The Truth About Androgens and Acne

Amy Murphy, PA-C, DSDPA
I see many patients with acne in any given day at the office. Acne is caused by oil production of the skin, bacteria, clogged pores (from overproduction of keratin in the follicles), and inflammation. Sometimes when hormones are off, the skin is more oily and this leads to a break-out. Androgens, a type of hormone, play an important role in causing acne. Often, we will see female patients of child-bearing age with this condition. When checking for further causes of hard to treat zits, we may check for thyroid issues. Stress can additionally affect hormone levels, which can cause more oil production.

So what is an androgen? Androgens are a group of hormones including testosterone and DHEA-S. These hormones cause oil to be produced by the glands in the skin. As the oil increases, the pores become clogged. This process can cause black heads or comedones, the bumps common in acne. The extra oil allows bacteria to grow, creating the redness, swelling and pus-like fluid involved in acne. As oil increases in puberty, so do hormonal levels.

Hormonal acne is often found in those who notice break-outs worsening after their teenage years. Sometimes when common acne treatments fail to work, we consider hormones as playing a part in skin problems.

Another strong sign of hormonal involvement is when acne becomes worse the week before your period. Sometimes hormone levels including free testosterone and DHEA-S will be at the high, but total testosterone and DHEA-S will remain normal.

We might think of acne as hormonal in women if they notice facial hair, irregular periods, changes in voice, increased sex drive, insulin resistance, or hair loss. Inflammatory acne on the lower face and neck is another clue of hormonal factors. A specific type of hormone condition that can involve acne is PCOS (polycystic ovarian syndrome). This disorder can involve acne, cystic ovaries, irregular periods and being overweight.

Usual forms of treating persistent inflammatory acne include antibiotics and isotretinoin. If these types of acne treatments do not improve skin, other medicines such as spironolactone can be helpful in treating hormonal acne. This is an antiandrogen medication. It works by stopping androgens from working in the body before they cause clogged pores. Spironolactone can also stop testosterone from becoming active, which can help decrease break-outs. In the end, this medicine can decrease oil production by about 30 to 50 percent. It is not for women who are pregnant or trying to become pregnant. It takes three to six months to tell if it is working well.

Oral birth control pills are also commonly prescribed to treat hormonal acne. Oral contraceptives that have estrogen and progestin may reduce androgens. If someone is already taking oral birth control pills, hormonal issues can be masked. This is in part because estrogens can decrease acne.

Men can also experience hormonal imbalances. Symptoms for men may include patterned baldness and acne, among other signs.

Lytic Sport Tx
We offer several products that target hormonal acne specifically. Epionce, a botanical skin care line, offers Lytic Plus Tx. This product works to help clear pores and improve skin texture. Lytic Plus Tx is a treatment product that helps reduce symptoms and inflammatory factors of acne, among other skin issues. Patients enjoy implementing this into their daily regimen morning and night after washing their face. It also helps reduce redness, irritation, and oil production. Some of the key ingredients include salicylic acid 2.95%, azelaic acid and willow bark extract, among others.

DIM pure

DIM (diindolylmethane) supplement is a natural, organic compound that promotes healthy estrogen metabolism in men and women. It is a phytonutrient and antioxidant found naturally in small amounts in cruciferous vegetables such as broccoli, cauliflower, cabbage and Brussels sprouts. This supplement helps the body break down estrogen into helpful substances and encourage healthy levels of hormones.

Lastly, when considering diet, it is important to eat dairy in moderation when you are trying to improve your complexion. Also, studies have shown that sugars such as those in high glycemic foods including bananas, melons, and other simple carbohydrates, can worsen acne. Therefore, watching your sugar intake can be worthwhile if combating break-outs.

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Collagen Regeneration at Home? Not too good to be true

Kingslea Moore, DNP, FNP-C

      Collagen loss is natural over time with the skin the aging process caused by chronological and environmental aging, neither of which we can control. Environmental factors that decrease collagen are heat damage, free radical damage, and visible light spectrum. These factors contribute to visible signs of aging, including a loss of skin’s radiance and firmness, as well as wrinkles, laxity, and pigmentation. Tools that prevent and correct the appearance of aging skin include sunscreen, antioxidant serums, diet, fillers, and laser procedures to stimulate collagen. Food choices that have a positive and nourishing effect on collagen include omega 3 fatty acids, plant proteins, calcium, vitamin C,  and vitamin D! It is also important to avoid collagen killers, such as smoking, sun exposure, spikes in blood sugar, poor nutrition, stress, and inadequate hydration.

      A fun new addition to our product voices for anti-aging is laser procedures. In previous blogs we have discussed collagen building benefits of laser resurfacing, which are huge! If you have made the investment in your skin for a laser procedure, an at home collagen stimulating laser may be the next step in order to protect from further damage. Or if you’re not ready for a laser procedure in the office, then an at home laser may be just the thing for you! SkinCeuticals introduced their TRIA at home laser system. The system incorporates active ingredients that reduce the appearance of hyperpigmentation, and stimulate the skin’s production of collagen.



 Daily clinical regimen to promote advanced skin correction including the only at-home laser FDA-cleared for use on the entire face and clinically proven to treat multiple signs of aging. Proven at home laser results combined with synergistic post-laser antioxidants. Laser light generates new collagen for a smoother, more youthful complexion. Tria age defying laser also enhances penetration of topical antioxidants

Step One


Skinceuticals Tria Age-Defying Laser + Antioxidant System is FDA Cleared non- ablative fractional laser device. It is used to treat signs of aging and has been clinically proven to be effective and safe. This product will help smooth out fine lines and wrinkles.

95% of users saw an improvement in overall appearance
94% of users showed significant improvement in the smoothness of their skin
82%  of users demonstrated significant improvement in wrinkles around their eyes




Step TwoSkinCeuticals

Ce Ferulic 1 oz – High Potency Antioxidant, special blend of 15% Vitamin C, 1% Viamin E and .5% Ferulic Acid. Protects against environment and has anti- aging correction.

Step Three

Resveratrol BE 1 oz – Boosts skin’s own antioxidant defenses. Will increase skin’s density and help skin glow.

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Tips and Tricks to Combating Itchy, Dry Skin

hands with waterThe colder, dryer months of the year can leave us itchy and dry at times, and even bring out a skin issue that was already present. There are so many different causes of rashes, and some of these causes may be the least expected.
Soap is a frequent cause of irritating skin on the hands. The distribution of a rash will give us clues as to its culprit. When suspecting soap as the cause of hand irritation, we will check the backs of the hands and web spaces of the fingers for involvement. If just one’s palms are affected, we will look for different answers than soap as the cause.

Other questions we often ask patients when they have rashes on their hands include considering their work environment. Such questions might be asked as: do you wear gloves at work? Are you washing your hands before you put the pair of gloves on? How frequently are you changing the glove? Working with odd chemicals at work can leave us further suspicious that the work environment is playing a role in the rash.

A trick that we like to share with our patients is considering using an alcohol-free hand sanitizer. If one already has irritant hand dermatitis, applying an alcohol-based hand sanitizer is comparable to putting salt on a wound. For cracked, dry hands, Gold Bond Hand Sanitizer is a great alcohol-free option. When avoiding soap to heal irritated hands, replace hand washing with hand sanitizer when possible.

Using a hand sanitizer five times for every one hand wash should definitely show improvement in dry, inflamed hands. We recommend EO Hand Sanitizer found at health food stores to our patients for a great everyday option.

Go for soaps that are gentler when washing hands. Choose Cetaphil bar, Aveeno, Neutrogena bar, among others. In the end, decreasing frequency of hand washing along with avoiding dish soap for hand washing will be helpful. Dish soap is designed to clean chemicals and is therefore too harsh for routine hand washing. Further treatments of irritated hands include soaking them for twenty minutes, applying ointments, and wearing cotton gloves overnight. Wal-Mart, Lowes and Home Depot sell brown jersey gloves that can be used for this purpose. We carry Vanicream at our office as a healing moisturizer for especially dry skin. A great hand cream is CeraVe Therapeutic Hand Cream. If these measures do not do the trick, there is further medical management we can offer.

What if just the fingertips of the hands are affected? Frequently, this distribution of hand irritation is found on the dominant hand and affects the middle finger, index finger and thumb. Such dermatitis can be related to writing. This rash would not itch. In those that handle packages every day, this may be the cause of such a rash. Golf gloves are another common cause of this type of hand irritation.

If one has frequently sweaty hands, this can be another factor to consider with hand irritation. This cause may present as blisters that come and go with itching. If blisters on the hands are always present, it might be time to check for allergies including nickel allergy. Other times, we may see bacteria or fungus contributing to rashes on the hands.

Moving on to the eyelids, there are innumerable causes of eyelid irritation. Some causes include an allergic reaction, a product irritating the skin specifically, psoriasis, dandruff, and eczema, among others. If a rash spreads outside of the eyelids, we may check your shampoos and face soap as causes of an allergic response. If the rash is only on one eyelid, we may check if there is something on your hands that is coming in contact with your eyelids that is causing the irritation. Since nail products can often cause skin issues, consider Revlon Nail Enamels as a safe alternative to irritating nail polish.

Otherwise, mascara is one of the most likely causes of eyelid rashes. Mascara, along with other volatile solvents can be problematic in this area. We offer several therapeutic measures when seeing patients with eyelid dermatitis. Important measures to be done at home include stopping the irritants and washing your face with a gentle cleanser (such as Cetaphil or CeraVe) after shampooing. Sarna Sensitive is a calming lotion sold over the counter. CeraVe or EpiCeram cream are other calming options to apply to irritated skin on the eyelids. Remember to wash eyelids very well after washing the face when suffering from irritation.

Another common location for irritated skin can be under a ring on a finger. Women’s rings have concavities that can allow water and soap to get trapped beneath. Furthermore if wearing two rings together, this provides more space for trapped irritants. Jewelers can adjust rings to close off the concavities beneath them and offer soldering to bring multiple rings together as one.

Rashes on the face have their own patterns to pay attention to for clues of causes. If a rash of the face is in the central face only, we may worry about what moisturizers and makeup a patient is using. Even jewelry can play a role in rashes on the face. Titanium dioxide, found in mineral-based sunscreens, can release gold in jewelry, a common allergen that can be underestimated.

However, if the rash is located on the sides of the face, think about your rinse off pattern when washing. Perhaps soap or shampoo is the cause in this scenario. A good shampoo to try when needing to stop irritation is California Baby Supersensitive Shampoo and Body Wash. Free and Clear is another brand we often have patients switch to with allergic prone skin.

In regards to a rash on the neck, consider perfume as a possible culprit. Sometimes discontinuing use of all perfumes until a rash on the neck clears is a good first step. Rashes on the sides on the neck can once again point back to the rinse off pattern of shampoo.

A toothpaste allergy is a potential cause when irritation shows up on the lower lip or chin. Tom’s Toothpaste at whole foods stores is a good allergen-free alternative.

When considering any rash, remember that there are a lot of chemicals in modern day life. Even if it is a product that you have used for years, it can still be the cause of your current rash. Unfortunately cumulative exposure can lead to cumulative toxicity at times. There is always patch testing for allergies if other treatments of a rash are not working.

Amy Murphy, PA-C

Reference: The SDPA Conference in San Diego, CA 2014 with Matthew Zirwas, MD 

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Glow and Go: Behind the Scenes, Behind the Science

To tan or no to tan?!

Exclusive offer to our clients, the January Glow and Go Package will set the tone for a vibrant year! The package includes an IPL laser treatment, Medical Chemical Peel, and C&E Ferulic Antioxidant Serum.

SkinCeuticals Micropeel®

is non-invasive and superficial. It utilizes exfoliation and medical grade solutions to maximize skin rejuvenating effects with minimal downtime. Your skin will have a radiant glow. It improves clarity, color and texture. This is a great first time chemical peel for patients looking for a gentle, superficial peel.


Having fun while learning! Amy Murphy, our Physician Assistant receives IPL treatment by Kingslea Moore, Nurse Practitioner


IPL Photofacial

or photorejuvenation simultaneously treats a range of facial concerns safely and effectively without disruption of the skin’s surface. Intense Pulsed Light technology is a treatment breakthrough that can improve a variety of skin conditions such as photo-aging, brown pigmented spots, and small broken facial veins. The damaged skin responds to the Intense Pulsed Light. The light is changed to heat energy as it reaches the collagen beneath the skin’s surface providing superior cosmetic results. Your skin will appear smoother with a reduction of pigmented areas. The result is brighter skin!


Protect your investment with SkinCeuticals’ C E Ferulic®.

This serum is an antioxidant combination that delivers advanced environmental protection against photoaging by neutralizing free radicals that cause accelerated signs of aging. It provides advanced environmental protection against damaging free radicals induced by UVA, UVB, and infrared radiation A effectively increasing sun protection and skin cell turnover 8 fold while protecting collagen! C E Ferulic® increases firmness and replenishes lipids to visibly reduce wrinkles. Once absorbed, this serum can’t be washed or rubbed off.

The well paired package of three retails for $770 and for the month of January we are offering this unique package for $550. A huge Savings!

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Looking to Shed Pounds in the New Year?

Amy Murphy, PA-C

HCG blog photo


We are excited to bring the hCG Diet to the table and offer a safe and effective way for our patients to meet their New Year’s resolution.


How does it work?

HCG (human chorionic gonadotropin) is a hormone that occurs naturally in both men and women, and it is abundantly present during pregnancy to support healthy cell development. Supplementing this hormone stimulates your metabolism and burns fat! HCG works with your body to pull the calories from the stubborn fat area in your body (aka, belly fat) preserving your muscles. Ideally, your total percentage body fat will decrease, leaving you leaner and more toned. You should not be hungry after the first week of the diet as the hormone suppresses hunger. On average, a female can expect to lose about half to 3/4’s a pound per day and a man can lose about a pound a day.


Dr. Simeon invented this diet in the 1950s when it was discovered that hCG mobilizes your fat stores. The traditional Simeon’s Protocol involves using injectable hCG with a 500-calorie daily plan. Our practice offers this protocol as well as two others, so that we can customize the plan to meet each person’s desired weight loss and life style needs. The modified plans use hCG sublingually (dissolved beneath the tongue). The length of the diet can be either 26 days or 43. The 43-day option works better for those who want to lose more weight, because the longer you stay on the program, the more you will lose. It’s important to strategically select a period of time in which you know that you will have fewer temptations so that you can be successful on the plan. Next, you’ll choose a meal plan of either 500, 800 or 1000 calories per day. The 500-calorie meal plan involves skipping breakfast and is the strictest, good for losing the most weight. We often recommend that men choose either the 800 or 1000 plans because men have greater calorie needs than women. In the 500-calorie scenario, you cannot exercise, as there is no energy reserve to exert. The other diet variations call for only light exercise such as light walking or deep breathing.


There are four phases of the diet. Phase One is optional and considered a detox. During two to three weeks before starting the hCG, this is a period when you can start eliminating sodas and fast foods to ensure optimal success when the diet starts. Phase Two is the diet. This is when you start taking the hCG hormone. The first two days are gorge days in which you should eat as many healthy fatty foods as you’d like while taking the hormone. Carbs are OK to eat during these 2 days as you are priming the body. Good options are avocadoes, almonds, coconut oil, and grass-fed beef. This is not a time to eat fast food, but to eat well so that your body will have some carbs to work with once the diet truly gets going. Day three is when the calorie counting and true diet starts. Phase Three is the end of the 26-43 day diet in which you are off of the hormone. You continue the diet for three more days while the hCG remains in your system. Then you continue calorie counting for a minimum of three weeks. Females will go up to 1200 calories at this stage. The key at this phase is to stabilize your new weight point and avoid sugars and starches. If one were to have a free-for-all and skip this phase, you would not only gain weight back, but you are likely to feel sick as your body has not had a chance to adjust to the different foods. Phase Four is the return to “normal eating.” You will slowly add sugars and starches back for the next 3 weeks, continuing healthy habits, small portions, and being mindful of what you’ve learned. Phase 2 can be repeated if you need to lose additional weight.


Which foods are approved on the diet?


There are several protein options during this diet. Leaner meats are best, including veal, chicken, turkey, and fish. Salmon, unfortunately cannot be eaten on the diet due to it’s high fat content. There are specific ingredients that can be added to foods for flavor including Bragg’s Liquid Aminos and Nutritional Flakes, among other options. No butter or oil can be added to foods at any time while on the diet. Grilling foods is highly recommended to enhance flavor without the added fats. This diet is strict in that one vegetable should be eaten each meal, and it should be different from the others eaten that day. No omega supplements such as fish oil are allowed. One must also avoid petrolatum and lanolin in skin care products since the skin will suck the oil out of even skin care products during the program.


Who’s a good candidate for the diet?


We want to make sure you have success if you choose to take the challenge of losing weight with the hCG diet. Sleeping about eight hours each night with uninterrupted sleep is crucial. Due to the low calorie meal plan, there will not be much energy on reserves, so we want you feeling your best before starting the diet. We will want you to rank your energy level between 1-10, 10 being fully energized. This will be a good assessment in determining if the diet is right for you. Any other symptoms such as fatigue, depression, hair loss, should be addressed ahead of time to further guarantee success. Some basic blood work may be necessary for this reason.


Who is NOT a good candidate?


Vegetarians and vegans will find the food options somewhat restrictive, but protein powder (we recommend Sun Warrior Protein) and egg whites are some of the few protein options. Struggling with other symptoms such as low energy, depression, or other health issues may mean now is not the best time for this diet, but perhaps a plan can be set in place to undergo the diet later. Gallbladder issues may also mean this diet is not for you.

If you are one who cannot skip a day at the gym, you may find the hCG diet to be restrictive because, on the diet protocol, you will be encouraged to do minimal exercise at most. It is a unique effect of the hCG hormone, however, that you will maintain your muscle tone and mass while on hCG, even without exercise.


What do I need to get ready for the diet?


You will keep a food journal, writing everything you eat while on the program. We would like you to also have a food scale at home, since caloric count goes off of weight in food. You’ll want a reliable scale at home to record you weight from daily. Calorie counter apps and websites will be helpful, as you will count calories while taking the hCG. Some people like using a Fit Bit or other convenient way to track calories.

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