Syler says she rarely had pimples as a teenager but that she developed skin problems in adulthood.
"I would say 90 percent of my patients that are women say the same thing. 'I never had it as a teenager and why now?' Most importantly they want a reason and a cure. Hormonal fluctuations. Teenagers go through bouts of hormonal changes but because of women's natural cycle it prolongs," Frank explains.
There are a number of medications and creams on the market, but the doctor says there is really no best treatment. "There are several options. We have to find something ideal for the patients. Fortunately now we have several new technologies available for people who didn't respond to traditional therapy."
Frank says there are several options that have been developed over the last five years, including new laser-based treatments. "Basically using light as a form of heat in ways to kill acne. Laser is more of a generic term."
One option is photodynamic therapy, which targets the sebaceous glands. The glands are attached to the hair follicle, which is where the pimple starts.
Frank says the therapy can cost about $650 a treatment. "Most need two or three to keep them 80 percent clear six months plus."
Another option is called the MedLite laser. "One of the older technologies before we had this photodynamic therapy and required almost biweekly treatment for several months at a time. So really, the patient had to dedicate a lot of time in the doctor's office. We tend to use the photodynamic therapy more efficiently now," explains Frank.
How do the lasers work on people with darker skin?
"You have to be careful. Fortunately a lot of the newer lasers see through the top layers where the pigment is so it doesn't cause burning trauma," he explains.
Cystic acne is when hormones create a susceptibility to inflammation where bacteria really take advantage and it creates like a little mini-infection. Dr. Frank says that can be painful, scarring and unsightly.
"This is where the new technologies are really hopefully going to improve the situation," he says.
A new at-home therapy is now available, called "Zeno." Frank says "Zeno" delivers a controlled amount of heat for two-and-a-half minutes through the top. "You place it on the skin, hold it there about two or three times in over a 24 hour period and can do what a cortisone shot does, decreases the size of the pimple."
The device costs $225 and there are 90-shot treatment tips that cost $35.
Of course there's always the old standby, cortisone, if you can't use one of the high-tech treatments.