort, and a bit more cost. For more aggressive therapy with better results, a fractionated laser such as the ProFractional laser should be considered; there is more downtime, more discomfort, and more cost involved. In some situations, TCA-CROSS therapy is used (e.g. ice pick scars), or subcision may be used. It is best to consult with one of our dermatologists to discuss the type of acne scarring you have, and the best treatment plan that weighs the benefits, downtime, cost etc.

FAQ - Rosacea

1. What causes rosacea?

Although we don't fully yet understand the cause, there are a number of theories. Blood vessels on the face may dilate too easily which will make the skin appear more red and flushed. We also know that various environmental and lifestyle triggers or factors can increase this redness response. Acne-like bumps or pimples can appear ("papulopustular rosacea") and this may be due to blood flow, skin bacteria, microscopic skin mites called Demodex, irritation of follicles, sun damage, an abnormal immune response, or even psychological factors. Most recently, there appears to be an immune response triggered by a type of antimicrobial protein called cathelicidin. As well, certain bacteria present on otherwise harmless Demodex mites may even cause an inflammatory response in the skin.

2. Is rosacea inherited?

We're not certain, but we think so. Approximately 40% of patients with rosacea surveyed by the National Rosacea Society (NRS) said they could identify a relative who had similar symptoms. We also know that ethnicity is likely a factor, as another survey by the NRS showed 33% of respondents had at least one parent of Irish heritage and 26% had a parent of English descent. Other ethnic/geographic groups at increased risk appear to be: Scottish, Welsh, Eastern Europeans, and Scandinavians.

3. Is rosacea contagious?

No! It is not an infectious condition, and it cannot be transferred by touch or inhalation. The reason topical and oral antibiotics are likely beneficial in rosacea is due to their anti-inflammatory effect, rather than their bacteria killing properties.

4. Is there any test for rosacea?

There is no specific blood test or skin biopsy that would identify rosacea. Rosacea is typically diagnosed by your physician/dermatologist after a thorough examination of your signs and symptoms. In particular, your doctor would be looking for symptoms such as dry, rough, irritable, sensitive, itching/burning/stinging skin, easy flushing, swelling of the nose (typically in men), persistent redness, dilated blood vessels, and/or pimples and pustules.

5. Will rosacea get worse with age?

Rosacea is considered a chronic condition and will wax and wane over time. One study showed that in almost 50% of patients, rosacea improved dramatically or cleared completely over about a 10 year period. While there currently is no cure for rosacea, we do have excellent options for symptom control involving lifestyle/trigger modifications and medical or laser therapy. Rosacea patients who continue treatment for the long term are less likely to experience recurrence of their symptoms.

6. Can I have both rosacea and acne?

While generally speaking most people have either acne or rosacea when properly diagnosed by a dermatologist, there does appear to be an overlap in some cases. Both conditions in adults are often informally called "adult acne," and the treatment in some cases is similar, but there are some distinct differences. Acne can affect the chest, shoulders, and back, and can cause blackheads and whiteheads, all of which would be quite uncommon in patients with rosacea who typically have only mid-face involvement.

7. Do people with rosacea have dry or oily skin?

Everyone is different, although about 50% of people with rosacea experience dry skin on their face. This dryness will greatly improve with proper medical therapy. A mild cleanser and good moisturizer selected by your physician will reduce dryness, roughness, and sensitivity of your skin. Less commonly, some patients will have oily skin, while others have normal texture. Your dermatologist will help determine your skin type and appropriate products to use.

8. Is seborrhea or seborrheic dermatitis connected to rosacea?

Seborrhea is a greasy scaling redness common around the nose and between the eyes ("dandruff of the face"), and is much more common in people with rosacea.

9. Is there any connection between lupus and rosacea?

No. Although they may sometimes look similar to the untrained eye, your dermatologist can quickly determine your diagnosis.

10. Are patients with rosacea more prone to skin cancer?

No, there is no direct evidence linking rosacea to the development of skin cancer.

11. Who is a rosacea expert and how do I find one?

Like all medical condition diagnoses, rosacea is typically diagnosed by a physician. A dermatologist is a specialist physician (5 years of specialized dermatology training following medical school) focusing on conditions and diseases affecting the skin, and thus is the expert for rosacea diagnosis and treatment..

12. Is there any relationship between rosacea and allergies?

Allergies can cause flushing, which can trigger some rosacea symptoms. As with more common rosacea triggers, identifying and avoiding allergens -- the substances you are reacting to -- may also help control your rosacea. That said, people with rosacea are not more prone to allergies than people without rosacea.

13. How do I determine what is causing my rosacea to flare up?

Rosacea signs and symptoms can be prompted by a variety of environmental and lifestyle factors that differ between people. As with an allergy, it is useful to keep a diary to pinpoint the particular elements that may prompt a flare-up in your case.

14. How long after a rosacea trigger occurs will a rosacea flare-up occur?

There are no data available on how quickly a rosacea trigger may lead to a flare-up; the time varies depending on the individual and the nature of the trigger. Note that while a wide range of factors has been identified as potential triggers, not every trigger affects every person every time.

15. Can rosacea be cured?

While rosacea cannot currently be cured, lifestyle modifications along with medical and laser treatments are available that can control or eliminate its various signs and symptoms.

16. Why are antibiotics often prescribed for rosacea? Is rosacea due to an infection?

Although we don't know precisely why antibiotics work against rosacea, it is widely believed that it is due to their anti-inflammatory properties, rather than their bacteria-fighting capabilities that they improve rosacea.

17. If I take a long-term medication consistently like a metronidazole topical product, will it lose its effectiveness?

Topical therapy usually controls rosacea on a long-term basis, without losing its effectiveness.

18. Should I still use my medication between rosacea flare-ups?

Rosacea is characterized by flare-ups and remissions, and a study found that long-term medical therapy significantly increased the rate of remission in rosacea patients. In general, treatment between flare-ups can prevent them.

19. How should I care for my skin?

A rosacea facial care routine recommended by many dermatologists starts with a gentle cleansing of the face each morning. Sufferers should use a mild cleanser that is not grainy or abrasive, and spread it with their fingertips. A soft pad or washcloth can also be used, but avoid rough washcloths and loofahs.

Next, rinse the face with lukewarm water several times and blot it dry with a thick cotton towel. Never pull, tug, scratch or treat the face harshly. Let your face air dry for several minutes before applying a topical medication such as metronidazole. Let the medication soak in for an additional 5-10 minutes before using any makeup or other skin care products.

20. What skin-care products are appropriate to use with rosacea?

The skin of many rosacea sufferers may be sensitive and easily irritated. Patients should avoid using any products that burn, sting or irritate their skin. In a National Rosacea Society survey, many individuals with rosacea identified alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus oil, clove oil and salicylic acid as ingredients that irritated their individual cases, and many also avoided astringents and exfoliating agents.

Sunscreens or better yet sunblocks (e.g. Elta MD) are effective against the full spectrum of ultraviolet A and B radiation can be especially important for rosacea patients, whose facial skin may be particularly susceptible to sun damage and consequent rosacea flare-ups. An SPF of 30 or higher is recommended.

21. How does laser therapy work?

To remove visible blood vessels or reduce extensive redness, vascular lasers emit wavelengths of light that target tiny blood vessels just under the skin. Heat from the laser's energy builds in the vessels, causing them to disintegrate. Generally, 4-6 treatments are required, depending on the severity of redness or visible blood vessels, and maintenance therapy once per year or so can be beneficial.

New laser technology has been developed to minimize bruising and downtime, and recently developed devices called broad band light (BBL) and intense pulsed light (IPL) sources mimic lasers but generate multiple wavelengths to treat a broader spectrum of tissue. At Toronto Acne & Rosacea Centre, you can be assured that we have the best equipment and the best trained staff for performing laser treatments for rosacea.

22. Are there research studies or clinical trials for rosacea?

At Toronto Acne & Rosacea Centre, we are at the cutting edge of treatment for a number of conditions including rosacea, acne, psoriasis and more. Please call or email our clinical trials division to find out if we currently have a rosacea study that you can participate in:
Call 416-633-0001 ext.4
OR
Email: research@torontodermatologycentre.com

23. Are there support groups for people with rosacea?

The National Rosacea Society is the world's largest support organization for rosacea. There are also support groups online such as: www.rosacea-support.org

Call 416-633-0001 or email us today for an acne consultation. Toronto Acne & Rosacea Centre is located at 4256 Bathurst St., Suite 400 (Bathurst & Sheppard) within Toronto Dermatology Centre in Toronto, Ontario, and serves patients in North York, Thornhill, Richmond Hill, Markham, Vaughan, York, Aurora, King City, Mississauga, Oakville, Etobicoke, Scarborough, Bramptom, Newmarket, Maple, Cambridge, Pickering, Ajax, downtown, uptown, midtown, and all of Greater Toronto (GTA)

Dr. Benjamin Barankin and Dr. Anatoli Freiman are dermatologists at Toronto Acne & Rosacea Centre, providing complete medical, cosmetic, surgical and laser skin care. Our acne centre provides a variety of physician-grade skin care products, prescription creams and gels, prescription pills for acne, as well as a variety of services that treat acne and prevent acne such as: facials, oxygen facials, chemical peels, microdermabrasion (medical-grade, SilkPeel DermalInfusion), BBL / IPL (photorejuventation), photodynamic therapy, and acne scar removal such as by subcision, TCA CROSS, fillers, excisions, and laser resurfacing using the ProFractional laser. Our physician-grade skin products include: Alyria, Cosmelan, Clayton Shagal, SkinCeuticals, SkinMedica, ZO Skin Health, ZO Medical, Jane Iredale, Elta MD, Latisse & Neotensil.

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