Mr. Anastasios Angelo Pappas, M.D.

I am so sorry you’ve had to go through this. Staph aureus including the MRSA variant essentially live all around us. It’s been cultured from doctors ties, countertops, etc. However, staff aureus has to live somewhere regularly. 20% of Americans approximately carry staph in their nose every day, 5% of us in our private areas, and 5% of us between the toes. And 3% American cats. One study showed over-cleaning countertops actually have made more room for the staph aureus. It may be worthwhile having your nose cultured, sometimes even your groin and rarely between your toes or your family members. There are some techniques combining antibiotics, which may help eradicate people from carrying staph. One of the most common associations with recurrent cellulitis on the legs is having athletes foot fungus. This breaks the bearer of the skin down low for the bacteria to get through.

I am not sure of your gender. There are more and more studies linking milk to acne. I am still not convinced reducing milk will make patients happy. Females at age 35 usually need more hormonal therapy for their acne, and aldactone is the most common and makes 70%-75% of patients happy. Males with acne at age 35, if conventional pills and creams have not worked, may need a hormone therapy. Metformin can help sometimes, but is not commonly used.

First and foremost, please know we have options to help. The cause can be variable. A not uncommon cause of excess facial hair can be polycyclic ovarian syndrome. Young or older women can have irregular cycles, facial hair, acne, and sometimes thinning of the hair on the scalp. But not all women will have all the features. Sometimes, hormonally, everything is just right, but the receptors on the hair follicles have become too sensitive and respond too sensitively to the normal amount of testosterone. At your age, I recommend a hormone work-up.

Sometimes, after any form of inflammation in the skin, the skin can turn a red or purple or occasionally brown color. This is referred to as post-inflammatory hyperpigmentation. This by itself is not a scar and thankfully fades over time. It’s similar to a stain in a carpet. It will fade slowly over time. If there’s a depression or a sunken area of the skin, this may represent a scar, and that will persist. Occasionally, a scar will have post-inflammatory hyperpigmentation overlying it.

For adult females, one of the most effective therapies for hormonal jawline acne is a pill called aldactone. It was developed for blood pressure, but never worked. It helps acne as it blocks testosterone from connecting the hair follicles. It is very safe overall, very affordable, and makes 70% of adult women’s acne much better.

That is a very difficult question. Stretch marks in a sense are scars from the skin not growing fast enough to meet the underlying growth. Stretch marks are often red at first and then over time fade to white. The red almost always fades on its own but can take months to years. Not days nor weeks. There are lasers that can reduce the red, such as pulse dye lasers. Often it is best to see if time will do it, and it often does.

The white stretch marks are hard to improve, but there are some options. The bigger question would be, is the investment worth it.

One study on pregnant women showed that BEFORE the stomach started expanding they started Vaseline jelly on one side and nothing on the other side of the abdomen. The Vaseline side showed fewer stretch marks. But that was more preventative.

Back to the white, older, stretch marks. Lasers may help. Such as fractionated lasers. Overall safe, many visits and average results. Topical creams such as Retin A have been used and these may minimally help. Chemical peels, depending on the depth of the peel, can have mild to mild/medium benefit.

Tasso Pappas, MD

Congrats on the wedding!!! Without seeing the acne and its residual it is hard; however the two most common steps are fractional for scarring- this is multiple laser treatments about 6 treatments spaced approximately 6 weeks apart. The time frame is tight. The “stains” that occur from acne, called post inflammatory hyperpigmentation can be treated with IPL treatm ents. These stains are the red, pink and purple areas where pimples were, but they are not true scars and fade on their own but it takes 6-12 months. Sunscreens are key regardless of path chosen.

Good luck