Acne affects just about everyone at one point or another. Generally, acne is caused by plugging of the pores and inflammation of the sebaceous glands in the skin. When the sebaceous glands function properly, they collect and excrete an oily substance called sebum, which helps to keep the skin healthy and prevent it from drying out. However, the very narrow channels through which the sebum leaves the sebaceous glands often become plugged.
Once these channels plug, bacteria that normally live within the sebaceous glands multiply rapidly, initiating the chemical reaction we know as inflammation. This in turn leads to the pimples and pustules typically associated with acne.
Depending on each patient’s unique needs, these four goals are accomplished by using a combination of medications, lights, lasers, facials, and peels.
Topical Medications
The application of medications to the skin surface is very helpful for controlling active acne and for preventing acne flare-ups. Topical medications represent the most common type of acne treatment currently utilized. Commonly used topical medications include the following:
- Topical antibiotics such as erythromycin, clindamycin, and sodium sulfacetamide to reduce surface bacteria
- Benzoyl peroxide to reduce surface bacteria
- Retinoids such as Retin-A, Retinol, and Tazorac to unplug the pores, gently exfoliate the skin, reduce inflammation, and increase cellular turnover
- Azelaic acid to soothe inflammation and reduce surface bacteria
It is very important that patients follow their topical skin care treatment plan carefully, as the ultimate amount of improvement obtained depends at least in part on how well patients take care of their skin at home.
Oral Medications
Oral medications are often used in combination with topical medications. In Dr. Green’s practice, we may at times prescribe the following oral medications:
- Antibiotics such as minocycline, tetracycline, and doxycycline to control the growth of bacteria in the skin and in the sebaceous glands
- Birth control pills and spironolactone (aldactone) to control the hormonal component of acne (only in women)
- Accutane, as a last resort, to control acne that has been resistant to improvement through any other means of treatment
Extraction of Acne Lesions
Extraction of acne lesions refers to the drainage of pus, oil, and bacteria from acne lesions. Removal of these substances relieves any pain and pressure that may be present, shortens the healing time, and reduces the risk of acne scarring. Extraction of an acne lesion is occasionally followed by injection of the lesion, as described next.
Injection of Acne Cysts and Nodules
With this treatment, a dilute steroid is injected directly into one or more acne lesions. When used in this manner, the steroid rapidly reduces the inflammation and redness in the lesion. Injection of a pimple with a dilute steroid is the ideal treatment when the skin absolutely and positively must look better within 24 hours. This treatment is one of the secrets of celebrity skin care.
Soft Tissue Fillers for Acne Scars
Dermal fillers such as Restylane /Perlane and Juvederm are injected in small amounts below the surface of the skin to elevate depressed scars.
Acne Chemical Peels
Chemical peels may also be used to treat acne. Chemical peels for acne work by removing the surface layers of the skin, thus exposing the deeper less involved layers of the skin underneath. When chemical peels are done for acne, they are generally relatively mild. Appropriate peeling agents for acne include 20-40% glycolic acid, 10-25% trichloroacetic acid (TCA), and salicylic acid. Regardless of the peeling agent used, a chemical peel for acne will help clear acne blemishes, reduce fine lines and wrinkles, lighten brown spots that result from acne (as well as from the sun or melasma), smooth the skin, and brighten the skin. Patients undergoing chemical peels for acne will generally need to repeat their treatment approximately every four to six weeks.
After an acne chemical peel, the skin may be minimally red and irritated, but the recovery from the peel is very rapid and should be complete within a few hours to a few days.
Aesthetic Acne Facial
Dr. Green performs acne facials with great success on patients – and then recommends an at-home regimen from MGSkinLab. The facial begins with a surface cleansing of the skin and a light glycolic acid treatment. This is followed by treatment with steam and extraction of any pimples. Then, a soothing and purifying mask is applied to the face. The final step in the facial is the application of oxygen. The Acne Facial improves acne, lightens any dark blemishes, and leaves the skin glowing. The facial should be repeated at monthly intervals until the skin is clear, and should be thought of as an integral component of the acne care program.
Vbeam Laser for Acne
Recent research has confirmed that the Vbeam Perfecta Laser is an effective acne treatment. Vbeam Perfecta laser treatment can significantly reduce both inflammatory acne and non-inflammatory acne. Generally, a series of three Vbeam laser treatments are given at 2-week intervals. Following laser treatment, inflammatory acne lesions are reduced by an average of 85% and non-inflammatory acne lesions are reduced by approximately 70%. In addition, the laser will help improve acne scars and reduce redness in the skin.
Fraxel Laser Treatment of Acne Scars
The Fraxel laser is the gold standard for the treatment of acne scarring. With the Fraxel, the acne scars are improved over a series of 4 or 5 laser treatments. The Fraxel laser utilizes Fractional Resurfacing Technology in which only a portion of the skin actually receives the laser light. With this technology, the laser delivers a series of closely spaced microscopic laser spots to the skin while simultaneously preserving normal healthy skin between the laser spots.
This preservation of healthy skin results in rapid healing following the laser treatment. The entire face can be treated with the laser in approximately 45 minutes, and there is no downtime following the procedure. We have been extremely impressed by the improvement in acne scarring following Fraxel laser treatment. The Fraxel laser is a “home run” when it comes to the treatment of acne scarring.
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