Acne in plain English - What is Acne?

A normal follicle

A normal follicle looks like this:

For reasons no one completely understands, follicles, often called pores, sometimes get blocked. Sebum (oil) which normally drains to the surface gets blocked and bacteria begins to grow. Both whiteheads and blackheads start out as a microcomedone. The picture below is a microcomedone:

There are two types of acne:

Non-inflammatory acne

Microcomedones become non-inflamed skin blemishes called comedones--either a whitehead or a blackhead:

Whitehead

When the trapped sebum and bacteria stay below the skin surface, a whitehead is formed. Whiteheads may show up as tiny white spots, or they may be so small that they are invisible to the naked eye.

Blackhead

A blackhead occurs when the pore opens to the surface, and the sebum, which contains the skin pigment melanin, oxidizes and turns a brown/black color. It is not dirt and can not be washed away. Blackheads can last for a long time because the contents very slowly drain to the surface.

A blackhead or whitehead can release its contents to the surface and heal. Or, the follicle wall can rupture and inflammatory acne can ensue (see below). This rupture can be caused by random occurrence or by picking or touching the skin. This is why it is important to leave acne prone skin relatively untouched.

Inflammatory acne

Papule

A papule occurs when there is a break in the follicular wall. White blood cells rush in and the pore becomes inflamed.

Pustule

A pustule forms several days later when white blood cells make their way to the surface of the skin. This is what people usually refer to as a "zit" or a "pimple".

An inflamed lesion can sometimes completely collapse or explode, severely inflaming the surrounding skin, and sometimes engulfing neighboring follicles. These lesions are called nodules or cysts:

Nodule

When a follicle breaks along the bottom, total collapse can occur, causing a large, inflamed bump that can be sore to the touch.

Cyst

Sometimes a severe inflammatory reaction can result in very large pus filled lesions.

Milia

Milia are tiny white bumps that occur when normally sloughed skin cells get trapped in small pockets on the surface of the skin. They are common in newborns across the nose and upper cheeks and can also be seen on adult skin. The bumps disappear as the surface is worn away and the dead skin is sloughed. In newborns, the bumps usually disappear within the first few weeks of life. However, for adults milia may persist indefinitely.

Treatment is usually not indicated in children. Adults can have them removed by a physician for cosmetic improvement.
for complete information on milia.

Ethnic Skin and Acne

Acne and Black Skin

Acne and black skin

Overview: Acne is the most common skin disorder in black adolescents and black adults and is often the primary reason for a visit to a doctor or dermatologist. According to the Journal of the European Academy of Dermatology and Venereology, "Acne vulgaris is an extremely common dermatological problem in Africans and people of African descent worldwide." Despite this prevalence, relatively few studies have been conducted on people with black skin. Not surprisingly, people with dark skin often experience the same intense distress from acne.

What is different about black skin: People with black skin tend to have inflammatory acne, which is the most common type of acne. This is actually good news because inflammatory acne is easier to treat than non-inflammatory acne. Black people also tend to have less nodules and cysts, the more severe types of acne lesions. Despite the fact that black people tend to have less severe lesions, there is a higher chance of keloid scarring, especially on the chest and back, making effective acne prevention paramount. Next, people with dark skin tend to have more incidence of post-inflammatory , a big word that means marks left after acne goes away. This is such a big issue that dermatologists often remark on how their black patients consider these marks worse than the acne itself. Click on the Dark Spots tab above to learn more about how to contend with these dark spots that acne leaves behind.

Pomade acne - a special case: Sometimes the greasy emollients which make up black hair care products can come into contact with the skin and aggravate acne. If you use these products and tend to break out along your hair line or in places where your particular hair style comes into contact with your skin, this may be the culprit.

How to treat acne in black skin: Luckily, inflammatory acne develops and is treated the same way in people regardless of skin color, and with the right regimen is easy to clear. There are several options including topical treatment as well as . According to the International Journal of Dermatology, "benzoyl peroxide is particularly effective for the inflammatory component." Benzoyl peroxide is a mild drying and peeling agent, but people with black skin tend to have less flakiness and scaling of the skin and tolerate it well. I outline a highly effective here on Acne.org.

The bottom line: The first and foremost concern should be prevention. Preventing acne will prevent the dark spots that are often left behind and will also prevent scarring. Concentrate your efforts on clearing up your acne and getting it under complete control. Then, if you choose, you can embark on one of the many methods of hastening healing of the dark spots that are left behind.

Note: People of African descent should not take the antibiotic minocycline to treat acne symptoms. "Fatal cases of hypersensitivity" have been reported with this drug in people of African descent.

Diet and acne

Info on the diet and acne connection

• Q:

  Are diet and acne related?

  A:

  The only real answer we have at this point in our research is we don't know for sure. More research is needed.

• Q:

  It seems like common sense that diet and acne would be related. But is there a scientific reason why they might be related?

  A:

  Diet has a direct effect on our body's insulin levels. Insulin is our master hormone and affects all of our other hormones, including our androgens (male hormones). Scientists heavily suspect that hormonal fluctuations, particularly in our androgen levels, can result in acne flare ups. Insulin also affects growth hormone and a host of other hormones which may be related to acne formation on a cellular level. It is hypothesized, yet unproven, that a diet which causes insulin spikes may affect the pathogenesis (development) of acne.

  The right diet may also be related to acne in positive ways. Eating a low glycemic diet rich in veggies, fruit, seafood, and grass-fed meat can help stabilize insulin levels, which theoretically may have an impact. Also, ingesting Omega-3 fats, such as fish oil, for instance, has been shown to be a powerful anti-inflammatory agent in our body. Since a big part of acne is inflammation, it makes theoretical sense that eating an anti-inflammatory diet would help.

• Q:

  So why have doctors always said it's a myth?

  A:

  Quite honestly, calling the diet and acne connection a myth just happened to catch on as prevailing wisdom after two studies were released in 1969 and 1971. The 1969 study was aimed at determining whether chocolate and acne are related. Two groups were given chocolate bars. One group was given chocolate bars with zero cocoa content, and the other group was given chocolate bars with a huge cocoa content. The two groups fared equally well as far as their acne was concerned. However, the chocolate bars both had sugar, milk, etc. The study was only testing cocoa in particular. The 1971 study asked college students, "What do you think causes your acne?" and the students were then given lots of that food. However, the students' baseline diets were not measured, there was no control group, the data was not analyzed, and the lesion count was not presented. No other studies comparing diet and acne have been performed since these two, until very recently. Obviously, from these two studies we cannot conclude that diet and acne are not related. We simply do not have the science until we perform more research. In my opinion, it is premature to say diet and acne are, or are not, related.

  The recent study I referred to was performed in 2002. It was an epidemiological study and was published in the Archives of Dermatology. Dr. Cordain and Dr. Lindeberg studied indigenous tribes of hunter/gatherers, including 1200 Kitavan islanders off Papua New Guinea as well as a small group of Ache people in the remote jungle of Paraguay. There was zero incidence of acne in either population. Is this due to their diet? We are uncertain, but it is intriguing.

• Q:

  So what are our next steps?

  A:

  We have a unique historical opportunity here at Acne.org to share our own stories and move toward a greater consensus regarding diet and acne. Please keep sharing them on the . I'm also working on releasing a few new parts of the web site which will be more scientifically sound and user friendly so we can approach this topic in an empirical way. In the meantime while we try to figure out how diet and acne are related, appropriate topical can get acne under control for now.

Stress and acne

Info on the stress and acne connection and tips on how to chill out

• Q:

  Are stress and acne related?

  A:

  Yes. Stress can aggravate symptoms, but moderate or light stress can be overcome with the right and need not prevent clear skin.

• Q:

  What do we mean by "stress" anyway?

  A:

  Stress is any taxing of our emotional or physical being. Widely defined this can include pretty much everything, but for our purposes here, we'll define it as any undue emotional or physical strain. What might be surprising about this definition is that it includes physical strain. Many people view stress as just an emotional issue, but when we're speaking about acne, it is best to include undue physical strain in our definition since both can come into play.

  Examples of emotional stress:

  • Anxiety regarding an upcoming big event, i.e. a wedding or important test
  • Bullying
  • Relationship problems
  • Overwhelming workload
  • Health of loved one

  Examples of physical stress:

  • Overly demanding sports or exercise schedule without adequate rest
  • Lack of sleep
  • A hectic lifestyle - can lead to physical tension and shallow breathing
  • Sedentary lifestyle
  • Smoking/drugs
• Q:

  So how does stress affect acne?

  A:

  The average acne sufferer has clogged pores that they can't even see. Stress has an inflammatory response in the body and can cause the walls of these pores to literally break. When this happens, the body's response is redness around the broken pore, and an influx of pus (a zit).

  Also, when we are stressed, our adrenal gland goes into overdrive. Androgens (male hormones), which are made in this gland, increase. Increased androgens can lead to more acne. This is especially true in women, who produce a much larger percentage of their androgens in the adrenal gland than men. This may explain why stress seems to affect women more than men when it comes to acne.

• Q:

  So what do I do to handle stress?

  A:

  Here are three effective tools:

  • Exercise: so long as you're not overdoing it, exercise is the best way to reduce stress. Get your heart going and it will reward you with more oxygen to your brain and a reduced stress response. Try to get your body moving at least three times a week for a good half hour or more. Don't believe it? Try it and see. It makes an incredible difference.
  • Take time each day to meditate or do deep breathing exercises.
  • Get a good night's sleep.

Acne.org - A community organization

Body acne - body acne treatment

Body Acne is common on the chest, back, shoulders and even the buttocks, but it can appear anywhere on the body.

• 
  

  Hi guys. is the result of over 20 years of researching everything Acne and using myself as a guinea pig. And the good news is I found what works. Its a very simple but very precise way of washing and treating your skin with over the counter products that you can get anywhere. It works for just about everyone. I still use it every day to stay clear. and let me know what you think.

• 
  

• See what people are saying or share your story on the body acne message board.

• 
• 

  Member posted pics and blogs about being on the regimen.

What is body acne?

Body acne, just like facial acne, is a genetic disease. If your mother or father had body acne, chances are you're likely to struggle with it yourself. Studies show us that most people with facial acne have some amount of body acne as well. Body acne develops in a similar way to facial acne. However, the skin on the body can be thicker than that on the face and often has larger pores, making for more severe acne lesions at times.

Acne can develop anywhere on the body except for the palms of the hands and the soles of the feet. That is because these are the only two areas which do not have sebaceous glands where acne is formed. So, if you're wondering if the pus filled red marks on your arms, legs, buttocks, or elsewhere are acne, chances are they just might be. If you are unsure, see a dermatologist for a diagnosis.

Causes of body acne

As with any type of acne, the exact cause of body acne remains unknown. However, we do know that irritation can make it worse. Anything that rubs against your skin can cause irritation. Our bodies are constantly in contact with things, so it makes no sense to try to avoid all rubbing. If you are experiencing acne in one area, try to be cognizant of what might be regularly rubbing and irritating that area and make a change if you can. Damp, sweaty clothing combined with irritation tends to aggravate acne even more.

Avoiding irritation

• Wear breathable cotton clothing when possible. If you get sweaty, try to change your clothing when you can.
• Time your workouts so that you can shower and treat your skin using the Body Regimen afterward.
• Generally try to be aware of what might be irritating your skin in areas where you break out regularly and make changes where you can.

Adult acne

Statistics

Adult acne affects 25% of all adult men and 50% of adult women at some time in their adult lives. One third of adults affected with facial acne also have . These are the official statistics, but I personally don't know many adults who have not had a zit or two in their adult lives. People can develop unpleasant acne or have an acne recurrence in their 20s, 30s, 40s and beyond. Dermatologists are seeing more adult acne than in previous decades. An article in the International Journal of Cosmetic Science in 2004 stated, "Recent epidemiological studies show that there appears to be an increase in post-adolescent acne, and that the disease is lasting longer and is requiring treatment well into the mid forties." Regardless of when someone struggles with acne, it can be difficult to cope, and can cause depression and social anxiety in an adult the same way it can in a teen.

Causes of adult acne

Although the acne are unknown, possible causes include , cosmetics, , and an increase of resistant bacteria. Women in particular often experience premenstrual flares, often around the mouth.

Treatment of adult acne

There are many adult acne products, however, in my experience, the overall best treatment for adult acne is identical to the best treatment for teen acne, benzoyl peroxide. But benzoyl peroxide must be administered in a very specific manner to achieve total clearing. See the for a step-by-step program you can use to clear your skin using benzoyl peroxide. Thousands of adults have used the Regimen to treat their acne with great results.

Not so uncommon

It is important to realize that adult acne is more common than people may think, and adult sufferers are not alone. If you are troubled by adult onset acne, promptly consult your doctor. She or he may have a hormonal adult acne treatment that can help, or read the and give it a go.

You can find further tips to stop adult acne on the . Many adults frequent the boards and are happy to answer questions.

Female acne

Some facts about women and acne

• As a general rule, women's hormones tend to fluctuate more than men, which helps explain why acne in women tends to be less constant and more erratic than acne in men.
• More than half of adult women experience at least occasional breakouts.
• 60-70% of women who battle with acne experience premenstrual flare-ups.
• Acne can occur throughout a woman's adult life, in early adulthood, in the late twenties and thirties (which I have personally seen quite a bit), during pregnancy, and during menopause.
• Hormonal acne can be frustrating, but can be effectively treated.

Hormonal acne influences

Premenstrual acne flare-ups may be caused by over-stimulated androgens (male hormones). These hormones stimulate oil glands in the skin. During the pre-menstrual period, a woman's oil-producing glands can go into overdrive. Women may also see acne throughout their entire monthly cycle, the cause of which we still do not fully understand.

When pregnant women experience an acne flare-up, it is typically early in their pregnancy. Later in the pregnancy, the skin will often clear up. Acne can then flare again a few months after giving birth. Why? Again, we are not certain, but we suspect this is due to a change in hormones. As a general rule, any time we see hormones fluctuate in any direction, acne can pop up. During pregnancy in particular, it is extremely important for the expectant mother to speak closely with her doctor regarding appropriate and safe

Women experiencing menopause or post-menopause may also experience hormonal acne. Why? You guessed it. We suspect this is due to hormonal fluctuations that occur at this time in a woman's life.

Treatment options

For many women, the right topical medications can keep acne at bay. However, for women who have found that topical medications have not been helpful, there are still options available. After consulting with a physician, many women may turn to birth control pills. As an acne treatment, certain birth control pills, when used in low dosages, can decrease the amount of androgens, thereby limiting breakouts. However, just like after pregnancy, when a woman stops taking birth control pills, her acne can flare. Before deciding on this type of treatment, women should be aware of the side effects associated with birth control pills and consult a gynecologist. Another more recent prescription option for women is . Spironolactone is a potassium-sparing diuretic which can be used as an androgen-receptor blocker to treat acne in women. By suppressing the androgens, it helps to reduce sebum production.

In my experience, men and women do not differ much in terms of effective acne treatments, and appropriate application of topical treatment is often the best option. I have personally coached many people, male and female, through the with equal success.

References

A. Goodfellow, J. Alaghband-Zadeh, G. Carter, J.J. Cream, S. Holland, J. Scully, P. Wise (1984) Oral spironolactone improves acne vulgaris and reduces sebum excretion. British Journal of Dermatology 111 (2), 209-214 doi:10.111/j.1365-2133.1984.tb04045.x

Fulton, James E. Acne Rx. James E. Fulton Jr., M.D., PhD: 2001. 107-115.

Preston, Lydia. "Breaking Out" A Woman's Guide to Coping with Acne at Any Age. Fireside 2004.

Hormones and acne

Acne by its very nature can be considered a hormonal disease. Hormones are responsible for the maturation of the oil glands in our skin. This is why children do not experience acne.

Testosterone

There are several times in our lives when our hormones can become unbalanced and wreak havoc, including puberty, pregnancy, menopause, and, well, any other time they feel like it. More specifically, acne may be precipitated by androgens, male hormones present in both men and women. The oil surplus created by these hormones may be instrumental in clogging hair follicles where bacteria grows and causes acne pimples and blemishes.

Estrogen

Hormonal acne is seen mostly in women due to the natural cycles a woman goes through, such as menstruation, pregnancy and menopause. Because of this, some low-dose are prescribed to reduce blemishes by keeping androgens steady. Anyone considering using this type of treatment should consult a physician first.

I have received many e-mails from women in their late 20s and older who are experiencing an acne flare-up or even acne for the first time in their lives. These women have also reported that the helps clear up their adult onset hormone induced acne, so the Regimen is definitely worth a shot.

References

Antibiotic resistance

Antibiotics have been a mainstay of acne treatment for decades. Antibiotics help kill acne bacteria (P. acnes) and also help reduce inflammation. However, it has also long been noted that they only work for about half of the population, and produce only moderate effectiveness. Next, they often only work for a short period of time. Acne tends to "get used to" antibiotic treatment and become resistant to it.

Stats: A large study conducted by the British Journal of Dermatology studied 4274 acne patients and found that since 1991 an average of 51% of patients harbored colonies of resistant bacteria. Other studies have shown similar levels of bacteria resistant acne bacteria. Interestingly, researchers are finding similar levels of resistance in both patients treated with antibiotics and those untreated as well, although those untreated have somewhat lower levels of resistance.

How it happens: On a microscopic level, geneticists and biologists are finding multiple possible reasons why this occurs. The first is gene mutation within a bacteria cell. Bacteria have also been observed banding together and producing biofilms, a coating which slows down penetration of antibacterial medication.

What to do about it: First, have a talk with your doctor if you are on long term antibiotic therapy. Next, if you are given antibiotics from a doctor, do not stop your course before speaking with her/him about it.

What stands out in the literature most boldly is the value of combining antibiotics with benzoyl peroxide or retinoids. When mixed with benzoyl peroxide, antibiotic therapy kills 99.9% of bacteria, resistant or not. Data is less available regarding the combination of retinoids such as Retin-A® or Adapalene® with antibiotic treatment. Lastly, isotretinoin (Accutane) has been shown to kill about 90% of these resistant bacteria, but still leave large colonies behind.

My 2 cents: I was on oral and/or topical antibiotics for a year or so altogether. Neither therapy did anything for me. Nothing. My skin was actually at its worst in my lifetime when I was on Clindamycin, a topical antibiotic. Antibiotics for me were like a bad joke-promising help but delivering nothing. Accutane finally cleared me up, although not entirely. When my acne returned after my the here at Acne.org finally got me cleared up for good.

References

"About antibiotic resistance." APUA: Alliance for the Prudent Use of Antibiotics. 8 April 2009. link.

Bojar RA, Holland KT. "Acne and Propionibacterium acnes." Clinics in Dermatology. 2004 Sep-Oct;22(5):375-9.

Coates P, Vyakrnam S, Eady EA, Jones CE, Cove JH, Cunliffe WJ. "Prevalence of antibiotic-resistant propionibacteria on the skin of acne patients: 10-year surveillance data and snapshot distribution study." The British Journal of Dermatology. 2002 May;146(5):840-8.

Coates P, Vyakrnam S, Ravenscroft JC, Stables GI, Cunliffe WJ, Leyden JJ, Johnson J, Eady EA, Cove JH. "Efficacy of oral isotretinoin in the control of skin and nasal colonization by antibiotic-resistant propionibacteria in patients with acne." The British Journal of Dermatology. 2005 Dec;153(6):1126-36.

Del Rosso JQ, Leyden JJ, Thiboutot D, Webster GF. "Antibiotic use in acne vulgaris and rosacea: clinical considerations and resistance issues of significance to dermatologists." Cutis. 2008 Aug;82(2 Suppl 2):5-12.

Del Rosso JQ. "Selection of therapy for acne vulgaris: balancing concerns about antibiotic resistance." Cutis. 2008 Nov;82(5 Suppl):12-6.

Dreno B, Reynaud A, Moyse D, Habert H, Richet H. "Erythromycin-resistance of cutaneous bacterial flora in acne." European Journal of Dermatology. 2001 Nov-Dec;11(6):549-53.

Dréno B. "General antibiotic therapy in acne." [Article in French] La Revue du praticien. 2002 Apr 15;52(8):841-3.

Eady AE, Cove JH, Layton AM. "Is antibiotic resistance in cutaneous propionibacteria clinically relevant? : implications of resistance for acne patients and prescribers." American Journal of Clinical Dermatology. 2003;4(12):813-31.

Garner SE, Eady EA, Popescu C, Newton J, Li WA. "Minocycline for acne vulgaris: efficacy and safety." Cochrane Database of Systematic Reviews. 2003;(1):CD002086.

Ishida N, Nakaminami H, Noguchi N, Kurokawa I, Nishijima S, Sasatsu M. "Antimicrobial susceptibilities of Propionibacterium acnes isolated from patients with acne vulgaris." Microbiology and Immunology. 2008 Dec;52(12):621-4.

Leyden J, Levy S. "The development of antibiotic resistance in Propionibacterium acnes." Cutis. 2001 Feb;67(2 Suppl):21-4.

Leyden J. "New developments in topical antimicrobial therapy for acne." Journal of Drugs in Dermatology. 2008 Feb;7(2 Suppl):s8-11.

Leyden JJ, Del Rosso JQ, Webster GF. "Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: a status report." Dermatologic Clinics. 2009 Jan;27(1):1-15.

Leyden JJ, Wortzman M, Baldwin EK. "Antibiotic-resistant Propionibacterium acnes suppressed by a benzoyl peroxide cleanser 6%." Cutis. 2008 Dec;82(6):417-21.

Leyden JJ. "Antibiotic resistance in the topical treatment of acne vulgaris." Cutis. 2004 Jun;73(6 Suppl):6-10.

Leyden JJ. "Effect of topical benzoyl peroxide/clindamycin versus topical clindamycin and vehicle in the reduction of Propionibacterium acnes." Cutis. 2002 Jun;69(6):475-80.

Leyden, JJ. "Current issues in antimicrobial therapy for the treatment of acne." Journal of the European Academy of Dermatology and Venereology. 2001;15 Suppl 3:51-5.

McInturff JE, Wang SJ, Machleidt T, Lin TR, Oren A, Hertz CJ, Krutzik SR, Hart S, Zeh K, Anderson DH, Gallo RL, Modlin RL, Kim J. "Granulysin-derived peptides demonstrate antimicrobial and anti-inflammatory effects against Propionibacterium acnes." Journal of Investigative Dermatology. 2005 Aug;125(2):256-63.

Mills O Jr, Thornsberry C, Cardin CW, Smiles KA, Leyden JJ. "Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle." Acta Dermato-venereologica. 2002;82(4):260-5.

Ochsendorf F. "Systematic therapy of acne vulgaris." Journal of the German Society of Dermatology. 2006 Oct;4(10):828-41.

Oprica C, Emtestam L, Lapins J, Borglund E, Nyberg F, Stenlund K, Lundeberg L, Sillerstöm E, Nord CE. "Antibiotic-resistant Propionibacterium acnes on the skin of patients with moderate to severe acne in Stockholm." Anaerobe. 2004 Jun;10(3):155-64.

Ozolins M, Eady EA, Avery A, Cunliffe WJ, O'Neill C, Simpson NB, Williams HC. "Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne." Health Technology Assessment. 2005 Jan;9(1):iii-212.

Qureshi A. "Survival of antibiotic-resistant Propionibacterium acnes in the environment." 14th European Congress of Clinical Microbiology and Infectious Diseases 2004, Prague, poster presentation. Abstract number: 902_p818. Accessed online on the 8th of April, 2009. link.

Ross JI, Snelling AM, Carnegie E, Coates P, Cunliffe WJ, Bettoli V, Tosti G, Katsambas A, Galvan Peréz Del Pulgar JI, Rollman O, Török L, Eady EA, Cove JH. "Antibiotic-resistant acne: lessons from Europe." The British Journal of Dermatology. 2003 Mar;148(3)467-78.

Ross JI, Snelling AM, Eady EA, Cove JH, Cunliffe WJ, Leyden JJ, Collignon P, Dréno B, Reynaud A, Fluhr J, Oshima S. "Phenotypic and genotypic characterization of antibiotic-resistant Propionibacterium acnes isolated from acne patients attending dermatology clinics in Europe, the U.S.A., Japan and Australia." The British Journal of Dermatology. 2001 Feb;144(2):339-46.

Simonart T, Dramaix M. "Treatment of acne with topical antibiotics: lessons from clinical studies." The British Journal of Dermatology. 2005 Aug;153(2):395-403.

Tan AW, Tan HH. "Acne vulgaris: a review of antibiotic therapy." Expert Opinion on Pharmacotherapy. 2005 Mar;6(3):409-18.

Theilitz A, Gollnick H. "Systematic acne therapy." [Article in German] Hautarzt. 2005 Nov;56(11):1040-7.

Thevarajah S, Balkrishnan R, Camacho FT, Feldman SR, Fleischer AB Jr. "Trends in prescription of acne medication in the US: shift from antibiotic to non-antibiotic treatment." The Journal of Dermatologic Treatment. 2005;16(4)224-8.

Worret WI, Fluhr JW. "Acne therapy with topical benzoyl peroxide, antibiotics and azelaic acid." [Article in German] Journal of the German Society of Dermatology. 2006 Apr;4(4):293-300.

Zouboulis CC, Piquero-Martin J. "Update and future of systemic acne treatment." Dermatology. 2003;206(1):37-53.

Cure Acne in 3 days!

The market is littered with "cures for acne". However, if you ask any dermatologist or medical researcher, they will tell you a cure does not exist. While Accutane does provide long term remission for some patients and an argument could be made that it approaches an "acne cure" in these cases, you will not find a cure on the Internet or in the back of a magazine.

Since there is no cure for acne, your time is better spent looking at how to treat and prevent acne. In my experience, is the best over-the-counter medication for preventing acne. But with benzoyl peroxide, as with any other acne medication aside from , you must be deliberate and steady and follow an acne treatment regimen until you grow out of acne naturally. Prevention is the key.

For a free, non-commercial acne prevention regimen, visit the pages of Acne.org.

Note: I think the human race would be better off without it, and with today’s knowledge and technology, I think it’s possible. I am spending most of my time researching at this point, delving deeper and deeper into how the pore works on a microscopic level and then researching possible ways to interrupt the acne process within the skin. I am always looking for interns to help me with this process. If you are passionate about research, meticulous, and a good communicator, please feel free to regarding internship opportunities.

Smoking and acne - how cigarettes affect the skin

Smoking causes three million deaths per year worldwide. It causes many forms of cancer and untold pain and suffering, not to mention billions of dollars in preventable health care costs. Common sense says that smoking negatively effects almost every bodily condition, but evidence is mounting from smoking studies around the world that people who smoke are no more likely to break out. The most impressive is a study published in the Journal of Investigative Dermatology in 2006 in which trained nurses interviewed 27,083 young men over a 20 year period. The conclusion was surprising: “Active smokers showed a significantly lower prevalence of severe acne than nonsmokers.” In another study, published in 2007 in the Journal of the European Academy of Dermatology and Venereology, researchers reported that of the 594 participants studied, “In girls, smoking was significantly associated with lower prevalence of acne…No significant associations between acne and smoking variables were detected among boys.” A study published in the British Journal of Dermatology in 2001 seems to refute these findings. 896 people were examined for the study. Smokers tended to have more acne, and the more they smoked, the worse their acne presented itself. Other studies have showed no statistical difference between smokers and non-smokers in regards to acne. In short, evidence is conflicting and the medical research community needs quite a bit more data to come to a consensus.

Smoking harms skin health: While smoking may or may not aggravate acne, it nevertheless does harm the skin. Smoking constricts blood vessels and damages the surface of many parts of our bodies, from the cells that line our organs to the skin that protects us. It also induces an inflammatory reaction in the body, precipitating a huge list of diseases. Specific to the skin, smoking is linked to poor wound healing and psoriasis. It may also be related to skin cancers.

Smoking harms skin appearance: Smoking is also closely associated with wrinkles and premature skin aging. Smoking creates free radicals, impairs collagen production, and degrades skin proteins, all of which age the skin. Quitting smoking, or not taking up smoking in the first place, is one of the best preventative measures against premature aging. Smoking can also stain the teeth and hasten hair loss. Not surprisingly, in surveys of body esteem, smokers tend to rank lower than non-smokers.

Nicotine, the wild card: As with many things in life, there are exceptions to the rule. For instance, evidence is showing that smoking may actually help protect against mouth sores and rosacea. And as we see in the latest studies of smoking and acne, smoking may perhaps help reduce the severity of acne. The potential positive effects of smoking are most likely from nicotine, and not from smoking itself. Nicotine by itself is not necessarily harmful. In the case of acne, the constriction of blood vessels that nicotine produces may inhibit the production of more severe forms of acne in a lucky few people. How and if this happens is still up to debate.

References

Beylot C. “Mechanisms and causes of acne.” [Article in French] La Revue du Praticien. 2002 Apr 15;52(8):828-30.

Chuh AA, Zawar V, Wong WC, Lee A. “The association of smoking and acne in men in Hong Kong and in India: a retrospective case-control study in primary care settings.” Clinical and Experimental Dermatology. 2004 Nov;29(6):597-9.

Firooz A, Sarhangnejad R, Davoudi SM, Nassiri-Kashani M. “Acne and smoking: is there a relationship?” BMC Dermatology. 2005 Mar 24;5:2.

Freiman A, Bird G, Metelitsa AI, Baranklin B, Lauzon GJ. “Cutaneous effects of smoking.” Journal of Cutaneous Medicine and Surgery. 2004 Nov-Dec;8(6):415-23.

Jemec GB, Linneberg A, Nielsen NH, Frølund L, Madsen F, Jørgensen T. “Have oral contraceptives reduced the prevalence of acne? a population-based study of acne vulgaris, tobacco smoking, and oral contraceptives.” Dermatology. 2002;204(3):179-84.

Just-Sarobé M. “Smoking and the skin.” [Article in Spanish] Actas Dermo-Sifiliográficas. 2008 Apr;99(3):173-84.

Klaz I, Kochba I, Shohat T, Zarka S, Brenner S. “Severe acne vulgaris and tobacco smoking in young men.” Journal of Investigative Dermatology. 2006 Aug;126(8):1749-52. Epub 2006 Apr 27.

Kornblau IS, Pearson HC, Breitkopf CR. “Demographic, behavioral, and physical correlates of body esteem among low-income female adolescents.” Journal of Adolescent Health. 2007 Dec;41(6):566-70. Epub 2007 Sep 29.

Krug M, Wünsche A, Blum A. “Addiction to tobacco and the consequences for the skin.” [Article in German] Hautarzt. 2004 Mar;55(3):301-15; quiz 316.

Morita A. “Tobacco smoke causes premature skin aging.” Journal of Dermatological Science. 2007 Dec;48(3):169-75. Epub 2007 Oct 24.

Rigopoulos D, Gregoriou S, Ifandi A, Efstathiou G, Georgala S, Chalkias J, Katsambas A. “Coping with acne: beliefs and perceptions in a sample of secondary school Greek pupils.” Journal of the European Academy of Dermatology and Venereology. 2007 Jul;21(6):806-10.

Rombouts S, Nijsten T, Lambert J. “Cigarette smoking and acne in adolescents: results from a cross-sectional study.” Journal of the European Academy of Dermatology and Venereology. 2007 Mar;21(3):326-33.

Schäfer T, Nienhaus A, Vieluf D, Berger J, Ring J. “Epidemiology of acne in the general population: the risk of smoking.” The British Journal of Dermatology. 2001 Jul;145(1):100-4.

Wolf R, Orion E, Matz H, Maitra S, Rowland-Payne C. “Smoking can be good for you.” Journal of Cosmetic Dermatology. 2004 Apr;3(2):107-11.

How to pop a pimple

Common advice is to let your body heal a pimple on its own without popping. But in the real world, some people absolutely refuse to go around with a bulging white zit for the world to see. Plus, when done properly, popping a pimple can actually be beneficial to the healing process. Reserve this technique for only pimples that are absolutely begging to be popped—all the way at the surface and white. After a shower is best, when the skin is supple.

1. Disinfect a needle with rubbing alcohol. A basic sharp sewing needle is a good choice.
2. Gently prick the pimple’s surface.
3. Take two tissues and wrap your index fingers with them.
4. Squeeze from the sides, confidently but gently, using a down-and-in motion. Don’t force it. If the pimple is ready, it’ll pop. If it doesn’t, leave it be. Be sure to stop if clear fluid or blood starts to come out.
5. Continuing to work at a lesion that is not ready to be popped can lead to scarring. Walk away from the mirror!

It is very important to leave deep, painful lesions (cysts and nodules) untouched. Do not attempt to pop them. Instead, a fantastic option for these types of lesions is to see a dermatologist who can administer a cortisone injection which will bring down swelling and potentially reduce or eliminate scarring. Often dermatologists will accept a quick “emergency” appointment for such matters.

What is Mobile VoIP?

Featured Mobile VoIP Provider Reviews

Check out the latest user reviews of these leading Mobile VoIP service providers:

Truphone Review

Truphone Overview

Truphone is a mobile operator for the internet era. Truphone provides service over a third-party WiFi (Wireless Internet) connection that you connect to using your Nokia cellphone. That means free mobile calls to other Truphone users or very cheap calls to anyone else. Truphone can offer these free calls to other Truphone users and low rates to others because Truphone does not use your cellular providers network to send or receive calls, it uses your home, business or public hotspot WiFi connection to route calls over the internet.

Basic Info	Service Provider Answers
Headquarters	London, UK
Year Established	2006
Call Type(s)	Voice over WiFi
Compatible Phones	Nokia E51, E61i, E65, E90, N95, E60, E61, E70, N80ie, N80, N81, N82, N95
Availability	Truphone service can be used anywhere a WiFi network connection is available
Free Calls	With Truphone you can make free WiFi to WiFi calls
Phone Number	Truphone users in the UK and US will get Truphone numbers appropriate to their countries (i.e. +44 and +1 respectively).
Calling Rates	Truphone offers low cost flat rate calling to every country in the world
SMS	Truphone charges 10p/20c per SMS sent to any country worldwide
Instant Messaging	No instant messaging capabilities are available
Special Features	With Truphone there is no charge for inbound calls and you can get your voicemails sent to email

Skype Mobile Review

About Skype Mobile

Skype is a little piece of software that makes communicating with people around the world easy and fun. With Skype you can say hello or share a laugh with anyone, anywhere. And if both of you are on Skype, it’s free. Skype mobile is the mobile version of the peer-to-peer (P2P) VoIP phone service. With Skype mobile and a Window mobile 5.0 and higher cellular phone that has WiFi capabilities you can call your Skype friends for free and everyone else for the same low rates as you would with your PC based Skype account.

Basic Info	Skype Mobile Answers
Headquarters	Luxembourg
Year Established	2003
Call Type(s)	Voice over WiFi (VoWiFi), Voice over 3G (Vo3G)
Compatible Phones	Skype Mobile is compatible with the Nokia N800/N810 Internet Tablet and all Windows 5.0 and higher handsets.
Availability	Skype Mobile is available anywhere there is a WiFi network connection or a 3G cellular network via the Skypephone.
Free Calls	All Skype Mobile to Skype Mobile user calls are free. SkypePro users can also call in-country for free.
Phone Number	With Skype Mobile you can use your existing Skype username and SkypeIn number or if you do not have Skype you will receive a new phone number.
Calling Rates	Skype offers low cost international calls that start around 2.1 cents per minute.
SMS	Skype Mobile offers users the ability to send and receive cheap international SMS messages.
Instant Messaging	Skype Mobile allows users to instant message other Skype users for free.
Special Features	In Europe, Skype has partner with 3, to offer the 3 Skypephone that supports 3G, has a 2-megapixel camera, mp3 player, mobile TV and internet all while leveraging Skype to send and receive calls. Skype also offers, Skype To Go which allows you to make calls over your cellular phone by giving you a number that lets you call friends and family abroad from any phone at Skype rates.

Mobivox Review

MOBIVOX Overview

MOBIVOX makes it possible to call family and friends around the world for free from ANY phone. Just call a local MOBIVOX number and say who you’d like to speak with. No calling cards and long numbers to remember. No need for a computer, special software or complex downloads. With global availability, MOBIVOX means more freedom to share experiences with those you care about no matter where you or they may be.

Basic Info	MOBIVOX Answers
Headquarters	Montreal, Canada
Year Established	2006
Call Type(s)	Call Connect and Call Back Service
Compatible Phones	All Cellular, VoIP and Landline Telephones
Availability	You can make calls with MOBIVOX anywhere you have the ability to make a phone call
Free Calls	You can make free calls to all MOBIVOX members and to all Skype users.
Phone Number	With MOBIVOX there is no need for a new phone number. The only new number you will need is a MOBIVOX local access number that is provided to you when you sign-up.
Calling Rates	MOBIVOX offers 1.9 cents per minute calling to over 40 different countries.
SMS	No SMS capabilities, Although MOBIVOX does offer a SMS Callback service
Instant Messaging	None
Special Features	With MOBIVOX, you can have conference calls with up to 9 different callers, initiate group calls and transfer calls from your mobile phone to a home phone.

Rebtel Review

Rebtel Overview

Rebtel is a mobile VoIP call back service. With Rebtel you give them the phone number of a friend in another country, and we give you a local number for them. You then save this number on your mobile so you can call your friend whenever you want, for a fraction of your normal international rate. Now, if your friend also has Rebtel, you can call each other for absolutely free. First, call your friend on their Rebtel number. Then, ask your friend to call you back. Tell them to use the number shown on their phone screen. From there, stay on the line. In a few seconds your friend will join you back on the call.

Basic Info	Rebtel Answers
Headquarters	Stockholm, Sweden
Year Established	2006
Call Type(s)	Mobile VoIP Call Back Service
Compatible Phones	You can use Rebtel from any cellular, VoIP or land-line telephone.
Availability	Rebtel service is available anywhere there is a cellular, landline or VoIP connection.
Free Calls	Rebtel users can make free calls to all Rebtel users.
Phone Number	With Rebtel there is no need for a new phone number as Rebtel uses your existing cellular, VoIP or land-line telephone to give you free and low cost calling. Rebtel works by taking your existing phone number and assigning it a Rebtel number that other Rebtel users can also use to call you for free. The only new number you will need is a Rebtel local access number that is provided to you when you sign-up.
Calling Rates	Rebtel offers low cost international calls and free in country calling to other Rebtel users
SMS	Rebtel allows you to initiate phone calls via SMS, but does not offer SMS services
Instant Messaging	Rebtel does not offer instant messaging services
Special Features	With Rebtel there is no need for a new phone number as Rebt uses your existing cellular, VoIP or land-line telephone to give you free and low cost calling. You can access their service via SMS, via the web (or via a mobile web browser) in addition to your VoIP, cellular or landline telephone.

fring Review

About fring

fring is a mobile internet service and community that allows users to access and interact with a variety of communication services such as Skype®, MSN® Messenger, Google Talk™, ICQ, SIP, Twitter, Yahoo!™ and AIM®. Through fring, you can send and receive calls as well as message all of your contacts all will using your cellular data plan or a WiFi connection rather than use your minutes. You can even make affordable local and international calls to landline and regular cellular numbers using your SkypeOut/SkypeIn account or almost any VoIP service. fring is compatible with Symbian 8, 9.1, 9.2, Windows Mobile 5 & 6 and UIQ handsets.

Basic Info	fring Answers
Headquarters	London, UK
Year Established	2007
Call Type(s)	Voice over WiFi (VoWiFi), Voice over 3G (Vo3G)
Compatible Phones	fring is compatible with all Symbian 8, 9.1, 9.2, Windows Mobile 5 & 6 and UIQ handsets.
Availability	fring service can be used anywhere you have cellular or WiFi network connectivity.
Free Calls	fring allows you to make free calls to all of your Skype, MSN Messenger, Google Talk, ICQ, Yahoo! and AIM friends.
Phone Number	With fring there is no need for a new phone number since fring leverages your existing communications services.
Calling Rates	fring users can make cheap local and international calls to landlines and regular mobile contacts using your SkypeOut account or hundreds of SIP-based providers such as Eutelia, GizmoProject, VoipCheap, VoipStunt, Free World & SIPNET over fring, even from non-SIP enabled handsets
SMS	fring utilizes your IM clients, rather than SMS messaging.
Instant Messaging	With fring you can instant message your Skype, MSN Messenger, Google Talk, ICQ, SIP, Twitter, Yahoo! and AIM friends.
Special Features	fring users can send and receive files, in addition to setting up auto-roam so that fring automatically detects when you move from one WiFi hotspot to the next.

Vyke Mobile Review

About Vyke Mobile IP

Vyke Mobile IP is a mobile VoIP service from VoIP service provider Vyke. Vyke Mobile IP utilizes a third party WiFi connection to allow users to send and receive calls at Vyke’s low international rates. All you need to use Vyke Mobile IP is a WiFi enabled mobile phone. Vyke Mobile IP features a mobile handset-based application that configures and manages the phone’s connection to Vyke Mobile IP. Ease of use and high quality service typifies the Vyke Mobile IP experience.

Basic Info	Vyke Mobile IP Answers
Headquarters	Snaroya, Norway
Year Established	2000
Call Type(s)	Voice over WiFi (VoWiFi), Voice over 3G (Vo3G)
Compatible Phones	Vyke is compatible with all Nokia E51, E61i, E65, E90, N95, E60, E61, E70, N80ie, N80, N81, N82, N95 handsets
Availability	Vyke Mobile IP is available anywhere there is a WiFi network connection.
Free Calls	All Vyke Mobile IP to Vyke Mobile IP user calls are free.
Phone Number	With Vyke Mobile IP there is no need to use a new phone number.
Calling Rates	Vyke Mobile IP offers low cost international calls that are typically 60% than an incumbant cellular carrier.
SMS	Vyke Mobile IP does not offer SMS service.
Instant Messaging	Vyke Mobile IP does not offer instant messaging services.
Special Features	NA

Yeigo Review

About Yeigo

Yeigo is a free and innovative application for your mobile phone, which uses your phones Internet connection to offer you free calls, Instant Messaging and cut-price text messages. Yeigo allows you to talk whenever you want, wherever you are for as long as you want: because calls to other people using Yeigo are free, and you’ll save up to 80% on calls to those who don’t have Yeigo. In addition to free and low cost calls, you can also use Yeigo to Instant Message other Yeigo users for free, as well as users of GoogleTalk, MSN, Yahoo!, AIM, ICQ and Jabber.

Basic Info	Yeigo Answers
Headquarters	Capetown, South Africa
Year Established	2005
Call Type(s)	Voice over WiFi (VoWiFi), Voice over 3G (Vo3G)
Compatible Phones	Yeigo is compatible with all Symbian 8, 9.1, 9.2, Windows Mobile 5 & 6 handsets.
Availability	Yeigo's service is available anywhere there is a cellular or WiFi network connection as Yeigo leverages Wi-Fi, GPRS/EDGE and 3G/HSDPA networks to send and receive calls.
Free Calls	All Yeigo to Yeigo user calls and instant message are free.
Phone Number	With Yeigo you get one phone number that can be used all over the world.
Calling Rates	Yeigo offers low cost international calls that are typically 80% than an incumbant cellular carrier.
SMS	Yeigo allows users to send and receive international SMS messages at low costs.
Instant Messaging	With Yeigo, you can instant message other Yeigo users for free.
Special Features	Yeigo gives users presence capabilities (ability for other to see your status) and minimizes data usages based on their P2P technology.

MobileTalk Review

Packet8 MobileTalk Overview

Packet8 MobileTalk lets cell phone users make cheap international calls from a mobile phone, reducing their international calling rates by as much as 90%– quickly and easily. No more special PIN codes to keep track of. No more long access numbers to dial. Just the highest quality digital voice service and great calling rates to any of your international locations— all for a low monthly access fee. Simply install the MobileTalk software on cellular phone and dial any friend or family member anywhere in the world.

Basic Info	MobileTalk Answers
Headquarters	Santa Clara, California
Year Established	1987
Call Type(s)	Mobile VoIP Call Back Service
Compatible Phones	You can use MobileTalk from any cellular telephone.
Availability	MobileTalk service is available anywhere there is a cellular network connection.
Free Calls	MobileTalk does not currently offer free calling.
Phone Number	With MobileTalk there is no need for a new phone number as MobileTalk uses your existing cellular telephone to give you low cost calling Over the Packet8 digital network.
Calling Rates	MobileTalk offers low cost international calls starting at 2 cents per minute, with rates 90% lower than traditonal cellualr carriers.
SMS	MobileTalk does not currently offer low cost international SMS services
Instant Messaging	MobileTalk does not offer instant messaging services
Special Features	With MobileTalk, users can call directly from their phone's contact list and speed dials. There are no preset limits, no prepayment required and they over a 30 day money back guarantee.

mobiVoIP Review

mobiVoIP Overview

mobiVoIP is the Mobile VoIP provider to offer a Mobile VoIP solution for Palm OS operating system and PalmOne devices. mobiVoIP is unique in that their service can be used in two ways. The first is as a product whereby a user can leverage their existing SIP based VoIP provider (like Vonage). The second is as a service, wherein the user would send and receive calls through mobiVoIP’s service. MobiVoIP allows a Palm to connect to the Internet through Bluetooth,WiFi, EVDO and even GPRS. The result is low cost international calls for Palm users.

Basic Info	mobiVoIP Answers
Headquarters	Milipitas, California
Year Established	2006
Call Type(s)	Voice over WiFi (VoWiFi), Voice over 3G (Vo3G)
Compatible Phones	mobiVoIP is compatible with all PalmOne devices and handsets using PalmOS 5.0 or greater.
Availability	mobiVoIP service is available anywhere there is a cellular or WiFi network connection.
Free Calls	With mobiVoIP, users can call other mobiVoIP users for free.
Phone Number	mobiVoIP has the ability to port your existing phone number or issue a brand new phone number.
Calling Rates	mobiVoIP offers a number of different plans with rates as low as 2.9 cents per minute.
SMS	mobiVoIP does not currently offer low cost international SMS services
Instant Messaging	MobiVoIP does not offer instant messaging services
Special Features	With mobiVoIP, users can make low cost international calls using their current SIP based service provide (like Vonage) or they can use mobiVoIP low cost service to make international calls.

Mobiboo Review

Mobiboo Overview

Mobibbo is the UK’s first commercial Mobile VoIP provider offering VoIP service over WiFi networks.With Mobiboo’s tovo WiFi phones you can make calls from WiFi hotspots worldwide and eliminate mobile roaming charges. In addition to offering users Mobile VoIP service, Mobiboo also offers a softphone client for a PC or laptop that allows calls to made over a fixed or WiFi internet connection.

Basic Info	Mobiboo Answers
Headquarters	Cheyenne, Wyoming
Year Established	2007
Call Type(s)	Voice over WiFi (VoWiFi)
Compatible Phones	Mobiboo utilizes tovo and UTStarcomm WiFi phones. It does not work on cellular handsets.
Availability	Mobiboo service is available anywhere there is an accessible WiFi network.
Free Calls	With Mobiboo, users can call other Mobiboo users for free.
Phone Number	Mobiboo has the ability to port your existing phone number or issue a brand new phone number.
Calling Rates	Mobiboo offers low cost calls to landline and cellular phones anywhere in the world.
SMS	Mobiboo does not currently offer low cost international SMS services
Instant Messaging	Mobiboo does not offer instant messaging services between Mobiboo users.
Special Features	Mobiboo gives users great flexibility in how they use the service. With the desktop softphone, users can send instant messages, share their desktop with other Mobiboo users and send/receive documents and files. This is in addition to the "mobile" aspect of the service that can be used in conjunction with their WiFi phone.

What are Books on VoIP?

Voice over IP Fundamentals Voice over IP Fundamentals	The authors of Fundamentals--three packet-voice specialists at Cisco Systems--initiate their exploration of next-generation technologies for supporting conversations across large distances: the switched telephone network as implemented on large (intercontinental) and small (building and enterprise) scales. They then point out problems with the old way of doing things and illuminate the standards and regulatory conditions that have made Internet telephony attractive. Signaling System 7 (SS7) gets particularly insightful coverage, with ample graphical support for the clear, fact-rich, example-laden prose. The authors do a great service for readers by breaking packet telephony into its component technologies and explaining each one carefully. Coverage of the various protocols that enable voice over IP, particularly H.323 and Session Initiation Protocol (SIP), is simultaneously clear and deep. The same goes for media gateway protocols and various schemes for translating sounds into digital signals and back again, while retaining maximum clarity. There's even some practical material; concluding chapters diagram Cisco router configurations for voice traffic and flesh out solutions with case studies. You'll like this book if you need to implement a voice over IP system and know more about IP than you do about traditional voice telecommunications. The patient and detailed explanations of traditional telephony concepts and voice over IP protocols will mesh nicely with your existing data communications knowledge, enabling you to make wise design and product decisions.
Switching to VoIP	More and more businesses today have their receive phone service through Internet instead of local phone company lines. Many businesses are also using their internal local and wide-area network infrastructure to replace legacy enterprise telephone networks. This migration to a single network carrying voice and data is called convergence, and it's revolutionizing the world of telecommunications by slashing costs and empowering users. The technology of families driving this convergence is called VoIP, or Voice over IP. VoIP has advanced Internet-based telephony to a viable solution, piquing the interest of companies small and large. The primary reason for migrating to VoIP is cost, as it equalizes the costs of long distance calls, local calls, and e-mails to fractions of a penny per use. But the real enterprise turn-on is how VoIP empowers businesses to mold and customize telecom and datacom solutions using a single, cohesive networking platform. These business drivers are so compelling that legacy telephony is going the way of the dinosaur, yielding to Voice over IP as the dominant enterprise communications paradigm. Developed from real-world experience by a senior developer, O'Reilly's Switching to VoIP provides solutions for the most common VoIP migration challenges. So if you're a network professional who is migrating from a traditional telephony system to a modern, feature-rich network, this book is a must-have. You'll discover the strengths and weaknesses of circuit-switched and packet-switched networks, how VoIP systems impact network infrastructure, as well as solutions for common challenges involved with IP voice migrations.
VoIP For Dummies	Put your phone system on your computer network and see the savings See how to get started with VoIP, how it works, and why it saves you money VoIP is techspeak for "voice over Internet protocol," but it could spell "saving big bucks" for your business! Here's where to get the scoop in plain English. Find out how VoIP can save you money, how voice communication travels online, and how to choose the best way to integrate your phone system with your network at home or at the office. Discover how to Use VoIP for your business or home phone service Choose the best network type Set up VoIP on a wireless network Understand transports and services Demonstrate VoIP's advantages to management.
VoIP Crash Course	Recent advances in VoIP (Voice over IP) technology have made it the solution of choice for voice service because of its low cost and increased reliability. Voice Over IP Crash Course offers practical technology coverage, while discussing the business, strategic and competitive implications of VoIP deployment in corporations. The book also covers the challenges faced by service providers as they evolve to an IP infrastructure while continuing to operate the PSTN.
IP Telephony Unveiled	This book explains four key points to help you successfully implement your strategy: IP telephony works today. This is not new, unproven technology. Thousands of customers have implemented IP telephony successfully. So can you. Expect to save money. IP telephony may well cost your organization money-initially. But the business impact and post-installation process improvements give you a significant and rapid return on your investment. It's more than voice over IP. You'll understand the difference between voice over IP (VoIP) and IP telephony and what that means for your business. This is critical. They are not the same. It's more than a dial tone. There are potential business-impacting applications within your own organization. IP Telephony Unveiled helps you recognize these applications. The emerging IP telephony market is fraught with misunderstandings and misinformation. IP telephony can impact a company's business model in tremendous ways. It can open new revenue streams, enhance profitability, drive new levels of customer and employee satisfaction, and be a key enabler in a company's strategy to differentiate itself competitively-but only if you're aware of these benefits. IP Telephony Unveiled is written for all those responsible for corporate strategies for revenue generation, cost containment, and customer satisfaction. IP Telephony Unveiled uncovers the value behind this technology, which helps you see past what might appear to be only a new telephone system, to understand the strategic enabler laying dormant in many companies' networks. Through this book, you will understand the real benefits of an IP telephony strategy and get assistance in developing this strategy inside your organization.
Taking Charge of Your VoIP Project	The step-by-step approach to VoIP deployment and management enables you to plan early and properly for successful VoIP integration with your existing systems, networks, and applications. The detailed introduction offers a common grounding for members of both the telephony and data networking communities. IT managers and project leaders are armed with details on building a business case for VoIP, including details of return-on-investment (ROI) analysis and justification. A VoIP deployment is presented as a major IT project, enabling you to understand the steps involved and the required resources. The comprehensive look at quality of service and tuning describes when and where to use them in a VoIP deployment. These are often the most complex topics in VoIP; you'll get smart recommendations on which techniques to use in various circumstances. You learn how to plan for VoIP security, including prevention, detection, and reaction. Voice over IP (VoIP) is the telephone system of the future. Problem is, VoIP is not yet widely deployed, so there are few skilled practitioners today. As you make your move to VoIP, how will you know how to make VoIP work and keep it working well? What changes will you need to make without disrupting your business? How can you show your return on this investment? Many books contain technical details about VoIP, but few explain in plain language how to make it run successfully in an enterprise. Taking Charge of Your VoIP Project provides the detailed plans you need to be successful in your organization's deployment of VoIP. Through their years of work in the field, authors John Q. Walker and Jeffrey T. Hicks bring a project-oriented approach to VoIP, with much-needed clarity on getting VoIP to work well. Taking Charge of Your VoIP Project starts with simple concepts, each chapter building on the knowledge from the last. Although not a technical manual, you learn about the standards, such as H.323, G.711, and Real-Time Transport Protocol (RTP), and the implications they have on your VoIP system. Most importantly, you'll gain expert advice and a systematic guide on how to make VoIP work for your organization.
VoIP Security	VoIP Security has been designed to help the reader fully understand, prepare for and mediate current security and QoS risks in todays complex and ever changing converged network environment and it will help you secure your VoIP network whether you are at the planning, implementation, or post-implementation phase of your VoIP infrastructure. This book will teach you how to plan for and implement VoIP security solutions in converged network infrastructures. Whether you have picked up this book out of curiosity or professional interest . . . it is not too late to read this book and gain a deep understanding of what needs to be done in a VoIP implementation. In the rush to be first to market or to implement the latest and greatest technology, many current implementations of VoIP infrastructures, both large and small, have been implemented with minimal thought to QoS and almost no thought to security and interoperability.
IP Telephony: Deploying Voice-over-IP Protocols	IP Telephony, enabled by softswitches, is going to usher in a new era in telecommunications. By putting voice and data over one IP network, operators can enjoy lower costs and create new, revenue-generating "multimedia" services. This valuable reference offers a comprehensive overview of the technology behind IP telephony and offers essential information to network engineers, designers and managers who need to understand the protocols and explore the issues involved in migrating the existing telephony infrastructure to an IP-based real time communication service. Drawing on extensive research and practical development experience in VoIP from its earliest stages, the authors give access to all the relevant standards and cutting-edge techniques in a single resource. IP Telephony: Deploying Voice-over-IP Protocols: Assumes a working knowledge of IP and networking and addresses the technical aspects of real-time communication over IP. Presents a high level overview of packet media transport technologies, covering all the major VoIP protocols - SIP, H323 and MGCP Details specific strategies to design services for public networks where endpoints cannot be trusted and can be behind firewalls. Explores the problems that may arise from incomplete protocol implementations, or architectures optimized for private networks which fail in a public environment. This amply illustrated, state-of-the art reference tool will be an invaluable resource for all those involved in the practical deployment of VoIP technology.
Beyond VoIP Protocols: Understanding Voice Technology and Networking Techniques for IP Telephony	This book offers a comprehensive overview of the issues to solve in order to deploy global revenue-generating effective "multimedia" services. Drawing on extensive research and practical deployment experience in VoIP, the authors provide essential advice for those seeking to design and implement a post-bubble VoIP network. Beyond VoIP Protocols: Understanding Voice Technology and Networking Techniques for IP Telephony Introduces the basics of speech coding and voice quality Demonstrates how quality of service may be built into the network and deals with dimensioning aspects, e.g. multipoint communications and how to model call seizures. Explores the potential of multicast to turn an IP backbone into an optimized broadcast medium Includes amply illustrated, state-of-the-art practical advice for formulating a complete deployment strategy A companion volume to "IP Telephony: Deploying VoIP Protocols", this book takes the reader a stage deeper into how to prepare the network and exploit VoIP technology to its full potential.
VoIP Hacks: Tips and Tools for Internet Telephony	Voice over Internet Protocol (VoIP) is gaining a lot of attention these days, as more companies and individuals switch from standard telephone service to phone service via the Internet. The reason is simple: A single network to carry voice and data is easier to scale, maintain, and administer. As an added bonus, it's also cheaper, because VoIP is free of the endless government regulations and tariffs imposed upon phone companies. VoIP is simply overflowing with hack potential, and VoIP Hacks is the practical guide from O'Reilly that presents these possibilities to you. It provides dozens of hands-on projects for building a VoIP network, showing you how to tweak and customize a multitude of exciting things to get the job done. Along the way, you'll also learn which standards and practices work best for your particular environment.
IP Telephony - The Integration of Robust VoIP Services	Now that virtually every leading telecommunications service provider has committed to delivering IP-based telephony services, communications professionals face the enormous challenge of implementation. This hands-on guide brings together today's best-known answers and solutions for delivering Voice Over IP (VoIP) services with the quality customers demand. No other book covers the combined issues of protocol signaling, media transport methodology, reference topological considerations, and voice quality testing in service offerings. Bill Douskalis presents systematic coverage of every aspect of IP-based telephony: Coverage includes: A realistic reference topology for implementing and benchmarking voice quality in IP telephony Detailed explanations of call setup using each major competing technology Signaling, bearer transport, and other key network elements In-depth network and service performance analysis in both "normal" and impaired scenarios State-of-the-art traces and performance measurements taken from actual IP networks No matter what your role in delivering VoIP services, IP Telephony delivers the specifics you need to speed deployment, improve reliability, ensure quality, and simplify troubleshooting. Precise, thorough, and based firmly in the real world, it is simply indispensable. The accompanying CD-ROM contains Hewlett-Packard Internet Advisor software that runs off-line—view live VoIP traffic examples! It also includes sample capture files of the H.323, MGCP, and SIP protocols; the latest IETF Working Group documents for VoIP; and an assortment of white papers and application notes that provide a real-world view of IP telephony.