Christopher Ewanowski, MD

Microdermabrasion and laser treatments work effectively for sun spots because they are superficial on the skin. Moles (nevi) are deeper in the skin, so these options are ineffective. Moles should be monitored regularly, by doing self skin exams monthly and by seeing a dermatologist yearly. Forty percent of malignant melanomas (an aggressive type of skin cancer) occurs in already existing moles. It is not practical to remove moles unless they look suspicious. Mole removal involves shaving it off the skin or cutting deep around it and putting the skin back together with stitches.

You have melasma, also known as "the mask of pregnancy" which is a condition caused by a combination of two things, hormones and sun exposure. Options to improve and control melasma include topical creams composed of hydroquinone (a skin lightener) and retinoic acid. There are also non-hydroquinone containing creams available. Our office also offers Intense Pulse Light (IPL) laser treatments for melasma.

Skin is constantly renewing itself, shedding dead skin and replacing it with new skin. Retin-A (retinoic acid) works at the cellular level to increase cell turnover, thus exfoliating the skin at a faster rate. This unclogs the pores, tightens the skin, and fades dark spots. This is why retin-a is used for both acne and anti-aging.

Cysts on the face are very serious because they can cause scarring, as you have already experienced. They should be treated aggressively, and unfortunately no home remedy is effective enough. I would recommend you seek treatment soon to avoid further scarring.

Isotretinoin (Accutane) should be dosed 0.5-2 mg/kg. Based on your weight you should take as little as 47 mg to as high as 190 mg/day. More importantly, however, is your therapeutic dose. This is 120-150 mg/kg total during the course. This therapuetic dose, when reached, gives you the best chance of cure so that you will never need another course of isotretinoin because the acne has come back. Therefore, it doesn't really matter what dose you start on, whether it be 20 mg, 40 mg, or 80 mg...what matters is how much you take total during the course. We generally start at a lower dose, usually 40 mg/day, and increase it monthly based on your tolerance of the side effects, and cap the dose based on weight.