For active acne, start with a clinician who can diagnose and prescribe: a board-certified dermatologist, or a certified physician assistant (PA-C) who works in dermatology. Both can work out what kind of acne you have, prescribe medicine, and adjust the plan as your skin responds. Facials and med spa services can be a pleasant add-on, but they can't replace medical treatment for breakouts that keep coming back, hurt or leave marks.
The details below explain what each type of provider is trained and allowed to do, and how to tell them apart when you're reading listings and reviews.
Board-certified dermatologists
According to the American Academy of Dermatology (AAD), a dermatologist finishes medical school, completes an internship and a three-year dermatology residency, and then passes a board exam to become board certified. That training covers the skin, hair and nails, so a dermatologist is prepared to:
- Tell acne apart from conditions that look like it, such as rosacea or folliculitis
- Choose among prescription creams, pills and in-office procedures
- Manage medicines that need careful monitoring, such as isotretinoin
- Handle side effects and adjust treatment when something isn't working
It's worth checking any "board certified" claim for yourself. Our guide to dermatologist credentials explains what the letters mean and how to check them for free.
Physician assistants (PA-C) in dermatology
Physician assistants are licensed medical providers who diagnose, treat and prescribe. The American Academy of Physician Associates (AAPA) says most PA programs take about 27 months, award a master's degree, and include more than 2,000 hours of clinical rotations.
After graduating, a PA must pass a national certification exam from the National Commission on Certification of Physician Assistants (NCCPA). The "C" in PA-C means the PA holds that certification. To keep it, the NCCPA requires 100 continuing medical education credits every two years and a recertification exam within each 10-year cycle.
PAs work as part of a medical team with physicians. State law sets how that relationship works, including supervision. Many dermatology practices include PAs, and they often see patients for common conditions such as acne. If it matters to you, ask who will see you and how the team works together.
Med spas, aestheticians and facials: what they can and can't do
Estheticians (also spelled aestheticians) hold a license for cosmetic skin services, like facials and deep cleansing. They are not medical providers. They cannot diagnose a skin condition or prescribe medicine.
Med spas vary widely. Some have physicians, PAs or nurse practitioners on staff. Others mostly offer services from estheticians. Before you book, ask who the medical provider is, who will actually treat you, and what license that person holds. Injections and prescription treatments are medical care, so they should come from a licensed medical provider.
Where med spa care can fit:
- A gentle facial may feel good and help skin look refreshed for a while.
- It can be a complement to a prescription plan, not a substitute for one.
- For inflamed, painful or scarring acne, a facial won't treat the cause.
Two cautions. The AAD warns that popping or squeezing pimples can lead to more noticeable acne and scarring, so aggressive extractions outside a medical setting are worth avoiding. And some acne medicines, such as retinoids and isotretinoin, make skin more sensitive. Tell anyone giving you a facial, peel or waxing what you use.
How the provider types compare
- Board-certified dermatologist. Diagnose: yes. Prescribe: yes. In-office acne procedures: yes. Handle complications: yes. Insurance: medical acne care is generally billed to health insurance, subject to your plan.
- Dermatology PA-C. Diagnose: yes. Prescribe: yes. In-office acne procedures: many, depending on training and the practice. Handle complications: yes, as part of a team with physicians. Insurance: generally billed like other medical visits.
- Esthetician or med spa service. Diagnose: no. Prescribe: no. If a med spa has a licensed prescriber on staff, that person would be the one to prescribe. In-office procedures: cosmetic services such as facials. Handle complications: refers you to a medical provider. Insurance: generally self-pay.
"Top rated" and "highly rated": what reviews can and can't tell you
Star ratings mostly reflect the experience of a visit: how long people waited, how the front desk treated them, and whether the clinician explained things clearly. That's useful. But ratings can't tell you:
- Who the reviewer actually saw. Reviewers often refer to whoever treated them as "the dermatologist," even if that person was a PA or an esthetician.
- Whether a credential is real. A "board certified" badge on a directory is worth checking against the board's own lookup. PA-C certification can be checked through the NCCPA.
- Whether a plan had time to work. The AAD says it takes at least 6 to 8 weeks to start seeing fewer breakouts. Keep that timeline in mind when reading about treatment that "didn't work."
"Acne specialist" is a description, not a separate board certification. When a listing uses it, look for the actual credential behind it. For more on judging listings, see how to read dermatologist reviews for acne treatment.
The Bay Ridge team
At Bay Ridge Dermatology, acne care is part of our medical dermatology services, and acne extractions are done in the office. The team includes:
- Dr. Evangeline Perez, a board-certified dermatologist with more than 20 years of experience
- Nicole Marie Colucci, PA-C, a board-certified physician assistant (NCCPA)
- Kerry Ly, PA-C, who speaks Mandarin and Cantonese in addition to English. To be seen in either language, ask for Kerry Ly when you book.
Each clinician's profile is on our providers page. When you book, ask which clinician you'll see. The practice accepts most insurances, including Aetna, BCBS, Cigna, United, Medicare, Oxford, Empire and Humana. Coverage depends on your plan, so check with your insurer before your visit.
Acne responds differently from person to person. Individual results vary.
When acne needs a dermatologist rather than another facial
Consider a medical visit if:
- Breakouts include deep, sore lumps or cysts
- Spots are leaving pitted scars or lasting dark marks
- Several weeks of daily over-the-counter products haven't made a difference
- Acne appeared for the first time as an adult, or came along with irregular periods or new hair growth
- You aren't sure it's acne, for example if your face also flushes easily or the bumps sit around hair follicles
- You're pregnant or planning a pregnancy and need treatment that suits that
- Acne is affecting your mood, confidence or daily life
If you're ready to talk through your acne, book online or call (347) 497-4984.
This article is general information, not medical advice. For advice about your own skin, see a dermatologist.