Your Guide to Pregnancy Acne


Pregnancy is supposed to be a magical time full of hope and wonder.   For some people, it is also full of pimples and cysts. Hormone changes responsible for creating a human being can also activate pathways that cause breakouts.  In some cases, women suffered from acne previously but were controlled on medications that needed to be discontinued. Other times, breakouts happen to people who never had acne.  Either way, pregnancy acne is no fun and here’s how to handle it.


  1. Make sure your skincare is not part of the problem.

Skincare really matters.  Many women embark on the journey to motherhood understandably wanting to be as chemical free as possible.  This means they eliminate their good ole Cetaphil moisturizer and purchase natural products that contain oils, waxes, or shea butter.  Unfortunately, these ingredients are often pore clogging and can cause or worsen breakouts. When choosing cleansers and moisturizers, be careful to select non-comedogenic and oil free products.


  1. What, and what not, to use.

During pregnancy, the typical acne treatments containing retinoids, benzoyl peroxide and salicylic acid are best avoided.  Products that contain alpha hydroxy acids and sulfur based are considered safe and effective.

Azelaic acid is a naturally occurring antibacterial that also has keratolytic, comedolytic and antioxidant activity.  This means it kills acne causing p. Acnes bacteria on the skin surface. In addition, it loosens skin cells so they don’t clog pores, reduces inflammation, and decreases hyperpigmentation.

Glycolic acid is another naturally occurring alpha hydroxyl acid derived from sugarcane.  It works by speeding up the process of exfoliating dead skin cells and eliminating excess oil.  This helps reduce pimple causing clogged pores and encourages new, fresh skin cells to come to the surface.  

Sulfur based products have antimicrobial effects and are effective in drying out excess oil.  While they are effective, most preparations have a strong, unpleasant scent that limits use in pregnant women who are hypersensitive to stinky smells.


  1. Get in with a dermatologist sooner rather than later.

If you are suffering from pregnancy acne, your dermatologist should be your best friend. First of all, there are forms of folliculitis that can mimic acne.  Early diagnosis and proper management can save a lot of frustration. Also, dermatologists offer face saving extractions, cortisone injections, and if necessary, pregnancy safe prescriptions and procedures to help your acne.  

An extraction procedure is a medical grade facial, where a dermatologist uses a sterile tool called a comedone extractor to remove clogged pores.  Since clogged pores turn into pimples, it is beneficial to eliminate them!

Cystic pimples begin underground, can be painful, and often leave marks behind.  Fortunately, a tiny dose of liquid cortisone can be injected into cysts to decrease the inflammation and shrink them quickly.  Cortisone shots contain a minute amount of dilute cortisone. Since there is very limited systemic absorption, it is considered a safe option throughout pregnancy and while nursing.

Other pregnancy safe procedures include blue light facials, microdermabrasion, and glycolic acid peels.  If prescriptions are necessary, there are options such as topical and oral antibiotics as well as prescription strength azelaic acid.

Pregnancy acne is unavoidable for some women.  However, it can be treated and improved safely by optimizing skin care, incorporating alpha hydroxy acids, and working with a trusted dermatologist.

A Breakthrough in the Treatment of Acne Scarring


Acne breakouts have a huge, negative impact on body image and self esteem.  Even after the pimples and cysts are gone, many patients are left with scarring that continues to affect their quality of life.  The good news is that technology continues to advance and the treatment of acne scars is safer and more effective than ever, with better lasers, microneedling, and the latest breakthrough: Secret RF (Radiofrequency) Microneedling.


Microneedling has become one of the mainstays of minimally invasive scar treatment.  It involves using fine needles to create numerous controlled, invisible puncture wounds called “micro-injuries” in the skin. These micro-injuries break up scar tissue and stimulate the body’s natural wound healing response to rebuild the tissue in a more organized (i.e. less scarred) fashion.  Now, the power of microneedling has been amplified with the addition of radiofrequency, revolutionizing how we treat acne scarring.  Radiofrequency is a type of energy that heats tissue and stimulates production of new collagen and elastin. When combined with microneedling, RF is directly delivered to the scarred, problem areas below the skin.


Cutera’s Secret RF is an FDA cleared RF microneedling device that utilizes 25 or 64 gold tip needles to create controlled micro-injuries and precisely deliver radiofrequency.  This device was designed to be totally customizable meaning: Your dermatologist determines the depth of needle penetration and the intensity of RF delivered based on your skin type, the treatment area, and the severity of scarring.  Since it is so customizable, it is safe in all skin types.


At Spring Street Dermatology, patients numb for at least 40 minutes with a strong anesthetic called BLT (benzocaine, lidocaine, tetracaine) to ensure maximal comfort.  The treatment itself takes 15 to 30 minutes depending on the area to be treated.  Afterwards, skin is rinsed with saline and a healing moisturizer is applied.  Most patients report a warm, sunburn like feeling afterwards that dissipates within 4-5 hours.  By the next day, minimal redness, swelling, minute scabs and gridlines can be seen.  At this point, make up can adequately cover the healing process, which takes 1-2 weeks in most cases.  A series of treatments is recommended bases on the degree of scarring.


If you suffered with acne and are left with scars, Secret RF is the breakthrough you have been waiting for.   By combining the power of two modalities, microneedling and radiofrequency, this device delivers unprecedented results without compromising safety.

Baby Botox


For most of us, somewhere between the ages of 25 and 35 is the sweet spot.   It is when the very first fine lines have begun to appear but have not yet had the chance to develop into full fledged, deep set wrinkles.  We used to notice these lines only when we made certain facial expressions. But now, we start to see them even when our faces are perfectly still – and we don’t like it one bit.  Enter: Baby Botox.


Our muscles of facial expression contract to make us raise our eyebrows, squint, scowl, purse our lips, and smile with our eyes.  Over the years, the muscles strengthen and cause the skin to crease. Creases turn into fine lines and then deepen into wrinkles. While age is a big factor, having an expressive face, sun exposure, smoking, and genetics all play a part in when and how much we will wrinkle.  The antidote – Botulinum Toxin is injected into muscles to relax them. And relaxed muscles no longer crease the skin, allowing fine lines to fade into the sunset.


In a person with faint lines and weaker muscles, we can utilize a relatively small dose of Botox to completely eliminate the lines.  Baby Botox leaves the skin appearing smooth, but more importantly, prevents wrinkles from setting in. Since the wrinkles were never allowed to appear in the first place, Baby Botox looks subtle and natural.  While typical Botox lasts only 3 months, people who start early usually enough get significantly more time out of their treatments.


Once a person has crossed over into more prominent musculature and deeper lines, Botox still works (phew!) – but more product must be used and more frequent injections are required.  However, if the deeper lines become etched in, then Botox alone will not do the trick. Additional treatments like fillers and lasers, along with Botox, may be necessary.


We are all getting older, what’s the alternative?  The bottom line is there is an individual choice to be made by every one of us – are we ok with having wrinkles or do we want to avoid them?   If you fall into the camp that believes the best wrinkle is the one you never get – then keep an eye out for your sweet spot, Baby Botox is here waiting.

What to do About Back Acne


Summer is a time for tank tops and bathing suits.  Unfortunately, it is also the worst time for people prone to back acne, a.k.a. “bacne.”  Heat, humidity and sweat lead to occlusion and clogged pores, trapping skin surface bacteria and attracting inflammation.  Pimples on the back are often cystic, which means they are not only unsightly, but can be painful and leave marks. Fortunately, bacne sufferers can take steps to minimize and treat breakouts.


  1. Control your sweat.

Sweat that does not evaporate sits on the skin’s surface, clogs pores and attracts bacteria.  The trapping and occlusion leads to inflammation and breakouts.

Whenever possible, make an effort to change out of sweaty clothing quickly.  For exercise, choose clothing that is loose fitting and made from sweat wicking fabric.  If you feel you sweat excessively, or have hyperhidrosis, consider seeing a dermatologist to learn about treatment options.


  1. Choose the right skin and hair care products.

Personal care products can worsen, or even cause breakouts if they contain pore-blocking ingredients.  

Look for body washes and moisturizers that are labeled “non-comedogenic” (meaning they shouldn’t cause black and white heads).  Avoid products based in oils, petrolatum, and wax. This includes shampoos and conditioners, which inevitably end up sliding off the hair and onto the back.


  1. Use a benzoyl peroxide wash daily.

Benzoyl peroxide (BPO) is an over the counter medication that is bactericidal, meaning it kills acne causing bacteria.  When used with antibiotics, it can help prevent antibiotic resistance. In addition, it helps turn over and remove the oil and dead skin cells within clogged pores.

For the back, benzoyl peroxide based washes are preferable to leave on preparations, due to its potential for bleaching fabrics.  Ideally choose a 10% wash and leave on the skin for 2 minutes before rinsing. Be sure to rinse thoroughly and dry with a white towel to prevent tie-dyeing.  Typically, breakouts begin to respond to a topical regimen in 4-6 weeks.


  1. Sometimes you need a dermatologist.

If your breakouts are cystic, scarring, started suddenly, or do not respond to the above, you should see a dermatologist.  Moderate to severe acne may require prescription medication. Also, there are types of folliculitis that mimic acne and require different treatment altogether.

Sagging Skin: Why it Happens and What to do About it



Skin sagging is inevitable – it will happen to every single one of us if we live long enough.  There are contributing factors beyond our control, such as age, genetics, and ethnicity.  Then, there are some lifestyle choices we can make to help the cause.

The aging process affects the entire facial structure. Over the years, our skin thins. There is a decrease in collagen and elastin.  Facial bones, the scaffolding that holds up our faces, begin to degenerate.  The combination leaves us vulnerable to the downward pull of gravity.

Genetics and ethnicity play a large role in how we age.  People of color typically exhibit less severe skin laxity with signs appearing a decade later than lighter skin types.

Lifestyle factors that can accelerate the aging process include excess sun exposure, smoking cigarettes, air pollution, rapid weight changes, and high sugar diets.

Sagging cannot be prevented, but it can be delayed and improved.  A lot can be achieved with wise choices that include a healthy, balanced diet, exercise, use of sunscreen, avoiding cigarettes, and minimizing exposure to pollution when possible.  The rest can be achieved by the right dermatologic care.

People who want to delay skin laxity should consider incorporating a topical Vitamin A derivative (retinol).  Retinols have been shown to increase skin turn over, boost collagen production, decrease wrinkle formation and improve skin texture over time. Since retinols have the potential to cause dryness and irritation, it is best to consult a dermatologist to help choose the best one for your skin and give you specific instructions on proper use.

Fortunately, various minimally invasive cosmetic procedures can target the specific factors that contribute to skin sagging.  Dermal filler injections can be utilized to replace volume lost by thinning of bone.  Titan, an infrared device, delivers heat energy below the skin to cause contracture of tissue and stimulation of collagen building.  It is most helpful for tightening the skin of the lower face, jowls and neck region.  For laxity in the eyelid region, microneedling with PRP (Platelet Rich Plasma) or with radiofrequency are most effective.

Life style modifications, retinols and cosmetic treatments are key to delaying and minimizing skin sagging.  In some cases, however, surgical procedures are necessary to achieve the desired improvement.