Acne is the most common skin condition in the United States — and one of the most undertreated. At Fayetteville Dermatology, Dr. James Prezzano treats acne in teens and adults across Central New York with two goals: clear skin, and preventing the scars that untreated acne leaves behind. Both are realistic.
Why See a Dermatologist for Acne
Over-the-counter products have a ceiling, and most people who walk into our office have already hit it. Prescription treatment works at the level of what actually drives acne — clogged pores, bacteria, inflammation, and hormones. Just as important: acne scars are permanent, and they're preventable. Treating acne early and properly is the single best scar treatment there is.
How We Treat Acne at Fayetteville Dermatology
1. Topical prescriptions. The foundation for most patients: retinoids (the workhorses of acne treatment), benzoyl peroxide, topical antibiotics in smart combinations, and azelaic acid for sensitive skin or dark post-acne marks.
2. Oral antibiotics. Doxycycline and similar agents calm inflammatory acne — used as a bridge for a defined period, not a forever plan, and always alongside topicals that maintain the result.
3. Hormonal therapy. For adult women with jawline and chin breakouts that flare with cycles, spironolactone and certain combined oral contraceptives are often the missing piece.
4. Isotretinoin. For severe, nodulocystic, or scarring acne — or acne that has resisted everything else — isotretinoin (formerly Accutane) remains the most effective treatment in dermatology. It runs as a structured, monitored program: monthly visits, lab work, and strict pregnancy-prevention requirements where applicable. Dr. Prezzano will walk you through it candidly.
The Honest Timeline
Any acne regimen needs 6-12 weeks before you judge it — skin often looks unchanged or even slightly worse in the first few weeks, and that's expected, not failure. The most common reason acne treatment "doesn't work" is switching products every three weeks. We'll set the plan, then adjust it on schedule rather than on frustration.
Adult and Hormonal Acne
Acne doesn't end at 19. Adult acne — especially in women in their 20s to 40s — tends to sit on the jawline and chin and flare cyclically, and it responds well to hormonal approaches. One caveat: if your "adult acne" has no blackheads, stings with products, and comes with flushing, it may actually be rosacea — a different condition needing different treatment, and a distinction we check at every first visit.
Acne Scars
Active acne first, scars second — treating scars while breakouts continue is working against yourself. Once your skin is clear and stable, we'll discuss what's realistic for improving the scars that remain.
Why See Dr. Prezzano for Acne
We see teens and adults, appointments are typically available within a week — which matters when a teenager is starting to scar — and office visits and most prescription treatments are covered by major insurance plans. Acne is not a rite of passage to be waited out. It's a treatable medical condition.
Frequently Asked Questions
The first step is always clearing the active acne — treating scars while new breakouts continue is working against yourself. Once your skin is clear, we'll discuss realistic options for improving the scars that remain.
Yes, if over-the-counter products haven't worked after 2-3 months, or if you're seeing any scarring or dark marks. Scars are permanent and preventable — treating acne early is the single best scar treatment there is.
Genetics and hormones are the main drivers. There's some evidence that high-glycemic diets and skim milk can worsen acne in some people, so it's reasonable to experiment — but diet changes alone rarely clear meaningful acne.
Isotretinoin is the most effective treatment available for severe or scarring acne, and it's managed within a structured monitoring program: monthly visits, lab work, and strict pregnancy-prevention requirements. It's a serious medication taken seriously — and for the right patient, it's often the treatment that finally ends the cycle.
Give any regimen 6-12 weeks before judging it. Skin often looks unchanged — or briefly worse — in the first few weeks, which is normal and not a reason to quit. Constantly switching products is the most common reason acne treatment fails.
Schedule Your Mohs Consultation
If you've been diagnosed with a skin cancer — or your primary care provider or another dermatologist has recommended Mohs surgery — we typically have appointments available within the same week.
We accept most major insurance plans including Aetna, BCBS, Cigna, United Healthcare, and Medicare.
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