Directory:Dr. Barry S. Goldberg

Dr. Barry S. Goldberg

Dr. Barry S. Goldberg has been practicing Dermatology in Danbury, CT since 1978. He is a graduate of McGill University Medical School in Montreal, Canada. Dr. Goldberg did his residency at the University of Colorado Medical Center in Denver, Colorado both in Pediatrics and Dermatology. He is on the Danbury Hospital staff in both the Department of Medicine and the Department of Pediatrics.

Dr. Goldberg's training and board certification in Dermatology and Pediatrics have contributed to his special expertise in the skin diseases of children as well as adults. His expertise also includes the latest technology for skin cancer detection and treatment. He has extensive experience in cosmetic procedures, including sclerotherapy for leg veins, BOTOX®, Restylane injections, chemical peels and the latest advances in photorejuvenation. Dr. Goldberg is currently on the teaching staff at Yale University School of Medicine in the Department of Dermatology and at Danbury Hospital.

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Research

Acne, an inherited disorder of the skin's hair-and-oil follicles, resulting in blemishes or pimples on the face, chest, and upper back. The common form of acne, acne vulgaris, is seen in most adolescent boys and girls. Although it may begin in earliest puberty—between the ages of eight and ten—it is most common in the mid-teens. Acne often clears spontaneously in late adolescence or early adulthood, but many people are plagued with it throughout life.

The first stage of acne vulgaris is usually marked by blackheads and whiteheads (comedones). Thereafter, during preadolescence, red, inflamed blemishes may appear with different degrees of severity. Most superficial red blemishes heal by themselves within a week, but deeper cysts may require several weeks before disappearing. Some deep acne cysts may be painful and result in permanent scarring.

Another form of acne, which develops in middle age, is termed acne rosacea. It causes the central part of the face to erupt in red patches, red blemishes, and occasionally pustules. Acne rosacea is most common in women but is often more severe in men. A severe variant, rhynophyma, may result in a bulbous nose.

Cause. Acne vulgaris is caused by the effect of androgen hormones on the hair follicle and its sebaceous (oil) gland. Blackheads and whiteheads result from the accumulation of skin fragments (scales) and a fatty substance (sebum) in hair follicles. Pigment, not dirt, residing in the follicles causes the black color of blackheads. Certain bacteria (Proprionobacterium acnes) appear to be important in promoting the evolution of blackheads and whiteheads into red, inflamed pimples, pustules, and cysts. These bacteria incite inflammation by attracting the body's white blood cells into the area of the follicle.

Contributing Factors. The tendency to develop acne vulgaris is inherited. Among individuals who are genetically predisposed to the condition, periods of stress and tension may bring about flareups of acne. Abrasive skin cleansing frequently worsens existing cases. Also, certain creams, lotions, and cosmetics encourage formation of blackheads and whiteheads (and possibly may lead to more severe acne).

Although a few individuals can correlate specific items such as sweets or oily foods with new eruptions, diet generally plays no significant role in the cause or treatment of acne. Even chocolate causes little trouble for most people.

Hygienic Treatment. Acne is not related to dirt or ineffective cleansing. In fact, it may be worsened by overzealous cleansing and abrasive scrubbing. Gentle washing of the face and other involved areas once or twice a day with mild soap or skin cleanser is generally all that is necessary. Astringents and alcohol can reduce oiliness on the skin surface but do very little to treat acne.

Medical Treatment. Great advances in acne treatment have been made since the early 1970s in both medications applied directly to the skin and internal medications taken by mouth.

Topical Medications. Because acne lesions begin as comedones, most topical treatment is designed to loosen and dissolve the plugs in the blocked follicles. Regular application of tretinoin (retinic acid, a derivative of Vitamin A) in the form of a cream, liquid, or gel over a period of a few months often helps dissolve most of the plugs. Benzoyl peroxide gels help both to dissolve comedones and to kill skin bacteria. Salicylic acid creams and gels and sulfur creams also may tend to dissolve comedones. Other topical lotions are designed to reduce the numbers of bacteria—specifically Proprionobacterium acnes—in the follicles. These lotions usually contain an antibiotic such as tetracycline.

Internal Medications. Two basic forms of internal medication generally are of great help in treating inflamed blemishes and cysts in acne. Antibiotic pills have been used for this purpose for several years. These antibiotics also reduce the bacteria present in the follicles. It may be necessary to continue the treatment for months or years, but with careful monitoring by a physician antibiotics have few side effects and are remarkably safe.

A retinoid drug taken by mouth—13-cis-retinoic acid—has a profound effect on severe cystic acne and is now widely used for this devastating disease. The therapeutic effects of this drug—unlike those of antibiotics—continue long after it is discontinued. Thus treatment may be required for only four to five months.

Vitamins and trace-metal supplements such as zinc have not been found useful in acne treatment.

Physical Agents. Because ultraviolet light in the form of moderate exposure to summer sunlight is helpful for most acne sufferers, acne tends to improve in the summer months. However, summer heat and humidity may increase the development of inflamed red lesions. For this reason, acne may be very severe in the humid tropics. Artificial ultraviolet light in the form of sunlamps should be avoided, for severe sunburns have resulted from their injudicious use. Excessive exposure to ultraviolet light from any source may lead to premature wrinkling and skin cancer.

X-ray treatment is not recommended, because it, too, may tend to induce cancer.

Hormone therapy with estrogen or cortisone-like hormones is considered only in severe cases, when more conservative treatment has not been effective, because of undesirable side effects. However, injecting a dilute cortisone solution into deep inflamed cysts is a routine procedure that is both safe and helpful.

Acne surgery sometimes is used to extract comedones and to open pustules and cysts. Chemical peeling of the skin with mild acids or thermal peeling by the controlled application of cold in the form of liquid nitrogen or a slush of dry ice may have superficially similar effects.

Psychosocial Effects. During the formative adolescent years disfigurement resulting from acne may have a profound emotional effect. The social development during the teenage years can be severely and permanently impaired by low self-esteem and a poor self-image resulting from severe acne. For this reason it is especially important that young persons with acne receive treatment. It is equally important that psychosocial counseling be part of the treatment.

Barry S. Goldberg, M.D.
Yale University

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Name: Dr. Barry S. Goldberg

City: Danbury
State: CT
Country: US
Web: http://www.advanced-dermcare.com/

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