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Acne FAQ






Q. Is there a cure for acne? 

A. For some, yes. for others, it is a chronic disease which 

can be successfully managed in remission. After the skin

clears there are products you can continue to purchase

in order to stay clear.


Q. Realistically, how long does it take to get clear? 

A. Inflamed acne usually takes around three months

(six treatments). Severe, non-inflamed acne usually

takes the longest. Healing times are different for everyone.


Q. What exactly is acne? 

A. Acne is a skin disease caused by several factors the most important of which are oxidation of sebum, infection by a pathogenic strain of bacteria (P. Acnes or Staph) and inflammation. It is not a virus but it is contagious. Acne is a condition where change in consistency and extent of sebum production, skin pH, bacterial flora cause sudden increase in baseline skin inflammation and opportunistic bacterial infection and blockage of pilosebacious follicular units. Successful treatment of acne involves management of all these elements, not just unblocking the follicles without damaging the skin. Unlike what you’ve been told, acne is not just a clogged pore condition.


Q. What is Dr. Ishoo’s philosophy about acne and acne treatment?

A. Doctor Ishoo explains acne similar to dental cavity. Both are caused by change in the local environment, diet related, not genetic, caused by change in pH and bacterial infection. You may have a low-grade infection and not have any symptoms for a long time but when the doctor checks, they can see the evidence of infection and tissue damage. The treatment is not topical creams or antibiotic pills. It is extraction of the infection and repair of the tissue. When there is a significant virulent infection causing cysts or abscess with pain, swelling and redness, the acute inflammation, which is body’s response to the infection, is diminished by short course of antibiotics before the extraction. Long-term prevention and maintenance required diligence hygiene are regular doctor visits, change in diet and use of appropriate products prescribed by the doctor. Just as cavities may run in families, due to similar diet and poor hygiene and sharing of bacteria, acne is similarly familial but not genetics and can occur throughout life. Just as you would not trust the health of your teeth and mouth to someone who took a few classes for 3-6 months, you should think twice to trusting the health of your largest organ, your skin, to an esthetician without direct, hands on involvement of a qualified doctor and staff specializing in acne treatment and skin health. The cavity and acne analogy presented by Dr. Ishoo carried well in all aspect of understanding acne.


Q. Why do so many teenagers get acne? 

A. As a young person enters puberty they are producing more testosterone (male hormones). These androgens stimulate the oil glands, which start producing sebum (oil) at an accelerated rate. This also leads to change in the make up of sebum and skin pH. Some pores may get clogged with the thicker oil and debris and become infected as opportunistic and virulent bacteria takes over. The body sends white blood cells to help fight the bacteria causing clinical or visible redness, pain and inflammation.  The infection and the inflammation, which is the body’s mechanism to contain the infection, can quickly spread. 


Q. Is there a change in desquamation or skin cell shedding that precede acne formation? 

A. No. We normally lose one skin layer every 28-45 days depending on our age and other factors. There is no evidence that any condition involving a change in normal skin turnover caused the formation of comedones or acne; however, the follicular inflammation may cause a reactive increase in keratin production or cell shedding as well as swelling of the follicular infundibulum or neck. In a person without acne the skin pores shed approximately one dead skin cell per day. A person with acne-prone skin can shed up to five dead skin cells per day. With all of the excess oil in the pores the dead skin cells get trapped. The body simply cannot keep up.


Q. Do you treat people of all ages? 

A. The physicians at the Boston Acne Specialists diagnose and treat acne-afflicted individuals of all ages, races and skin types. 


Q. Can I still get sporadic pimples during my treatment? 

A. Yes. You can expect it to happen. Why? It doesn’t mean the treatment isn’t working. It could take three months for a microcomedone (new pimple) to form into a full-blown pimple. That microcomedone may have started to form before you started your treatment. That’s why we need at least three months to clear most inflamed acne.


Q. I have terrible body acne. Can you treat that too?

 A. Yes. Boston Acne Specialists treatment centers are designed for effective, aggressive and comfortable treatment of face and body acne. Acne on the back, shoulders, arms, and buttocks are common but may be mistaken for other more serious lesions and must be properly diagnosed before effective treatment can be implemented. Don’t agonize over it. Come in and get it treated. We’re here to help.


Q. Do teens, men, and women suffer from acne differently? 

A. Yes. Males tend to suffer from face and body acne a lot more severely. They are prone to cystic and nodular acne lesions. Women tend to have acne longer due mainly to hormonal challenges. Most others treat acne all the same. Not here.


Q. I scrub my face six times a day to keep it clean. Is that good? 

A. No. Remember, your face is not dirty; your pores are clogged. Washing simply can’t get deep into the follicles to clean them out. You need to use effective products. Over-washing can be very bad for acne prone skin and can actually make things even worse especially if you use soap which can breakdown protective sebum and change the skin pH more basic making opportunistic bacterial and fungal infection much more likely.


Q. How do your product lines work? 

A. By staying ahead of your acne. Your skin can adapt and get used to acne products. When it does the products lose their effectiveness. Each time you come in for your treatment we will reevaluate your skin and see how the products are working. We will always use the most effective and economical skin care products to keep your skin from adapting. Our specialists take time to individualize each patients home care regimen.


Q. What is a blackhead? 

A. A blackhead is also known as an open comedone. The dark colored material is oxidezed melanin which is normally released from dead skin cells that clogs a pore. We can usually extract blackheads and treat it with various keratolytic chemicals to breakdown the harder debris. Contrary to what you may have been told, these lesions rarely develop into nodulocystic acne even if untreated and rarely scar.


Q. What is a whitehead? 

A. A white head is also known as a closed comedone but may also be an unoxidized open comedone. It is usually white in color because it has not oxidized like a black head or the impaction is microscopic at the surface keeping the fullness is below skin surface. Whiteheads and blackheads are generally treated in the same manner and frequently coexist in the same individual. Both whitehead and blackhead comedones are inflammatory lesions but the inflammation is not clinical. Similar to having dental cavities without symptoms but there is still an infection to which body is reacting with low grade inflammation.


Q. What is cystic and nodular acne? 

A. This is a visibly or clinically inflamed type of acne. It is also known as Grade 4 acne. It runs deep into the skin and spread deep similar to an apical dental root infection, which may involve several surrounding teeth with more serious consequences.  Cystic acne needs to be treated more urgently. These large nodules have caused significant deep tissue damage and remodeling leading to more disfiguring deep scarring. This is the type of acne that is more common in males and on back.


Q. What is Inflammation?

A. Inflammation is the natural state of all organic beings. As human beings we must coexist with our bacterial flora to survive our environment. All the surfaces of our body that come into direct contact with our environment, such as our colon, our teeth and our skin, are covered with helpful or commensal bacteria that defend us against opportunistic, virulent organisms. Whenever you change your environment, such as going on vacation to Mexico, it takes a while for your new protective bacterial flora to populate your surfaces. In the meantime, you may become very sick if you drink the water or even sleep on the sheets. Our body naturally is in a constant state of defending itself and being inflamed by trying to recognize foreign or offending organisms or objects and trying to contain or destroy them by releasing a cascade of chemicals and recruiting white blood cells for direct cellular combat. We only become aware of the inflammation when it reaches a tipping point and caused symptoms of swelling, redness, pain etc. Inflammation is not bad. It is out natural state. However, when it becomes clinically symptomatic, it needs additional help such as physical extraction of infection or systemic antibiotics. Our goal should never be to eradicating all bacteria or inflammation. That will lead to much more serious problems for the individual later.  Our goal is the restore homeostasis or balance between our body, our protective flora and the environment. This is how we maintain or restore your skin’s health while treating the acne.


Q. Why do so many people not seek treatment for their acne? 

A. Only around 11% of the population with acne will seek any kind of treatment. Many people think that “nothing works” and that their acne will eventually go away. It is important to get treated early. Scarring is quite common because people did not get the effective treatment they needed early enough. Those that do seek treatment usually try a host of products or treatments that don’t work and they just give up. They live their lives in a depressed state. They don’t go out very much. They don’t date. The acne has literally taken over. We believe that if more people realized that acne can be effectively treated then more of them would seek help. Again, scarring can be minimized in many cases if treatment is started early.


Q. Tell me more about acne scars? 

A. Scars can be treated but with limited results. Once your skin becomes scarred by acne it will never be the same again. There are scar therapies that exist but they have limited results. Laser, skin grafting, skin punches, and dermabrasion are just some of the treatments available. Scar therapy can help to lessen the degree of scarring but once your clear skin is scarred then the damage is done. It is so important to get your acne treated as early as possible to minimize scarring.


Q. Should I steam my face at home? 

A. Steaming the face in and of itself has no real healing properties. Slight steaming may help soften the skin and the impaction of the comedones prior to extraction. Over steaming inflamed acne can do more harm than good. For clinically inflamed nodulocustic lesions cooling the face is preferred.


Q. Should I use the strongest form of benzoyl peroxide on my face if I want the best result? 

A. Benzoyl Peroxide, BPO, has been used for a longtime and for the most part, it is safe if used judiciously and conservatively. Internationally, BPO is suspected of causing skin cancer in animal model with prolonged use. BPO causes oxidative stress of all tissue that it comes in contact with leading to free radicals and DNA damage which is how it kills the P. Acnes bacteria; however, it is also how it damages the surrounding skin. Prolonged and especially high strength BPO will cause premature aging and indiscriminate killing of all bacteria. Sometimes its not what you put on our skin its how you use it. We will guide you to the most effective products for your particular acne and skin type and then show you (along with written instructions) how to use them. You just need the right products and instructions on how to best use them.


Q. Will I outgrow my acne? 

A. Most people eventually do outgrow their acne; they just don’t know when it will happen. Some people (mostly women) can get acne in their forties and beyond due mainly to hormone issues. When it comes to acne one thing is for certain: acne is different in everyone. The main reason people should seek treatment early is to avoid as much scarring and pigmentation as possible. Living with acne scars for the rest of your life is the real problem.


Q. Is acne inherited? 

A. No.  Acne is NOT genetic. 85% of people in the western society experience acne. Nothing that common is genetic, especially in genetically heterogeneous populations. Acne is similar to dental cavitiy. It is common, bacterial, preventable, treatable, and above all diet and hygiene related. The reason why it may run in families is not genetic (which would not be treatable) but common diet, hygiene habits and shared virulent strain of P. Acnes bacteria. 


Q. I have really bad acne. I have these big cysts on my face. What can Boston Acne Specialists do for me? 

A. We will carefully evaluate your skin and acne type and severity of your disease. You may need to start on a short course of antibiotics and even have steroid injection in the most inflamed nodules as well as e started on a home care regimen for 1-2 weeks. If your skin is not ready for extraction and Isolaz treatment. After your skin calms down, medical extraction and Isolaz treatment of all affected area will be performed weekly for 6-8 weeks to achieve clearance. Remember, nodular and cystic acne can cause the worst scarring so the earlier you get it treated the better for your skin. Clinically inflamed acne are infected cysts similar to boils or apical tooth abscess (going back to Dr. Ishoo’s dental analogy) and respond very well to surgical drainage / extraction treatment because of its location deep below the surface of the skin.


Q. Does steroid use have anything to do with acne? 

A. Yes. Prolonged use of systemic catabolic or corticosteroids can cause acne-like eruptions just as Anabolic steroids but to different extent and type (severe nodulocystic disease).


Q. Does eating chocolate or french fries cause acne? 

A. Probably.  Diet has a very strong impact on the skin and formation of acne. High sugar, dairy,           Omega 6/Omega 3 ratio diets such as the typical diet in the western civilization are known to aggravate as well as trigger acne breakouts. It’s the fried food and not the iodide as some who have chosen to propagate this baseless myth done so for the last 4 decades. 


Q. Can large pores on my nose and face be fixed?

 A. Yes, sometimes. Usually people with oily skin have large pores. Generally, beauty or personal hygiene products cannot permanently shrink your pores; however, appropriately prescribed treatments such as the Elite MPX and the Fraxel LASERS provided by Boston Acne Specialists can achieve a significant improvement in skin texture.


Q. I can’t help touching and picking my face! 

A. Picking and touching your acne may scar your face and spread your acne. Improperly treated open wounds may lead to face full of scabs. The scabs will diminish but acne scarring is for life. Do anything (even wear gloves) at home to remind you not to pick. Hands and fingers are full of bacteria. You want to keep the skin as clean as possible. 


Q. Can swimming aggravate acne? 

A. Yes. Swimming in a chlorinated swimming pool may irritate your skin..


Q. I hate pimples and squeeze them when they get big. Is that bad?

 A. Yes. It is best to leave them alone. Popping pimples could lead to a longer healing time and it could cause scarring as well. It is best to come to see one of our specialists in the greater Boston area for professional skin care and extractions.


Q. Can acne rosacea and folliculitis be treated effectively? 

A. Yes. Our highly skilled physicians and acne specialists offer treatment modalities and have a great track record in treating both conditions.


Q. I have these dark acne spots left over from old pimples. Can you help? 

A. Absolutely. Those dark spots are the result of old acne lesions. They are called post inflammatory hyperpigmentation. We have very effective light-based modalities and products to deal with those unattractive dark spots. Remember that those dark brown or red spots are pigmented scars,which can be effectively prevented as well as treated at Boston Acne Specialists. 


Q. Could my personal hygiene or beauty products make my acne worse? 

A. Yes. The products you are currently using could contain comedogenic ingredients that are clogging your pores. Our acne specialists will tell you what those ingredients are at your consultation. This type of acne is called “acne cosmetica.” Remember, even if your products say, “non-comedogenic” they may not be. Also, comedogenic is not the same as acnegenic. Contrary to common misconception, many ingredients that are suspected of being “comedogenic” are not and in combination form are not acnegenic.


Q. What is the toughest acne to treat? 

A. Eruptions that are misdiagnosed as Acne Vulgaris, such as Pityrosporum or Tinea which are skin fungal infection presenting as homogeneous dull, sluggish bumps on the skin especially if they have failed antibiotic treatments or mismanaged by a cosmetologist.  Otherwise, comedonal Acne Vulgaris lacking symptoms of inflammation, may take the lonest to clear and require more modalities than acutely symptomatic nodulocystic acne. Exfoliation and extraction especially using the Isolaz IPL is the main focus for treatment on comedonal acne. Products designed to be non-irritating are necessary for healing and restoration of skin health. Proper initial recognition of the skin lesions by a qualified physician is paramount in any successful treatment.


 Q. Can smoking marijuana make my acne worse?

 A. Yes. Marijuana is thought to cause or mimic androgenic stimulation of sebum production, leading to change in the P. Acnes substrate and food source and increased chance for opportunistic infection by the virulent and communicable strain of the bacteria. Smoking cigarettes is also terrible for your skin but for different reasons. You want to refrain from any drug use when you decide to make a personal commitment to getting clear skin.


Q. Is the sun bad for my acne? 

A. Generally yes, if you are unprotected and burn or tan. But if done safely, sun is good for you, your mental health and may even help clear your skin.  P. Acne bacteria’s porphyrin is stimulated by the sun’s UV light, which cause death of the bacteria and improvement in the acne as many people experience during summer. Sunlight can also decrease oil production which may also temporarily improve the skin. This is the basis for use of blue and red lights as well as photodynamic therapy as in-office treatment of acne.  However, over exposure to sun or burn must be avoided at all times. Skin cancer is a real problem. It can kill you. Always wear sunscreen when outdoors. Wear a hat for when spending extended time outside. Avoid tanning beds at all costs. A “good” tan is anything but healthy. A tan is really sun-damaged skin.


Q. I am a fast food junkie. It that bad for acne?

 A. Yes. There are many foods that are known to cause or aggravate acne but they can make your existing acne worse. Much of fast food is high in unsaturated fats and carbohydrates or sugars, which are the real culprit.


Q. I tried some acne products advertised on TV. They only helped for a while. Why? 

A. Your skin can eventually adapt to acne products. Products can only temporarily help control mild acne. Long term use of any products will damage the skin just as exposing your body to any chemicals longterm will cause imbalance, change in chemistry and tissue damage. Dr. Ishoo and Boston Acne Specialists intentionally do not privately label their own brand of product or exclusively endorse or subscribe to a single line of products to avoid a conflict of interest where selling of products becomes the goal, not clearing our patient’s acne. Beware of any office or salon that relies on selling products for their success. Infomercial products treat all acne and acne-afflicted individuals the same without taking you as an individual or your acne type or cause into consideration.


Q. After I get clear how do I stay clear? 

A. You need to keep using your home care products as instructed. After you have been clear for a while you can start to use your products less frequently. Similar to dental care, despite good homecare regimen, you still need to see your acne specialists doctor on regular basis for deep cleansing, hydration, antioxidant treatment, exfoliation etc. to restore and maintain skin balance and health. 


Q. What types of acne are there? 

A. There are different grades of acne, which indicate severity based on extent and clinical symptomatic inflammation. Not all acne is Acne Vulgaris (meaning common) which may present as comedonal or nodulocystic. The different types of Acne, based on their cause are listed and described in a different section of this site. Different types and grades of acne may coexist in the same individual, requiring refinement and customization of treatment. Knowing the cause of the eruptions is key to successfully treating them. This takes committed and experienced physicians and team of real acne specialists. In the greater Boston area, the clear choice for treating all things acne is the Boston Acne Specialists.


Q. I am so tired of this acne. I am tired of everything that doesn’t work. I just want some help from someone who isn’t interested in just taking my money. 

A. You are not alone. Boston Acne Specialists are here to help.  We are committed to helping you get clear and stay clear safely and cost effectively through evidence-based, clinically proven treatments.

There is still extensive and widespread misunderstanding of what causes acne and how to treat it effectively, especially within the cosmetology community and even many doctors. Dr. Ishoo has spent years studying Acne and has developed his own approach based on scientific literature, not following the crowd and perpetuating existing misunderstanding. Unlike many esthetic and medical practices, we consider Acne a serious skin disease and we have chosen to concentrate exclusively on diagnosis, treatment and prevention of Acne.  We hope that you have learned a little more about acne. We believe every acne-afflicted individual should be armed with correct information to empower them to become effective partners with us in clearing acne and keeping their skin clear, youthful and healthy (our motto and our mission). We welcome you as a partner in your quest for clear skin. After your treatments and counseling at Boston Acne Specialists, you’ll know more about acne than most professionals.


Are you ready to get your skin clear? The Boston Acne Specialists look forward to helping you. Come spend some quality time with us and finally get the clear skin you deserve. Make your appointment today.

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