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  • I'm doctor Mike Evans my question is work is the best way to treat

  • acne acting vulgarities a skirt a clue

  • your auger send bad but in fact it's an old word that means common

  • which acne certainly is acne is fascinating in the pantheon of diseases

  • many ways trivialize it is simply part of teenage life that faith and and

  • really doesn't have any health consequences

  • but what if I framed in a different way acne is a disease that makes people feel

  • bad

  • often very bad about themselves just when it was critical that they feel good

  • about themselves

  • it's a disease that can scar for life but that could have been prevented

  • a disease that research shows this is damaging the quality of life

  • is chronic distressing condition such as as per epilepsy or diabetes

  • and the timing is so unfortunate just as we start to be more where her parents

  • oil geyser center located near upper chest back neck and face

  • all highly visible areas begin pumping out skin Greece

  • adults can get acne about 10 percent still have a 25

  • but almost all teenagers do get acne which 15 having a more severe case

  • it tends to come on earlier in women but do to get a little bit works

  • unlike most likely resources on the internet I'm not gonna offer you 100

  • percent here

  • there really is no cure for acne most to the therapies and gonna discuss have

  • about a 40 to 70 percent success rate

  • getting to a higher success rate really depends on you finding your own special

  • recipe that often requires

  • you combine different agents what we call step up their

  • p okay the first piece advice is to talk to a doctor about it

  • repeat after me my doctor has see more embarrassing things and whatever I show

  • him or her

  • so bring acne up and go back if your team isn't working

  • now

  • I bet I can guess the current approach them if you're taking who are suffering

  • from acne

  • perhaps you wash your skin vigorously to keep like it

  • to a minimum maybe put people claim or whenever you have an outbreak

  • any made even avoid certain foods you think worsen your

  • me well actually the black and black kids

  • is really just melanin in oxidized lipids not there

  • so cleaning vigorously or picking can actually inflamed pimples

  • washing once daily with the mild soap for so close Kinder's fine

  • pretty people came under existing actually doesn't actually make much a

  • difference

  • a key key learning is that when you treating acne you're actually not doing

  • much for the current pimple

  • you're preventing the next round so if you are playing the cream

  • NEC going where you get pimples for most people this is in what we call the

  • T-cell

  • it takes 60 weeks and sometimes longer to see if acne treatment is working

  • diet and acne is interesting

  • most research shows no connection but the trial quality is generally poor

  • for example studies trying to provoke acne with large amounts of chocolate

  • show expect but the trials for to shorten too small to be definitive

  • a small trial using a low-glycemic diet showed some improvement but

  • I I'd say there's not enough evidence at this kinda recommend one way being over

  • another

  • the answer is likely just eating healthfully and if a patient find a big

  • difference with a food

  • I say if I so that food that understand the best treatment for acne we need to

  • start with the biology lesson

  • than a mere test then step up their p I think if you comprehend the biology

  • Lackie it makes treatment a lot easier to understand

  • when you hit puberty many things happen but

  • two things in particular at your skin first we get more plugging

  • this is because the hormonal changes appear ready cause more

  • oil production what we call see them and the surface of the skin becomes a bit

  • more crusty

  • what we call karen is a sin the second thing that happens as we get more

  • information

  • this is mostly because the bacteria to colonize is our skin called P acnes

  • the P acnes mixes with this evil man oil and causes an inflammatory reaction

  • which gives redness and swelling

  • now acne confuses as I think because there are so many treatments

  • 1 review indicated a hundred and forty different treatments in into engine 50

  • combos

  • so kicker for the mall but we can ask what the clinical research says is the

  • most effective all these treatments

  • and I think it follows our biology lesson it's developing a strategy to

  • a reduce plugging Mb minimize information

  • we just have acne treatment is to start with one therapy

  • if it works great if if it only works personally or not at all then you need

  • to step up to the next level by changing or adding a therapy

  • okay let's take a bit of a detour into a topical 101

  • total cals are r medicine see you apply your skin like a cream or gel or lotion

  • jails had to be stronger and more drying cream so if you have oily skin

  • and a gel might be a good idea if you have less oily skin

  • the cream would be better and we all react differently to different topic or

  • so it's a good idea to experiment with a topical in one area before you apply

  • everywhere

  • mister with a lower strength and then ramp it up if you need more

  • effectiveness

  • now let see look in the mirror and now by the way is a good time to take a

  • picture of yourself

  • pre-treatment leader for comparison let's see you see mostly red and

  • inflamed pimples

  • then you need to do something about the information which means you need to try

  • to reduce the bacteria P acnes

  • benzoyl peroxide or BP is first line here and it's available over the counter

  • at any pharmacy

  • it's good to go graduate bps as he didn't seem to be much difference with

  • the different strengths I tell people to start with los drinks like

  • 2.5 percent and and start putting on for two hours for four nights in for four

  • hours for four nights and then the whole night

  • and then wash it off in the morning if you tolerate that well but you want more

  • fact than you can try switching to a stronger version

  • remember you have to give it a few months to see if it works

  • alright back to the mir look in your face if you see plugin on your skin

  • which would be small bumps blackheads or whiteheads then you need to focus on

  • unplugging the classic can plug in agent in acting cares called the retinoid

  • retinoids work by making your skin less Christina and you need a prescription to

  • get this treatment

  • sometimes you can make your skin a bit red and dry so again experiment

  • dryness can be helped with a moisturizer so if you look in the mirror and see

  • both red spots

  • and black or white heads on your skin they need to both

  • unplugged and reduce information by using a combination of both retinoid NPP

  • but I suggest you start with one to see how your skin reacts

  • there's some debate about which one should be first but usually

  • most people start with BP as its over the counter

  • okay if these first-line agents have worked it's time to look at the NEX

  • options for step up therapy

  • if your women you can consider using a birth control pill as it reduces the

  • hormones that cause plugging in the first place

  • this is an especially effective approach if you can have flare-ups have acne

  • around your period

  • you can also consider a topical antibiotic to reduce P acnes and

  • information

  • these can be prescribed to pre mixed with BP or retinoid

  • if you already know you tolerate these next we often step up to antibiotics

  • take by mouth

  • now we do you worry a bit about over using antibiotics

  • so it's good to take a break every few months to see if you still need it

  • if your step up their peers not worked after all these treatments your doctor

  • has

  • other options that you can discuss finally if you've exhausted

  • all your options there is a very strong right now I taken by mouth called

  • isotretinoin

  • it is the supreme employer and and it's incredibly effective for severe acne

  • been a mixed message here though isotretinoin has some potential side

  • effects and and a powerful drying effects are you really need to pack your

  • lip balm and moisturizer and so on

  • and including the fact it absolutely can not be taken by women that is pregnant

  • so you need to be monitored closely when you're on this medication

  • having said that I have seen isotretinoin change the lives of more

  • severe acne sufferers

  • in and if you think scarring is likely then this may be a reason to consider it

  • a try no

  • in some sense acne treatment a simple reduce plugging

  • information but it's all so complicated as there are many many agents that do

  • these two things

  • treating acne is a bit like basketball have to experiment with various players

  • in combinations

  • the score can fluctuate initially and it takes a little while to figure out who

  • will win

  • but you can win if you stick with

  • I made a card to help you sort out all the different treatments it's free at my

  • favorite medicine DICOM

  • I really hope this helps take care

  • just

I'm doctor Mike Evans my question is work is the best way to treat

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