My Doctor Online The Permanente Medical Group

Symptoms

The symptoms of acne can be mild to severe, and they include:

• Pimples, pus bumps, whiteheads, blackheads, and cysts
• Discoloration of the skin 
• Pain
• Swelling
• Scarring

Severe acne can also lead to other problems. It may affect your emotional well-being, causing depression, embarrassment, or lowered self-esteem. These negative feelings can discourage you from interacting socially, on the job, or at school.

Diagnosis

We can usually diagnose acne by looking at your skin. In most cases, no additional testing is needed.

In rare cases, there are problems with hormone levels that may be linked to a condition called polycystic ovary syndrome, or PCOS. If you are a woman with moderate to severe acne, irregular menstrual periods, and excess hair on the face or body, you may have PCOS or another hormonal imbalance.

Types

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There are several different types of acne lesions. Most of the time, if you have acne, you will have a combination of these lesions in varying severity:

• Blackheads and whiteheads (also called comedonal lesions). These are spots or bumps on your skin, caused when the opening of a hair follicle gets plugged. Because these lesions can progress, it is important to treat them at an early stage.
• Pimples (also called inflammatory lesions). This type is the classic lesion better known as a pimple or pus bump. When hair follicles get clogged with oil (also known as sebum), the clogged pores become swollen or inflamed, resulting in pimples or pus bumps on the skin.
• Cysts (known as nodulocystic lesions). These develop when smaller inflamed lesions swell up into larger lesions. These are deep painful lesions that can last from a few days to several weeks and often lead to scarring and discoloration.
• Scars are the last stage of acne resulting from severe inflammatory lesions. They are usually permanent.

Causes

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The following factors cause acne:

• Increased stickiness of the cells in the hair follicles, combined with sebum (oil), creating a plug in the hair follicle
• Increased production of sebum, or oil, especially during adolescence, when hormones increase
• Increased growth and activity of bacteria called Propionibacterium acnes, also known as P. acnes

As you go through puberty, some hormones cause your skin to produce more oil. This oil combines with a buildup of debris and shedding skin, causing hair follicles on your face and other acne-prone areas to plug up. This causes the acne lesions.

More sebum results in an increase in the number of bacteria (P. acnes) on the skin surface. As bacteria break down surface oil and interact with your immune system, your skin becomes irritated and inflamed. This causes acne pimples to form. 

Because the highest concentration of the sebaceous or oil glands is present on the face, chest, and back, these are the areas where acne usually develops.

Hormonal changes

Hormones are one of the most important causes of acne. Several kinds of hormonal changes can affect this condition, including: 

• Puberty brings a surge in sex hormones, resulting in an increase in sebum production by the sebaceous glands in our skin.
• Menstrual periods can cause acne to flare up because of hormone level changes during the menstrual cycle.
• Polycystic ovary syndrome (PCOS) is characterized by severe acne, excess hair growth, premature loss of hair on the scalp, and irregular menstrual periods.

Diet

The role of diet in acne remains controversial. It is best to avoid foods that make your acne worse. Some studies suggest that milk and other dairy products may increase the risk or severity of acne because of the animal hormones they contain.

Foods rich in carbohydrates, such as simple sugars found in candy, cookies, and other baked goods, may make acne worse. There is no good evidence that chocolate or fried foods cause or worsen acne.

Stress

Stress and tension have been shown to worsen acne. When we are stressed, our body releases cortisol – a natural steroid hormone that further increases your skin's production of oil.

Medications

Certain medications are known to worsen acne. These include medications that contain steroids such as prednisone, methyl prednisolone, topical steroids, and some psychiatric medications such as lithium.

Other factors

• Oil-based cosmetics may worsen acne by clogging your pores. We recommend that you try water-based "non-comedogenic" cosmetic products if you have acne.
• Overwashing the skin. Using rough washcloths or aggressively scrubbing your skin to try and remove dirt may make your acne worse by causing irritation and inflammation. Dirt is not the cause of acne.
• Heat and friction. Helmets, bra straps, shoulder pads, adhesive tape, orthopedic casts, and other constricting items that rub against the skin may worsen acne.

Your Care with Me

You may be able to control your acne by caring for your skin at home.  However, if you are concerned about your skin or if you don't see an improvement with home treatment, please contact the Appointment and Advice line.  Our advice nurses can give you immediate advice and our telephone staff can send me a message or schedule an appointment for you.

Contacting Me and Protecting Your Privacy

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

If your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for you.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Protecting your privacy

Teens 13 and older can get help from any medical professional without parental permission for these confidential services. 

Make an appointment to talk with me privately if you:

• Think you might be pregnant.
• Need birth control.
• Think you have a sexually transmitted disease (STD).
• Need information about alcohol or other drug use.
• Want to talk about personal, school, or family issues.

You can make your own appointments for confidential services by calling our Appointment and Advice Line, 24 hours a day, seven days a week.

What we talk about is private. In most cases, I cannot tell your parents or guardians anything about your visit for any of the confidential services listed.

One important exception: I do need to tell them if you are in danger or if you are thinking about hurting yourself or someone else.

We will protect your privacy. We also encourage you to talk with your parents or another trusted adult, if possible, for advice and support.

For General Questions and Nonconfidential Concerns

You can:

• Contact me by phone by calling the Advice and Appointment Line.  
• E-mail me using this site, once you have registered on kp.org.
• Schedule an appointment online to see me in person. 

Important notes about e-mail

• If you have signed up to e-mail me, keep in mind that your parent/s or guardian/s may have, too, using our Act for a Family Member feature. 
• This means that anyone who is legally entitled to manage your health care can read the e-mails you send to me, and that I send to you. 
• If you want to discuss something private, please call me or make an appointment to see me in person instead of sending a secure e-mail.

For Parents of Teens

How teen care is different

In partnership with you as a parent, we want to teach our young adolescent patients to begin to take charge of their personal health care as they transition from childhood to adulthood.

We sometimes request confidential time with teens to ask about sensitive issues. Time alone allows us to address important health and safety issues. It also gives your teen a chance to confidentially ask questions or voice concerns about topics that may be embarrassing. Many teens (and adults) find it difficult to talk about sensitive issues and prefer to see their doctor privately.

As your teen’s doctor, I also want to talk with you about your questions or concerns. At your teen’s appointment, please let the medical assistant or nurse know if you have any specific concerns that you wish to  discuss. I will make sure to set aside time during the appointment to talk with you about any concerns or questions you may have.

Contacting me

For nonurgent concerns or questions, you can e-mail me using this site, once you have set up access to manage your teen’s health. Use the Manage Your Family’s Health links to get started.

If your concerns or questions are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your teen.

How We Coordinate Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to 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.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed.
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your height, weight, or vital signs.   

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many teens like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you.

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed.

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.

If refills are needed in the future, you can:

Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.

• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

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, such as X-rays, we will schedule an appointment with the Radiology Department.

When the results are ready, we will contact you with the results by phone. We may ask you for a phone number where you can receive your results confidentially.  If you do not have a cell phone, we may ask you to call us for the results instead, to ensure that we protect your privacy.  

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
 

Convenient Resources for You

My goal is 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 to help you manage your care at any time that is most convenient for you. From my home page you can sign up for kp.org and:

Stay on top of your health

• Manage your prescriptions and refills.
• Schedule well visit and non-urgent appointments.
• View your preventive health reminders to see whether you are due for any immunizations or well visits.
• View and send secure e-mail messages*

*Secure means e-mail communication between you, me, and other members of your health care team is behind our firewall and password protected.  Anyone who can act on your behalf (for example, your parents) will have access to this e-mail box.  If you want to talk confidentially, l encourage you to call me or make an appointment to see me in person, instead of sending a secure message online.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition. 
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• Check to see if you are due for a well teen visit or need any immunizations.