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Expert solutions to your top skin problems

My Family Doctor
by Charles E. Crutchfield III, M.D.

Trying to choose the right skincare products can be absolutely bewildering. In department stores alone, it’s dizzying to see the hundreds if not thousands of choices. Salespeople wearing white coats, looking like either mad scientists or doctors, are all-too-eager to recommend the 34-step skincare program offered exclusively by their company that will solve all of your complexion woes.

Even at home in your own living room, you’re flooded with a bevy of late-night infomercials touting the latest and greatest of skincare products.

Here, I’ll cut through the clutter and give you some practical tips on combating seven common skin problems.

Unsightly Pores

Pore size is genetically determined. You can no more change it than the size of your hands or the color of your eyes.

What you can do is improve their appearance by making sure they’re not clogged. Try a products with salicylic acid (which can penetrate pores and help clean them out) or an alpha-hydroxy acid, such as glycolic or lactic acid (which can help slough off residue in the pore openings). Be sure to put on a sunscreen after using such products.

Circles Under the Eyes

I find this to be one of the most challenging skin conditions to treat. I am often disappointed by the commercials on late-night TV about creams and lotions and potions that promise cures. The reason is there are three major causes for dark circles, and you have to choose your treatment based on your particular problem.

1. A deposit of melanin (pigment) in the skin, called hyperpigmentation. Sometimes, lightening products, such as those that contain kojic acid or hydroquinone, will work on this. You can get them over the counter or, for stronger products, by prescription. Alternately, there are some newer lasers that may work for you.

2. Visible veins. If the skin is thin or your veins (which carry deoxygenated blue blood) run close to the skin, the area appears darker. Over-the-counter products with vitamin K may help. My preference is to inject a filling agent, like hyaluronic acid, to thicken the area so the veins are not as apparent.

3. A concavity that actually casts a shadow under the eye, making the area look darker. Once again, injecting a filler can help this.

You can also try eye creams with alpha-hydroxy acids, which may help get rid of darkened skin or, over time, stimulate collagen production, thickening the skin in that area.

To get an idea of what’s causing the circles under your eyes, using good lighting, look in a mirror and pull the skin taut. If your problem is hyperpigmentation, it will remain dark. If there are veins under the skin, you will see those. If there is a concavity, it will disappear.

Bumps on the Arms

Affecting approximately 40 percent of adults and even more adolescents, keratosis pilaris is a common condition. It’s what results in those tiny red bumps that appear on the back of upper arms and sometimes the tops of thighs and cheeks. (They’re actually hair follicles that are clogged with a skin protein called keratin.)

Because keratosis pilaris is so common, many dermatologists think of it as a normal skin variant, and it’s difficult to treat things that are normal. But people still don’t like rough, red bumps on their skin.

The approach on this is to improve the appearance rather than eradicate the condition. I recommend over-the-counter alpha-hydroxy acid lotions such as AmLactin and LactiCare. The Glytone Keratosis Pilaris Kit is a product with a special moisturizing lotion and loofah. Though there’s no cure for keratosis pilaris, it does tend to disappear with time.

Puffy Eyelids

Puffy eyelids, along with swelling, flaking and itching, are oftentimes a sign of skin allergy.

Because the skin around the eyes tends to b the thinnest on the body, it is the most sensitive to ingredients or products to which one may be allergic. Most dermatology offices have readily available allergy testing to evaluate and treat such conditions. For short-term relief, you can try cooling compresses.


When fibrous strands under your skin tug on some fat and other fat pops up around it, the skin dimples, and you have what we call cellulite. It’s perfectly normal; the vast majority of women and even a few men have it. Nonetheless, people want to get rid of it. Unfortunately, there’s no proven, safe way to accomplish that yet.

There are a couple of newer contraptions that somewhat work: the laser based TriActive and the light-based Velasmooth. But they don’t get rid of all the cellulite, and their effects are temporary, requiring monthly maintenance sessions. Plus, at around $1,000 to $2,000 for an initial series of treatments, they’re not cheap.

Genes determine whether you have cellulite. Losing weight may improve its appearance but won’t banish it. I’ve seen many Olympic-caliber athletes in their early 20s with dimply skin.

Blotchy skin

Skin irritation or inflammation (from allergies, eczema, dry skin, acne) can activate cells that produce color, resulting in blotchy skin. The best way to prevent this is to keep the skin gently cleansed and well-hydrated.

For dark spots you already have, you can try lightening products with kojic acid or hydroquinone. The strongest of these are by prescription only.


Entire textbooks have been written about acne. There are four points to consider when treating it: plugged pores, bacteria, inflammation and excess oil.

When you have acne, dead skin cells and oil are clogging your pores. Bacteria can feed on this banquet and cause pimples. Alternately, the stuff in your pores can oxidize, just like rust on a car, and turn black. These are blackheads.

Even better, all this time, glands under the plugged pores are producing oils.

To unclog the pores, salicylic acid and benzoyl peroxide, the most common ingredients in over-the-counter acne treatments, work well. If they don’t fix your problem, your dermatologist has prescription options.

Prescription meds can also help with excess oil. (On some patients, I use the Aramis laser, which shrinks oil glands.)

Finally, people often wonder whether what you eat matters when it comes to acne. The textbooks say no; however, everyone has different triggers. I tell patients that if they know that when they eat a certain food it causes their acne to flare, then they certainly should avoid that food.


Board-certified dermatologist Charles E. Crutchfield III, M.D., is a professor at the University of Minnesota Medical School and medical director of Crutchfield Dermatology in Eagan, Minn.

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