Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
No single treatment works for everyone who has acne. We will create a treatment plan for your specific needs. Because acne has multiple causes, a combination of treatments usually works best. It takes time for acne to improve. Try to be patient and follow your treatment plan for 2 to 3 months to determine if it is working for you.
General recommendations that everyone who has acne should follow include:
If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.
There are several commonly used over-the-counter products that you may have already tried for mild acne symptoms:
Benzoyl peroxide is a topical antibacterial medicine that is very effective in killing the bacteria that cause acne. It can be used on the face, chest, and back. It is commonly used for mild acne and is effective for milder forms of comedonal and inflammatory acne. There are combination products (topical antibiotic and benzoyl peroxide) that may limit the development of antibiotic resistance.
Benzoyl peroxide is available in solutions, creams, gels, and washes ranging from 2.5 to 10 percent concentration. Concentrations greater than 5 percent are no more effective and can increase skin irritation.
Be cautious, as benzoyl peroxide can bleach clothing and hair. Irritation usually appears as redness, dryness, stinging, and peeling of the skin. Some people develop an allergic reaction and cannot use this product, but that is rare.
Salicylic acid is a beta-hydroxy acid that is similar to the chemical found in aspirin (acetyl-salicylic acid). It helps to reduce the stickiness between the cells and the development of whiteheads and blackheads.
If you have oily skin, this medication can penetrate deeper into your pores and oil glands and may be more useful. This medication comes in many forms including washes, creams, and gels. You should not use a concentration higher than 2 percent. Higher concentrations are available for other skin conditions such as warts and psoriasis.
Alpha-hydroxy acids are weak acids obtained from fruits and other plants (glycolic acid from sugarcane) or milk (lactic acid). These work by breaking down the dead cells on your skin and clearing out the blackheads and whiteheads. They are available in concentrations of up to 10 percent.
For mild acne, consisting of mostly whiteheads and blackheads and rare acne pimples that are not responding to over-the-counter medicines, we may prescribe topical retinoids. However, do not use retinoids if you are breastfeeding, pregnant, or planning to get pregnant.
This medication works by unplugging clogged pores and reducing the formation of new whiteheads and blackheads. Sometimes, during the first few weeks of treatment, your acne can get a little worse before it improves. Here are some tips for using retinoids:
It may take 2 to 3 months before you see the benefits of this medication.
The 3 most commonly prescribed topical retinoids are:
Isotretinoin used to be known as Accutane, a brand name that has been discontinued by the manufacturer. Isotretinoin is used for the treatment of severe nodulocystic acne that has not improved with any other treatments. It controls acne by unclogging skin pores and shrinking oil glands. It is made from Vitamin A (a retinoid). Treatment usually lasts for 4 to 6 months.
Isotretinoin has many side effects. The most severe is its ability to cause defects in a developing fetus in pregnant women. Because of its effect on the fetus, this medication cannot be used by pregnant women. To avoid severe side effects such as birth defects and to ensure that all patients are well informed on its usage, the FDA has implemented a program called iPLEDGE.
iPLEDGE has very strict requirements regarding how isotretinoin can be prescribed. We will discuss this program in detail if you are a good candidate for this medication. Other potential side effects of this medication include:
Given the number of risks, treating acne with isotretinoin should not be taken lightly and should include a detailed discussion of each of the side effects.
We may recommend topical antibiotics if you have mild acne that is not responding to over-the-counter medications.
These medicines work by reducing the overall numbers of P. acnes bacteria on your skin. They also reduce inflammation, which plays an important role in acne. Some common types of topical antibiotics include:
We may add oral antibiotics to your acne treatment if your acne:
More effective than topical antibiotics, oral antibiotics also reduce the number of bacteria and treat inflammation. We usually prescribe these for a limited time until your acne can be controlled with topical medication.
The oral antibiotics we commonly use for acne belong to the tetracycline family. They include tetracycline, doxycycline, and minocycline. They are very effective and are usually well tolerated. Except for tetracycline, the other cyclines can be taken with food to reduce stomach upset. Some of these medications may make your skin more sensitive to the sun; use sunscreen on a daily basis if you take them.
Other oral antibiotics we may recommend include erythromycin, trimethoprim/sulfamethoxazole, clindamycin, and penicillins.
Women may notice a flare-up in acne just before their period, and it is likely that hormones are playing a role.
Hormones can increase oil production in acne-prone skin. They may be one cause of your acne if you continue to suffer from moderate to severe acne after your teen years are over, or if you started to develop acne long after adolescence.
If this is the case for you, it does not automatically mean that you have abnormal levels of hormones. Your oil glands may be more sensitive to normal levels of hormones. If so, we may recommend a low-dose birth control pill that has been approved by the FDA to control adult-onset acne. We might also recommend oral antibiotics depending on your specific needs.
Women who have severe acne, irregular menstrual periods, excess hair on their face or body, and hair loss on their scalp may have a hormone disorder known as PCOS.
If you think you might have this disorder, please talk to your personal physician or to us.
Several laser and light devices are being studied for the treatment of acne. They are used to reduce the number of bacteria on the skin, shrink oil glands, and lessen inflammation. They have not been shown to be as beneficial as standard treatments.
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we may discuss your medical and family history and I will examine your skin. Usually, no special tests are needed. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.