Leading up to the wedding day, every bride has some concern over her skin – whether she’s nervous a breakout won’t clear up in time, or has nightmares over a skin surprise the day or week of. We’ve all been there, whether as a bride or not, and had to deal with these not-so-fun issues. Well, battling acne just got a whole lot simpler and less time consuming with the Spruce Health App. It’s basically a dermatologist on your phone. Yes, you read that correctly. You can get a full skincare regime through a virtual appointment with a dermatologist, saving you time and hassle. We decided to try it out, and got set up with Dr. Elan Newman. We presented him with the common problems bride’s go into the dermatologist with leading up to their wedding and he gave us the step-by-step on what to do. After this you will want to try out Spruce, an app to treat acne, for yourself! On hand dermatologists via the app are available in California, New York, Pennsylvania, Florida, Virginia, Rhode Island, Ohio, North Carolina, and many more states coming soon!
A patient comes to you who has had a history of battling acne and wants to have her skin looking its absolute best for a wedding coming up in 6-12 months – what general advice do you give her?
I see this quite often in my clinic. Oftentimes it’s the bride, but other times it’s a relative who will be in the wedding (mother, in-law, etc). The first thing I say is to feel optimistic that together we will be able to clear up her acne. When a patient comes to my clinic with 6-12 months of lead time, we have plenty of time to try different treatment regimens (if needed) to fully control the acne. Time is pretty much the key because there is a date on the horizon (the wedding!) and all acne treatments need time to work — no matter what you use. So getting in sooner to see a dermatologist is best.
A lot of patients come to see me having already tried and failed a lot of OTC treatments. Dermatologists have the ability to use these and many other treatments including antibiotics, retinoids, hormonal treatments, and exfoliating agents that you cannot obtain over-the-counter. In almost every case, we are prescribing a combination of prescription and OTC products to treat acne.
One thing I am noticing is that a good proportion of my female patients come in for treatment not knowing that they have a hormonal acne. There isn’t an over-the-counter medication that can treat this type of acne, so it’s important to see a dermatologist to find a solution. This type of acne takes a couple of months to improve with treatment so the earlier I see a patient, the better chances we have of clearing out her acne before the wedding.
What is a typical treatment?
6 months out is the best time to start an acne regimen with a dermatologist. The earlier we start a treatment, the better since there will be time to see the full impact of a regimen and to also make adjustments, if necessary, well in advance of the wedding date!
I know this is an annoying truth, but acne medications really do typically take 2-3 months to work
The regimen I prescribe will really depend on your own personal medical history, the type of acne you have and what treatments you’ve used in the past.
For example, a female patient with blackheads on the forehead and painful deep pimples on her jawline and around the mouth might have a hormonal component to her acne. This type of acne often worsens with her period (or every month). Oftentimes, she has tried OTC products containing salicylic acid, benzoyl peroxide, or a glycolic acid. These are fine for some patients to use, but not for everyone and they may not fully treat the acne. The best treatment combination is to target the blackheads, the deep pimples, and the underlying hormonal cycles that are triggering the acne. So most patients will need to use 2-4 separate medications.
For blackheads, I like to give a combination of retinoids, cleansers and topical antibiotics/anti-inflammatory medications. I commonly prescribe clindamycin gel, Aczone(™) gel, or a combination product such as Onexton(™). Deciding which product to use will depend on how well it works for the patient and whether it’s tolerated.
Cleanser choice depends on the type of acne and skin type (oily, dry, sensitive).
Retinoids such as Ziana(™), Epiduo (™), and Retin-A(™) or their generic equivalents are also effective.
Treatment for the hormonal component can include oral birth control pills that contain drospirenone as the progestin. Or I may prescribe spironolactone off-label – this is a blood pressure medication with mild hormonal side-effects. In dermatology, we actually take advantage of those mild side-effects as a treatment for the acne. These will take 2-3 months to work, so there is plenty of time to try 1-2 treatments before the wedding.
If necessary, I can even start using isotretinoin (formerly known as Accutane (™)) at this time since most women need to wait 1 month before starting the medication.
Coming back 3 weeks before the wedding and again 1 week before the wedding gives us the best chance of making sure results are sustained through to the big day. In the meantime, all the typical advice around managing stress levels close to the wedding and staying hydrated definitely remains true
What if the bride has her first visit only 3 months out?
I understand that with all the preparations for the wedding, skincare is often only halfway down the list of priorities or some people take a little while to finally decide that they want to leave nothing to chance and seek clinical help
Given medications taking so long to work, this really leaves us only one chance to get the acne under control with a treatment regimen
However, despite time being a bit less on our side, and depending on the type of acne, we can see good results with a combination of oral and topical medications, and sometimes even some simple procedures
Depending on the type of acne, a combination of oral antibiotics (Doryx (™), Acticlate (™), Solodyn (™), or Ampicillin) would be started.
In addition,I will add on a topical antibiotic such as Aczone(™) gel and a retinoid such as Tretinoin. If the acne is mild, then topical therapy might be all that is needed.
There isn’t enough time for hormonal therapy to work at this point, so it’s up to the oral and/or topical antibiotics to do the best they can.
Again, I still advise them to return 3 weeks and 1 week before the wedding date.
What if the bride comes in one week out?
Now we get to one of the most typical dermatologic ‘emergencies’ we see in our practice.
At this point, there is no more time for the usual topical medications or oral antibiotics to work.
Patients are most concerned about inflammatory acne which is reddened, inflamed and can appear raised – a steroid injection into each lesion should resolve them in 2-3 days
The bad news is that for anything that appears 3 days prior or sooner to the wedding, we don’t have any medication-based interventions that will work in such a short timeframe. Hopefully, the pre-work we’ve done helps to avoid that situation but in these cases we’d have to resort to cover-ups, heavier foundation and concealer, as well as digital retouching of photographs.