Acne is common among teenagers and is still a challenging disease treated by dermatologists. Teenage acne is usually self-limited, but it can last a decade. Yet, 10-15% of teenage acne evolves to chronic adult acne, manifesting a pattern of relapse with a slow onset or acute outbreaks. Untreated acne can affect the individual's quality of life. Therefore, acne warrants early and aggressive treatment while maintenance of an effective therapy is needed to achieve optimal outcomes. The causes of acne have been linked to (1) excess production of sebum (oil), (2) proliferation of the bacteria Propionibacterium acnes in hair follicles, (3) excessive formation of keratin plugs (known as black heads and white heads), and (4) release of inflammatory mediators, which induce redness and pustules of the hair follicles. Research reveals that inflammation precedes the formation of black/white heads. P acnes bacteria initiate the inflammation cascade. Furthermore, oxidized lipids in sebum stimulate the production of inflammatory mediators. Androgens (such as testosterone) also have influence on the formation of keratin plugs and proliferation of oil glands. The goal of acne treatment is to control, not "cure". Specific therapy focuses on the types of acne. Treatments may not be restricted to just oral or topical antibiotics alone. As we learn more of how acne is induced by multiple factors mentioned above, effective therapy tailors to blocking the inducers of acne. Oral and topical antibiotics reduce the colonization of the P acnes. Antibiotic resistance is a significant public health concern. Combining antibiotics with benzoyl peroxide minimizes the formation of black/white heads; a topical retinoid should be used in conjunction with antibiotics. Retinoids also have an anti-inflammatory activity against acne. Systemic/oral retinoid use is reserved for resistant, severe or cystic acne. Moreover, chemical peels, manual extraction and microdermabrasion of the black/white heads help exfoliate clogged pores and keratin plugs. This treatment not only reduces the entrapment and accumulation of sebum within the hair follicles, but also allows better penetration and effectiveness of topical medications. To achieve the best acne control, all above treatment modalities must be used together as a combination therapy. Equally important is the selection of an adjunct skin care regimen, such as soap, lotion, sunscreen, and, especially, make-up products in women. It is best to use a gentle cleanser instead of soap to reduce irritation and dryness. Thick moisturizing lotion, heavy sunscreen, and oil-based make-up all contribute to the clogging of hair follicles, simulating the comedogenic condition of black/white heads. Thus, non-comedogenic products should be used to avoid exacerbation of acne.

Eczema is a chronic relapsing skin disease affecting up to 20% of children and 3% of adults, characterized by itching and red rash, and may be associated with other atopic diseases such as asthma, allergic rhinitis (hay fever, seasonal allergy), hives, allergic reaction to foods, and elevated immunoglobulin-E production. Eczema is also known as eczematous dermatitis or atopic dermatitis. Raincross Medical Center of Dermatology & Cosmetic Surgery is one of the largest facilities in the Inland Empire committed to treat mild, moderate, and severe cases of eczema. The facility is fully equipped with the latest technology to deal with this chronic skin disease. Dr. Ethan Nguyen was fellowship-trained at the University of California, San Francisco (UCSF) and specializes in providing therapy for a wide range of atopic skin diseases. One of the most important aspects in treating and maintaining the control of eczema flares is repairing and normalizing skin-barrier function of eczema patients. In addition, the immune T-cells are directly involved with the flares of this disease through a number of cytokine hormones being released from these T-cells. Other exacerbating factors such as diet, stress, low humidity and cold temperature also contribute to the flares of eczema. Our facility offers both conventional and cutting edge technologies to treat eczema. Therapy may range from topical steroids, non-steroidal topicals, calcineurin-inhibitors, to specific skin barrier repair emollients. Phototherapy, such as narrow-band UVB, combined with eximer laser can be added to enhance the control of eczema flares. Systemic use of cyclosporine or corticosteroid is reserved for very severe cases. Most patients and parents who are concerned with the side effects of long-term corticosteroid use may benefit from the newest steroid-free, skin-barrier repair emulsions, such as EpiCeram. This product, approved by the Food and Drug Administration (FDA) in October 2008, contains the basic ingredient of the bi-lipid layer of skin cell membrane ceramides, cholesterol and fatty acids. EpiCeram has similar efficacy and safety compared to a steroid such as Cutivate cream. This means pregnant patients, infants, children, and adults can enjoy using a steroid-free medication to treat eczema on any part of their body without limitation of quantity, restriction on duration of use, or worry about potential side effects of comparable topical corticosteroids.