Dr. Alexandra Bowles expands upon her insights on scalp acne from her recent First For Women feature: How to Get Rid of Scalp Acne According to Top Dermatologists.

What is scalp acne?

Scalp acne is an informal term used to describe small pimples or bumps that appear on the scalp. In some cases, this is not technically true acne. Scalp acne, also known as scalp folliculitis, is a condition characterized by small, inflamed bumps on the scalp. These bumps often look similar to acne lesions on the face and body. Folliculitis is typically caused by inflammation or infection of the hair follicles. This is due to factors such as excess oil production, bacteria, yeast, or other irritants. 

Scalp acne can be relatively common in both men and women, but several factors contribute to its development in women. Hormonal fluctuations, stress, certain medications, hair care products, and underlying skin conditions can cause scalp acne in women. Additionally, women may be more prone to hormonal fluctuations due to menstrual cycles, pregnancy, or menopause. These hormonal fluctuations could potentially influence the frequency and severity of scalp acne outbreaks.

What is folliculitis?

Folliculitis is an inflammation or infection of the hair follicles. It typically appears as small red or white bumps surrounded by redness. It sometimes also forms with a central area containing purulent fluid. In more severe cases, folliculitis can lead to larger, painful lesions or cysts. While sunburn itself doesn’t typically cause folliculitis directly, sunburned skin can be more vulnerable to infection and may contribute to the development of folliculitis. Similarly, excessive sweating can create a warm, moist environment that promotes bacterial or fungal growth, increasing the risk of folliculitis in affected areas.

What exactly is dandruff? 

Seborrheic dermatitis, more commonly known as “dandruff,” is a common scalp condition characterized by flaking of the skin on the scalp. It typically appears as a formation of visible white or yellowish flakes. Dandruff can be caused by Malassezia fungus. This fungus is naturally present on the scalp and feeds on the oils produced by hair follicles. An overgrowth of Malassezia can lead to irritation and inflammation of the scalp, resulting in greasy yellow or white scales. These scales are what we commonly refer to as dandruff. Dandruff is not a form of acne. 

Inflammation of the hair follicles does not typically cause dandruff. Instead, scalp flaking is the primary cause. Wearing hats can potentially worsen dandruff in some cases. Tight-fitting hats or helmets can trap heat and moisture against the scalp, creating an environment that is conducive to the growth of Malassezia fungus. 

What is acne mechanica?

Acne mechanica is a form of acne that is caused by friction, pressure, or heat against the skin. It typically occurs in areas where there is repeated physical contact or irritation, such as the face, shoulders, or back. Acne mechanica is not usually caused by the same factors as traditional acne (such as excess oil production and bacteria), but rather by external factors that disrupt the skin barrier and lead to inflammation. Acne mechanica can appear as small, red bumps, pustules, or papules on the skin. It may resemble traditional acne, but it arises primarily from physical irritation rather than hormonal imbalances or bacterial presence on the skin. Tight clothing, backpack straps, sports gear, and other sources of friction or pressure on the skin are typical triggers for this condition.

How common is scalp skin cancer caused by the sun? 

Skin cancer of the scalp caused by sun exposure is relatively common, particularly in individuals with fair skin or a history of extensive sun exposure. The most common type of skin cancers affecting the scalp are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). While melanoma can develop on the scalp, it’s not as prevalent as non-melanoma skin cancers such as BCC and SCC in this area. Areas exposed to the sun like the face, neck, arms and legs are commonly associated with melanoma. However, it can occur anywhere on the body, including the scalp.When melanoma develops on the scalp, it may present as an irregularly shaped mole or lesion that is asymmetrical, has uneven borders, exhibits various colors, and may change in size or appearance over time. It’s very important to protect your scalp from the sun whether that is with sunscreen or wearing hats.

Dr. Mona Foad expands upon her insights shared in her recent Very Well Health feature, The 6 Best Wart Treatments.

What are warts and why do people get them? 

Warts, or verruca, are small, grainy, bump-like growths that develop on the skin. They are especially common in areas like the hands and feet.  Warts are caused by strains of the human papillomavirus (HPV). There are many different types of warts, including common warts, flat warts, plantar warts, filiform warts, and genital warts. All types of warts can vary in appearance and location.

• Common warts usually grow on the hands, fingers, and around the nails.
• Flat warts typically develop on the face, arms, or legs and are generally smaller and smoother.
• Plantar warts grow on the soles of the feet. These can be very painful while walking or standing.
• Filiform warts often appear on eyelids, lips, face, or neck.
• Genital warts are typically sexually transmitted and grow on and around the genital and anal areas.

Warts are transmitted through direct contact with the virus. This can occur through skin-to-skin contact with a person who has warts or by coming in contact with surfaces or objects that the virus has infected. Warts tend to be more prevalent among children and teenagers because their immune systems are still developing and, therefore, not strong enough to combat the virus. Additionally, some people are more susceptible to the virus because their genetic makeup and immune system are not as equipped to fight the virus when they come in contact with it. For example, it’s quite common to see warts on multiple siblings in the same family or children of parents who had warts as children.

Over-the-counter wart removal options 

Two of the most recommended over-the-counter wart removal options include products with Salicylic Acid and Cryotherapy (freezing) products. Salicylic acid products come in a range of formulations, including liquids, gels, pads, and plasters, each designed to gradually dissolve the wart tissue. A popular OTC salicylic acid treatment that I like to recommend is either Compound W® One Step Pads or  Dr. Scholl’s ClearAway Wart Remover.  Both of these have salicylic acid in an easy-to-apply bandage and can be effective, non-painful ways to decrease the size and potentially remove warts.  

OTC freezing products usually come in the form of a spray. By spraying the product directly onto the warts, the tissue is frozen and killed. These products commonly contain dimethyl ether or propane. These cold substances freeze the wart, causing it to turn into a blister, and ultimately fall off. For these types of products, I like to recommend Compound W Freeze Off or Dr. Scholl’s Freeze Away.  Although this can be an effective way to remove smaller warts, it can be a more painful process than the salicylic acid options and generally does not work on larger warts or plantar warts, which go deeper into the skin.

In-office wart removal options 

There are also in-office and prescription treatments for warts that might be more resistant or difficult to treat with OTC products. The most common treatment used by most dermatologists is cryotherapy, or freezing therapy, which involves using liquid nitrogen to freeze the wart. The liquid nitrogen used in an office setting is more effective than the OTC freezing options. Only a trained professional should use liquid nitrogen. With this treatment, the wart will blister and eventually fall off.

Another in-office procedure that we use to treat small warts is electrosurgery. We place a thin, needle-like tip on the wart that burns and kills the skin cells. Lasers can also be an effective way to treat warts.  A pulse dye laser, such as a VBeam, uses a specific wavelength to target and shut off the blood supply that feeds the wart. The treated wart turns purple or black and falls off.

We can also use injections for stubborn and hard-to-treat warts. These can include 5-fluorouracil, bleomycin, and candida. Only a trained professional should perform these injections to minimize damage to the surrounding tissue. Although we can surgically cut out warts, this is not an effective treatment because they tend to recur at the edge of the excision site.  Any method, no matter whether at home or in the office, may require several treatments to effectively remove the wart.  

What products/ingredients are most effective at removing warts at home?

Over-the-counter (OTC) wart removal products usually include salicylic acid or freezing agents (cryotherapy) as the main ingredient. Most wart treatments focus on removing the top layers of skin where the warts reside. Warts and plantar warts are commonly treated with salicylic acid. It is slowly absorbed into the skin and causes the skin cells that contain the wart to shed and peel off. By softening the hardened skin of the wart, salicylic acid products effectively destroy the wart without causing significant damage to the surrounding skin. OTC salicylic acid products range in strength from 17% to 40% and can come in the forms of liquids, gels, and pads 

Freezing agents, such as dimethyl ether, isobutane, or propane, work by quickly freezing and destroying both the wart tissue and a small area of normal skin around the wart, causing it to dry out and eventually fall off. These products can be effective in treating common warts. However, it is necessary to perform several treatments to remove the wart entirely.  Plantar warts, on the other hand, go deeper into the skin of the foot and are harder to treat. For this reason, freezing agents may not be as successful on plantar warts.

Dr. Mona Foad expands upon the insights she shared in her recent Woman’s World feature: How To Get Rid of Adult Acne, Plus Doctors Pinpoint Why Women Over 40 Deal with Breakouts

What causes skin to be acne-prone?

A combination of genetic, hormonal, and environmental factors can cause acne-prone skin. One factor is excess sebum production by the sebaceous glands in the skin, which can clog pores. Hormonal changes, particularly androgens, can also increase sebum production. This is why acne is common during puberty, menstruation, pregnancy, and in conditions like polycystic ovary syndrome (PCOS). Another factor is clogged pores, whereby dead skin cells that do not shed properly can mix with sebum and clog hair follicles, forming comedones (whiteheads and blackheads). Bacterial growth in clogged pores and inflammation caused by this bacterium in the pores also play a crucial role in acne development, leading to redness, swelling, and pus. 

Additionally,  genetics can determine how much sebum your skin produces, how your skin cells shed, and your body’s inflammatory response, all of which can make you more prone to acne. Some studies also suggest that diets high in refined sugars and dairy products may exacerbate acne. Stress is another factor that can cause acne since it increases hormone levels that stimulate sebum production. Frequent touching of the face, wearing tight clothing, or using items like helmets and backpacks can cause further friction and pressure on the skin, leading to acne mechanica.

What is a good skin care regimen for someone with acne-prone skin?

A good skincare regimen for someone with acne-prone skin should focus on keeping the skin clean, reducing excess oil, and minimizing pore blockage without causing irritation. I always recommend a morning and evening skincare routine for my patients.

For a morning routine, start by using a gentle, non-comedogenic cleanser such as La Roche-Posay Effaclar Gel Facial Wash to remove excess oil and impurities. Using a toner is optional, but if you choose to do so, opt for one that is alcohol-free and contains soothing ingredients like witch hazel or glycolic acid to help exfoliate and remove any leftover impurities.

Next, apply a serum with active ingredients like salicylic acid, niacinamide, or tea tree oil to target acne. Niacinamide can also help reduce inflammation and control oil production. I like to recommend SkinCeuticals Silymarin CF to my patients. Use a lightweight, non-comedogenic moisturizer to hydrate the skin without clogging pores. Elta MD Moisture Seal is a moisturizer I typically recommend to my patients. Finally, apply a broad-spectrum sunscreen with at least SPF 30. Sunscreen is crucial to protect the skin from UV damage, which can worsen acne and cause hyperpigmentation. EltaMD UV Facial SPF 30+ Dry is a great sunscreen product I highly recommend. 

For an evening routine, start with cleansing the skin to remove makeup, sunscreen, and daily grime. Next, apply targeted acne treatments that can be stronger, like retinoids, which can promote cell turnover and prevent clogged pores. Finally, make sure to use a non-comedogenic moisturizer (same as your morning routine) to keep the skin hydrated. It’s essential even for oily skin to maintain the moisture barrier.

What ingredients should they look for?

Certain ingredients can help manage and prevent breakouts for acne-prone skin while keeping the skin balanced and healthy. Some ingredients to look for include salicylic acid, a beta hydroxy acid (BHA)  that penetrates pores to exfoliate and reduce sebum production, and glycolic acid, an alpha hydroxy acid (AHA) that exfoliates the skin’s surface to remove dead skin cells. For serums, look for niacinamide to reduce inflammation, retinoids to promote cell turnover, unclog pores, and reduce the appearance of acne and fine lines, and zinc to help control sebum production.

When it comes to moisturizers, look for hyaluronic acid to hydrate the skin without clogging pores, ceramides to restore and maintain the skin barrier, and aloe vera to soothe and hydrate the skin. For sunscreens, opt for non-comedogenic formulations specifically designed not to clog pores, as well as mineral sunscreens with zinc oxide and titanium dioxide that provide broad-spectrum protection with less risk of irritation. If you like to use mask treatments, look for products that include charcoal to draw out impurities and help detoxify the skin and clay, which helps to absorb excess oil and unclog pores. 

What ingredients should they avoid?

Avoiding certain ingredients that can exacerbate breakouts or cause irritation is crucial for someone with acne-prone skin. Avoid comedogenic ingredients like heavy oils and butters, waxes, and silicones that clog pores and contribute to acne formation. Additionally, steer clear of irritating ingredients such as alcohol and both synthetic and natural fragrances. You’ll also want to avoid harsh exfoliants like apricot and walnut shell powder. All of these ingredients can cause inflammation, irritation, and worsen acne. 

Product recommendations for acne-prone skin

For acne-prone skin, using products that help keep the skin clear without causing further irritation or breakouts is essential. The cleanser I typically recommend is the La Roche-Posay Effaclar Medicated Gel Cleanser. I like that it contains 2% salicylic acid to target acne and clear pores. For a serum, I like La Roche-Posay Effaclar Serum. For a moisturizer, CeraVe PM Facial Moisturizing Lotion is a non-comedogenic, oil-free moisturizer with niacinamide and hyaluronic acid. These ingredients will help to control oil. EltaMD UV Clear Broad-Spectrum SPF 46 is a lightweight sunscreen that protects against UVA and UVB rays. It is also formulated with niacinamide to help calm the skin. Differin Gel is an over-the-counter retinoid that helps prevent and treat acne by promoting cell turnover.

Dr. Mona Foad expands upon the insights she shared in her recent Cosmopolitan feature: The Best Acne Light Therapy Devices Are Worth Adding to Your Routine, Stat

What is light therapy?

LED light therapy is also known as light-emitting diode therapy. This is a non-invasive skincare treatment that uses specific wavelengths of light to stimulate various cellular processes in the skin. It’s a popular treatment because it can help decrease inflammation in the skin. It can also treat a variety of skin conditions, including acne, fine lines, and eczema.

LED light therapy is a versatile treatment, with different colors of light offering a range of benefits for the skin. For instance, red light stimulates collagen production, reducing wrinkles and enhancing skin texture. It also aids in controlling inflammation and promoting wound healing. Blue light, on the other hand, targets acne-causing bacteria, effectively reducing breakouts. It’s a popular choice for mild to moderate acne treatment. Green light works to even out pigmentation and enhance skin tone while also providing a soothing effect. Lastly, yellow light promotes lymphatic flow, improving overall skin health and reducing redness and irritation.

What light kills acne bacteria?

Blue light therapy is the type of light commonly used to kill acne-causing bacteria. Specific wavelengths of blue light, typically in the range of 405 to 420 nanometers, are used to target and destroy the bacteria known as Propionibacterium acnes (P. acnes), which is a major contributor to acne.

Blue light therapy penetrates the skin and reaches the sebaceous glands where P. acnes bacteria reside. When exposed to blue light, the bacteria produce molecules called porphyrins, which then generate free radicals that ultimately destroy the bacteria. This process helps reduce inflammation and prevent new acne breakouts from forming.

Blue light therapy is often used as a non-invasive and drug-free treatment option for mild to moderate cases of acne. It can be administered on its own or in combination with other acne treatments. Depending on the severity of your acne and other individual factors, your provider may recommend other acne treatments. These can include over-the-counter skin care, prescription topical medications, oral antibiotics, birth control pills or isotretinoin.

Dr. Mona’s favorite devices  

When recommending LED devices to patients, I take into consideration individual preferences, skin types, and specific needs. Belowa are some of the more notable options I like to recommend to my patients:

• LightStim for Acne LED Light Therapy Device uses blue light to destroy acne-causing bacteria, and red light reduces redness to help soothe and calm the skin. LightStim has advanced NASA’s LED technology to simultaneously emit multiple wavelengths (colors) of light that work together to help clear existing breakouts and give your skin a more radiant and clear complexion. This device is great for adults and teenagers and is maintenance-free with no cartridges, LEDs or battery replacement costs.
  • For an even more effective treatment, we offer the LightStim Professional LED Treatment here in our office!
• The Neutrogena Light Therapy Acne Mask is an over-the-counter mask that uses blue light to target acne-causing bacteria and red light to reduce inflammation. It’s a convenient and accessible option for at-home use and is suitable for mild to moderate acne.
• Foreo ESPADA is a handheld device that emits blue light and low-frequency pulsations to target acne bacteria and stimulate faster healing, thereby promoting clearer skin. It’s portable, rechargeable, and suitable for treating individual acne spots. This device uses a smart skin sensor that only turns on the blue light when it is in contact with your skin. I like this feature because it protects your eyes from any harmful LED light exposure.
• Dr. Dennis Gross DRx SpectraLite FaceWare Pro is a wearable LED mask that combines red and blue light therapy. By offering both light options, this device can target acne and promote skin healing. It’s designed to be worn for just a few minutes daily and is suitable for all skin types.
• The Environ Omnilux Contour FACE  is also a handheld LED device that emits blue and red light therapy for acne treatment. It’s portable, easy to use, and suitable for spot treatments or larger areas of the face and body.

How to choose the best acne light therapy device for you? 

Choosing the best acne light therapy device involves considering several factors to ensure it meets your specific needs and preferences.

Determine Light Type

First, determine whether you prefer blue light therapy, red light therapy, or a combination of both.

• Blue light targets acne-causing bacteria
• Red light reduces inflammation and promotes healing.

Some devices offer both types of light for comprehensive acne treatment. If possible, I would recommend getting a device that has both red and blue light to target both the acne and the inflammation that can cause hyperpigmentation.

Determine Design That’s Right For You

Consider the size and design of the device and whether it’s suitable for treating the areas of your skin affected by acne. Some devices are designed for spot treatments, while others cover larger areas like the entire face or back.

Next, check the intensity and wavelength of the light emitted by the device. Higher intensity and specific wavelengths are often more effective but may also increase the risk of side effects. Look for devices with adjustable settings to customize treatment intensity according to your skin’s sensitivity and the severity of your acne. 

Determine Desired Features

Additionally, opt for a user-friendly and convenient device to incorporate into your skincare routine. Consider factors such as portability, ease of setup, and whether the device is rechargeable or requires disposable batteries. To guarantee its safety and effectiveness, ensure that the device is FDA-cleared or CE-marked for acne treatment. Avoid purchasing unregulated or uncertified devices, as they may not provide reliable results and could pose risks to your skin. Make sure to research customer reviews and recommendations from reputable sources to learn about the experiences of other users with the device. Look for feedback on effectiveness, ease of use, durability, and customer service. Finally, compare the prices of different devices and consider the overall value they offer in terms of features, effectiveness, and long-term benefits. While investing in a high-quality device may require a larger upfront cost, it can provide better results and durability over time.

Ensure Eye Protection

It is very important to protect your eyes while using an LED treatment. If used incorrectly, LED light therapy has been shown to damage your eyes. At-home use can be safe if you follow the appropriate guidelines. Make sure to use a high-quality, reputable device that meets all safety standards, and be sure to read and follow the instructions and guidelines included. Some devices, as mentioned, only turn on when in contact with your skin, some are made to be used around the eyes with a lower intensity of light and have built-in safety features, while others may require eye protection. Make sure to research the right device for you.

Dr. Alexandra Bowles expands upon her insights on nail-strengthening habits from her recent Body Network feature: Nail Strengthening Habits for Thicker, Longer Nails

When it comes to strengthening your nails, incorporating certain habits into your routine can promote stronger, thicker nails and encourage healthy nail growth over time. Dr. Bowles shares 9 nail strengthening habits to incorporate into your routine. 

Maintain a Balanced Diet

For one, it’s important to maintain a balanced diet that includes essential nutrients such as protein, biotin, vitamins (particularly C and E), and minerals like iron and zinc, which are important for nail health.

Hydrate

Stay hydrated by drinking plenty of water to keep your nails hydrated and prevent them from becoming brittle.

Wear Gloves

Protect your nails by wearing gloves when doing household chores or working with harsh chemicals to prevent damage and breakage to your nails.

Avoid Acetone

Avoid harsh chemicals by limiting exposure to nail polish removers containing acetone, as it can dry out and weaken your nails. Opt for acetone-free formulas instead.

Moisturize with Hand Cream

Moisturize regularly by applying a moisturizing hand cream or nail oil to your nails and cuticles daily to keep them hydrated and prevent them from becoming dry and brittle. 

File Nails Carefully

Use a gentle nail file to shape your nails, avoiding harsh filing motions that can cause damage and weaken the nails. 

Take a Break From Nail Polish

Limit Nail Polish use by occasionally giving your nails a break from nail polish to allow them to breathe and recover. When using nail polish, opt for formulas free of harsh chemicals like formaldehyde, toluene, and dibutyl phthalate (DBP). 

Be Gentle with Your Nails

Be gentle with your nails by avoiding using them as tools for tasks like opening packages or scratching surfaces, as this can cause them to break or become damaged. 

Protect Them From Trauma

Protect your nails from trauma by being mindful of activities that can cause trauma to your nails, such as biting or picking at them or wearing acrylic tips, which can weaken and damage the nail structure.