Meet the Acne Specialist
Joshua Zeichner, MD FAAD, is the Director of Cosmetic and Clinical Research and an Assistant Professor in the Dermatology Department at Mount Sinai Medical Center in Manhattan. As a board certified dermatologist, he sees patients with all skin conditions, but specializes in the treatment of acne and cosmetic dermatology. He is actively involved in clinical trials, testing the newest medications for both cosmetic and medical skin conditions. In addition to treating patients with acne, sensitive skin, eczema, psoriasis, rosacea, and skin cancer, Dr. Zeichner employs the most effective and current procedures to diminish the signs of age by reducing the appearance of fine lines and wrinkles, volume loss, dark spots, red spots and blood vessels.
What are some of the newest developments for the treatment of acne?
While most of the active ingredients used for the treatment of acne remain the same, what has changed are the vehicles by which the medicines are delivered. The newest vehicles have been developed to reduce irritation to the skin and maximize penetration into the follicles, which is where acne lesions develop. One of my favorite medicines is Atralin® Gel, a topical retinoid that I find to be extremely effective yet causes minimal irritation.
Another big development is the use of products that combine more than one ingredient. These combination products reduce the number of times a medication needs to be applied in one day. Epiduo® Gel is a favorite. It combines a retinoid and benzoyl peroxide in one.
There have been great strides in the treatment of acne scarring. While acne scars are permanent, the appearance can be improved. I use the Fraxel® re:store laser to treat scars on the face. Patients need multiple treatments, and there is some swelling associated with the procedure. While I can’t make the skin perfect, I certainly can improve it significantly.
What are some tips you can give acne patients?
Acne patients always want to get better fast. Unfortunately, acne is a chronic condition, and will not go away overnight. Most of the topical medicines start to kick in around six weeks, with maximal improvement peaking around 12 weeks.
Other tips include:
1) More medicine is not better. Usually a pea-sized amount of a cream is enough to cover your whole face. More can lead to irritation.
2) Do not pick! If you have a red, painful spot, come into the office. Your doctor can help open up the pimple or give an injection of cortisone to decrease the inflammation.
3) Use mild cleansers in combination with prescriptions. Over-the-counter washes or creams that contain other acne treatments can overly dry out the skin.
What are the most common misconceptions patients have about acne?
Many patients think that cause their acne by doing something wrong in their daily skin regimen. This is not always the case. Patients who wash their face often can have acne, and patients who never wash their face can have clear skin. Having acne does not mean you are dirty! Acne is caused by several factors, such as how much oil your body makes, which is determined by hormones. You have no control over this!
What are the newest developments for the treatment of fine lines and wrinkles?
Fractionated lasers, such as the Fraxel® re:store, have revolutionized the treatment of fine lines and wrinkles. The lasers work by punching microscopic holes in the skin. When the skin heals, the texture and tone is improved. Since only small holes are created and the entire skin surface is not treated, it is a much safer option than previous lasers for lines and wrinkles. In addition, there is less down-time than in the past.
Sagging skin and laxity is another issue that can be treated. The new Thermage® CPT treatment is an effective way to non-surgically tighten the skin. This machine gently vibrates during treatment so patients do not feel pain. In fact, no numbing is needed for this procedure. Thermage® is a radiofrequency device that gently heats collagen in the skin. As it cools, the collagen heals and tightens. It takes several months to see the full improvement. Thermage® can be used on the face as well as on other areas of the body, such as the abdomen (especially post pregnancy), the buttocks and the thighs.
The combination use of Thermage® CPT and Fraxel® can significantly improve the tone, texture, and tightness of the skin—and all without going under the knife.
The newest dermal fillers now incorporate lidocaine directly in the product. This helps reduce the discomfort patients experience during the procedure. My favorite products are Restylane-L®, Perlane-L®, and Juvederm-XC®. All of these are hyaluronic acid fillers that are have a great safety profile and contain numbing medicine right in the product.
What are the best topical treatments for fine lines and wrinkles?
The topical treatment I usually give my patients for fine lines and wrinkles is a topical retinoid. I typically use Atralin® Gel because it is extremely efficacious and causes minimal irritation.
Other topical treatments I recommend contain anti-oxidants, such as coffee berry, which reduce the damage caused by free radicals in the skin. There are a lot of great creams and serums on the market with peptides and niacinamide that may help build collagen. Finally, some new serums use stem-cell technology and may have great promise in rebuilding damaged skin.
What advice do you give your cosmetic patients?
Prevention is key! Dermatologists can improve the appearance of lines, wrinkles and uneven skin tone, however, there is no better treatment than preventing these changes from occurring. Wear sunscreen every day and use a moisturizer that contains a sunscreen every morning. I tell patients to cover the face, upper chest, neck and the hands. The incidental light you get while walking to and from your home can do a lot of harm. Thirty minutes every day adds up over a lifetime.
Develop a relationship with your dermatologist. Cosmetic work must be maintained. While some patients may have just one cosmetic procedure and never have another, most come back to the office about two to three times a year for touch-ups. We need to work together to address cosmetic issues that arise, and these issues change over time. The key to cosmetics in my practice is that “slow and steady wins the race!”
At what age do you recommend patients use anti-aging products?
It is never too early to start using anti-aging products. At the same time, it is never too late. No matter how old you are and how much sun damage you have, you can always try to turn back the clock.
There are several different types of anti-aging products that patients can use:
1) Sunscreen—it’ the best anti-aging product available.
2) I typically recommend a topical retinoid for patients in their mid-30’s. By the time a patient reaches their 30’s, the skin does not heal as well as it did in their teens or 20’s. By using a topical retinoid, you can help thicken collagen and hopefully prevent fine lines and wrinkles from developing as you age. However, patients in their 50’s, 60’s, and 70’s commonly come into the office and are given retinoids for the first time. They can help all skin to some degree, regardless of the age.
What are the most common errors you see patients making in trying to cosmetically improve the face?
Sometimes patients become fixated on one problem, often the nasolabial fold. Patients feel that if they fill their fold, they will appear younger. When rejuvenating the aging face, it is important to treat all the areas that age you. A nasolabial fold develops because of changes in the fat and bones of the face. Cheeks drop and the hollows under the eyes become more prominent. Jowls develop. I stress to my cosmetic patients the importance of a pan-facial approach that treats all the signs of aging. A patient with hollow cheeks but no folds will not look natural. Even young people have nasolabial folds. It is important for cosmetic patients to look natural and be the best they can be for their age. This is done by treating the entire face, not just one area.