Acne -Benjamin Lockshin, MD Adenovirus Adolescent Health: The Birds and the Bees with Ease!TM -Chrystal de Freitas M.D., FAAP Allergic Rhinitis: The Basics Allergic Rhinitis: Treatment Options Animal Bites -Elizabeth Jacobs, MD Ankle Injuries -Rob Freishtat MD, MPH Asthma Attention Deficit Hyperactivity Disorder (ADHD) -Julie Bindeman, Psy-D Autism Bedwetting -Howard Bennett, MD Bee Stings -Ellen Scholnicoff, MD Breastfeeding: Part 1 -Amy Evans, MD, FAAP, FABM Breastfeeding: Part 2 -Amy Evans, MD, FAAP, FABM Bullying -Sarah Kanter, MS School Counselor Childhood Obesity -Carrie Zisman, MS,RD Colds & Cough and Cold Medications Concussion -David J. Mathison M.D. Croup Dental Caries (Cavities) -Jessica Exelbert, DDS Dental Trauma -Jessica Exelbert, DDS Ear Infections (Acute Otitis Media) -Jerome Schwartz, MD Eczema (Atopic Dermatitis): The Basics Febrile Seizures -Amy C. Goldstein, MD Fever Basics Flu Vaccine and Kids Food Allergy Basics -Emily Poole, RD, LDN Halloween Safety Tips Headaches -Amy C. Goldstein, MD Heat Related Illness Immune System -Ellen Scholnicoff, MD Jaundice in a Newborn Lead Dangers Learning Disabilities in Children/Adolescents -Jennifer Engel Fisher M.Ed. Lice Mono (Infectious Mononucleosis) Newborn Care: Part 1 -Howard Bennett, MD Newborn Care: Part 2 -Howard Bennett, MD Occupational Therapy: An Overview -Marci Gutmann, MS, OTR/L Pediatric Dental Issues -Jessica Exelbert, DDS Pneumonia -Dinesh Pillai, MD Postpartum Depression (PPD) -Jennifer Kogan, LICSW Puberty: Healthy Chats for Girls and Boys -Chrystal de Freitas M.D., FAAP Rotavirus Sleep Issues in Infants and Children -Candice Alfano Ph.D. Speech Development…What is Normal? -Beth Abramowitz MS, CCC-SLP Stuttering (Disfluency) in Children -Kathy Dow-Burger, M.A., CCC-SLP Sudden Infant Death Syndrome (SIDS) Summer First Aid Kit Sun & Sunscreen -Benjamin Lockshin, MD Tick Talk Tics -Amy C. Goldstein, MD. Tinea Capitis: Ringworm of the Scalp

Acne - Benjamin Lockshin, MD 1. What causes acne? Acne is a hormonally driven condition that results in clogging of the pores causing the formation of open and closed comedones (blackheads and whiteheads). This occlusion causes a backup of sebum, which can lead to inflammatory papules and cysts. 2. Does diet effect acne? This is controversial. Currently, the common belief is that hormones in cow’s milk may exacerbate acne. There is no evidence that eating fried food, chocolate, peanuts, or soda causes acne to flare. 3. What should I use on my face? There are many products available that do not cause or exacerbate acne. Look for products that state they are non-comedogenic. In addition, women should only apply loose powder. Pressed powder contains paraffin which can clog pores. 4. Are blackheads caused by dirt? No. Blackheads are the results of sebum and sloughed-off cells plugging the pore. When exposed to the air, melanin undergoes oxidation. This gives the material in the follicle the typical black color. 5. Is acne hereditary? Yes. But there is genetic variability. Use your parents’ acne history as an approximate estimate of what you should expect. It is certainly possible that your acne will be worse or better than that of your parents or siblings. 6. Will I outgrow acne? Most likely. Although many people show significant improvement of their acne in their late teens to early twenties, some have persistent outbreaks that can continue for years. Persistent acne in women can be hormonally driven and flare around their periods. 7. Can mediations cause acne? Yes. There are a number of medications that have been directly liked to cause or exacerbate acne. Most notably, topical steroids, oral steroids and lithium. 8. Should I pop my pimples? No. Even though a dermatologist may extract your blackheads in the office, it is not recommended to pick at your face or pop pimples. This can result in scarring and infection. 9. What is the truth about Accutane? Accutane (isotretinoin), a systemic retinoid that is a vitamin A derivative, has been used to treat acne for over 30 years. Although its mechanism of action is not exactly known, isotretinoin works by decreasing sebum production. Isotretinoin is not an antibiotic. A typical course of isotretinoin is 5-6 months. After finishing a course of isotretinoin, 60% of patients are virtually cured of their acne, 20% respond well to topical therapies, but 20% will need an additional course of isotretinoin. This medication is tightly regulated and only dispensed by physicians enrolled with the iPledge program. Isotretinoin patients need to be followed closely. Monthly visits to the prescribing physician are mandatory. Women are required to have monthly pregnancy tests to ensure they are not and do not become pregnant. Birth defects are common in patients who become pregnant while taking isotretinoin. However, there is no birth defect risk attributable to isotretinoin one month after finishing the medication. In addition, triglycerides, circulating fat, can be elevated while on the medication. This returns to normal after finishing the course of isotretinoin. Other common side effects include dry lips, skin, and eyes. Like other medications, there is a long list of rare but not life threatening side effects. You can refer to the package insert for additional information. There has been significant negative press in the past few years about depression and suicidal thoughts attributed to isotretinoin. Large studies have not determined any link but care should be given when electing to use isotretinoin on patients with a history of depression or suicidal thoughts. 10. How do I treat my acne? This is not a straightforward answer. Acne treatments are tailored to each patient. Many patients with mild acne can be controlled with over the counter benzoyl peroxide or salicylic acid products. If your results are not satisfactory, a visit to your primary care physician or dermatologist will likely be beneficial. Prescription medications include but are not limited to topical retinoids (e.g. Differin , Retin-A or Tazorac), combination benzoyl peroxide and antibiotic products (e.g. Duac, Benzaclin, or Benzamycin), topical antibiotics (e.g. clindamycin, or dapsone), systemic antibiotics (e.g. doxycycline, tetracycline, minocycline, and Bactrim), hormonal therapy for women (e.g. some oral birth control pills, and spironolactone) and oral isotretinoin. Benjamin Lockshin, M.D. Dermatologist DermAssociates, Silver Spring, MD www.silverspringskin.com