X's Q & A

Q&A: What can I do to smooth out acne scars from bad acne when I was younger?

There are a number of things you could do for enlarged appearing pores or acne scars. You could consider a microdermabrasion treatment, a very gentle "sanding" of the topmost layer of the skin. This helps the skin to smooth out over the course of a number of treatments. You could consider a few "Beta-Lift" peels, which place salicylic acid in the pores to exfoliate them and allow them to shrink. You could also start on a skin care regimen such as with a retinoid (like Retin-A or Differin- both are prescription) or you could try an overy-the counter version of retinol (such as Afirm 2X available at my website, or a combination with an alpha hydroxy acid cleanser. Or let the skinwizard tell you what to do at click on the skinwizard and answer 3 questions (your skin care goal would be "toning") and it will guide your selection of a skin care regimen for your individual needs.

Q&A: Can the Estratest I am taking for hot flashes and mood swings cause facial hair growth and what can I do about it?

If your hair is darker than your skin it can be removed with a laser. But facial hair is the most resistant to permanent removal. The Estratest has some testosterone in it, which may be mood stabilizing for you but may contribute to the hair growth. Any doctor can prescribe Vaniqa, which is a pretty harmless cream- perhaps the doctor that put you on Estratest would do this for you? Another consideration would be Spironolactone, an oral medication that blocks hormone action at the level of the hairs. If your gyne is not interested in discussing these things with you, see a dermatologist or an endocrinologist. Good luck!

Most likely it is "tinea cruris" kind of like athletes' foot of the groin. Fungus likes warm and moist places like inside body skin folds. You can purchase Lotrimin Cream in a drugstore. Use this 2X per day for 4 weeks. Also try baby powder cornstarch (NOT TALC) and put on in A.M. over cream as this helps to keep the sweat off the body and not irritating the skin surface. If this doesn't help I am afraid you'll need a trip to the dermatologist.

Most likely it is "tinea cruris" kind of like athletes' foot of the groin. Fungus likes warm and moist places like inside body skin folds. You can purchase Lotrimin Cream in a drugstore. Use this 2X per day for 4 weeks. Also try baby powder cornstarch (NOT TALC) and put on in A.M. over cream as this helps to keep the sweat off the body and not irritating the skin surface. If this doesn't help I am afraid you'll need a trip to the dermatologist.

Dear Donna, Please accept my condolences at your terrible loss. When you say no treatment, does this mean that the melanoma was never re-excised? Usually for .7 the mole would at least have been re-excised with a margin of normal skin and an excision that was fairly deep, ie all the way to the top of the muscles. Unfortunately, medical treatments are based on statistics and weighing the pluses and minuses. The statistics are that with a .7 deep melanoma, the odds were very positively in your son's favor (I'd have to know all the facts to run an "exact" odds estimate, but assume it was more than 80% chance of cure). But this doesn't help the folks like your son who was one of the unlucky ones. Let's say we had 10 men your son's age who had melanoma like his. 8 or 9 of them would probably be cured by re-excisional surgery alone. 1 or 2 would wind up having a metastatic lesion (as your son did) later. Do you think the other 8 or 9 should have to take interferon for a year with all the attendant side effects and the interference with daily life? From your perspective you might say yes, but from the other 8 or 9's view it would be no. So, typically, we go with the odds when they are as one-sided as this. With respect to the dye in the lymph node procedure, it still is not usually done for people who have thin melanomas (like your son's) unless there was something else in his history (it was ulcerated or it was deep in the skin even though it was thin, etc). Even then, it has not been clearly established that this procedure would have actually been able to save his life. You would have known that it had the potential to spread sooner, but it might not have helped. Whenever we make a diagnosis of cancer, we always try to soften the blow and look on the bright side. This is human nature. Especially when there is a thin melanoma, it is very reassuring to people that it is likely they will beat the odds. But there still are odds. Once you have a malignant tumor, there is always the chance that it could spread or has spread via cells that cannot be seen now but eventually will grow and will then be detected. See? My response was even longer than your question! May your grandsons bring you joy and give you some peace in your grief.

Q&A: Could my son's elevated bilirubin and alkaline be from the use of minocycline for acne?

It is possible that it could be due to minocycline, although it is highly uncommon. The good news is that if so, it is reversible with discontinuation of the drug. However, they often do multiple other tests to determine what the cause of elevated liver enzymes are. You didn't tell me how elevated either- people occasionally get liver enzyme elevations that are mild for not always know reasons and they can resolve on their own. Accutane is a great drug for acne (although it does have potential side effects which he should thoroughly discuss with his doctor before taking it) and although liver problems are listed as a side effect, I have only seen about 2 people in my 12 years of practice get elevated liver enzymes and they both went back to normal after the drug was discontinued.

Q&A: What can I do to get rid of acne, especially when it appears when my period is near?

There are innumerable treatments for acne. I like the Complete Acne Treatment Kit at, especially since I hand picked the ingredients and products. You need to give any new regimen at least one month to work. If this doesn't work you may need an oral antibiotic to clear things up. For a complete description of the causes and treatments of acne, see and click on topics and from there acne. Good luck!

Q&A: What is next for my husband who has moles that are malignant melanoma and what about my children with moles?

First of all, you should go to a dermatologist who is thorough. You shouldn't have to ask to have his scalp looked at. His doctor should look everywhere- his scalp, between his toes and even at his scrotum. Second of all, your doctor should tell you what the depth of the melanoma is, called the Breslow depth. The dermatopathologist should measure the melanoma under the microscope. This is the most important piece of information you can get. This measurement is the most important predictor of future biological behavior of his tumor. You should ask your doctor if the mole was sent to a board certified dermatopathologist for this diagnosis. If not, seek out a second opinion. Finally, ask the surgeon whether they can do a sentinel lymph node biopsy. This involves injecting a dye at the site of the melanoma and then removing the first lymph node at the time the melanoma is re-excised. Again, if this node is negative, it is a very good sign that the melanoma has not spread. If this lymph node has melanoma, then you should consult an oncologist experienced in the treatment of melanoma. When you get all of this information back, write to me again. Your husband definitely should have surgery, which in many cases can be curative. You should take your children to a dermatologist experienced in this area for a total body examination. Although melanoma is rare in children, it does occur, and melanoma is partially an inherited disease. Finally, your husband should see an ophthalmologist for a complete eye exam as occasionally moles are present on the back of the eye. Good luck!!

Q&A: What treatments are there to remove dark pigment scars resulting from past acne on my back?

There are a few potential treatments: microdermabrasion, mild chemical peels, and laser treatments. I would start by seeing a dermatologist who is affiliated with the American Society of Dermatological Surgery by going to and seeing if you can locate someone in your area by clicking on where it says "find a dermatologic surgeon". These are dermatologists who are more oriented towards cosmetic problems and hopefully can find a solution for you. Good Luck!

Q&A: Is it possible to find any relief from the severe pain caused by hidradenitis suppurativa (acne inversa)?

I am so sorry to hear that your father-in-law is in such terrible discomfort. I did a literature search and found that there are really two main treatments for hidradenitis. One you might consider is oral isotretinoin, brand name Accutane, which is usually used for severe acne but has been shown to be successful in suppressing (not curing) the symptoms of some cases of hidradenitis. The most widely accepted treatment, however, appears to be radical surgery, that is wide excision of the entire skin surface in the affected area. With 20 surgeries behind him, it doesn't sound like this option is going to be one that gives him much hope. The authors that were associated with these papers about surgical procedures included Drs. Ratz and Finley at the Department of Dermatology at the Ochsner Clinic and Alton Ochsner Medical Foundation in New Orleans, LA and Drs. Brown, Rosen and Orengo, from the departments of dermatology at Baylor College of Medicine and Veterans Administration Medical Center in Houston Texas. Perhaps contacting one of these doctors for consultation on your father-in-law's case would prove fruitful. In addition, please have him checked carefully as squamous cell carcinoma, a type of skin cancer, can develop in long-standing open wounds. If he has hidradentis in the groin, he also may need to be evaluated by a gastroenterologist as this has been associated with rectal cancer. Good luck!

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