Acne Therapy: A Clearer Path to Healthier-Looking Skin
What’s new and what’s promising
Dermatologists, plastic surgeons or family physicians with added training in aesthetic medicine may offer procedural options in additional to traditional medications for the treatment of acne. These may include one or more of the following:
Photodynamic therapy (PDT) in combination with a topical photosensitizer known as 5-aminolevulinic acid (ALA) has shown promise in treating mild to severe acne. This approach may also help to improve the appearance of acne scars.
Diode laser treatment to destroy the excess sebum-producing sebaceous glands in the deeper layer of skin known as the dermis.
Pulsed light and heat energy therapy utilizing green-yellow light to treat mild to moderate acne.
Blue light therapy or a combination of blue and red light to kill or control the bacterium known as Propionibacterium acnes. This bacterium is known to contribute to the inflammatory components of acne.
Other procedures to consider in combination with traditional acne treatments for more severe cases include microdermabrasion and chemical peels, as well as dermabrasion and soft-tissue fillers that treat and lessen the appearance of acne scars.(www.mayoclinic.com/health/acne/DS00169/DSECTION=treatments-and-drugs)
Acne: Same beginning, different forms
Acne has many forms. Sometimes it appears as small and irritating bumps, while others may be red, inflamed, and tender. But despite their differences, they often begin in the same way: as a comedone.
Essentially, a soft “plug,” or comedone, is formed when a hair follicle becomes clogged with a mixture of an oily substance called sebum and dead skin cells. This in turn may bulge out to produce a “whitehead,” or open up on the surface of the skin, where it darkens in color to form a “blackhead.” If excess sebum continues to be produced by the sebaceous gland at the base of the hair follicle, mild inflammation and possible bacterial infection may occur. This process can lead to a further progression of acne, and with it, the potential for more noticeable skin changes. These include:
Papules—Raised pink or red bumps on the skin. These may be tender to touch and should never be squeezed, as that action raises the potential for scarring.
Pustules—Tender red bumps that often appear as a raised circle with yellow or white pus in the center.
Nodules—These are considered to be severe forms of acne and are often large and painful. Even though these hard bumps are located under the surface of the skin, they are solid and often cause the skin on top to protrude slightly upward. These often last for months and may cause scarring.
Cysts—Similar in size and similar in location as nodules, but with a major difference: These contain pus. They are often painful and can also lead to the formation of scars.
How is acne treated?
Whether it’s a small group of pimples or a large area of painful cysts on the face, chest, and back, acne can affect the quality of life for those teenagers and adults affected by this skin condition. It’s therefore important to design the treatment based upon the type, location, and frequency of acne, as well as the affected individuals’ personal perception of how it makes them look and feel.
Fortunately, there are many treatment options that are designed to attack, control and possibly eliminate acne. For example, certain medications dry the oily sebum or prevent the hair follicles from plugging up, while others fight the infection or inflammation attributed to the moderate to severe forms of acne. Hormonal treatments such as birth-control pills like Ortho-Cyclen may be considered in those women who have acne flares that occur around the time of menstruation.
Accutane or Claravis (brand names of isotretinoin) may be prescribed for severe cystic acne or when other treatment approaches have been unsuccessful. Note that while often effective, isotretinoin has very rigid prescribing parameters due to the potential for significant side effects, including birth defects.
Here’s a quick guide to a menu of treatment options for specific types of acne. These are by no means the only ways to treat, but serve as a starting point of discussion with her physician. That said, the categories include:
Mild(whiteheads and blackheads)—Over-the-counter products containing ingredients such as benzoyl peroxide, sulfur, lactic acid or salicylic acid, or prescription products containing some of those ingredients in more concentrated strengths, as well as additional medications known as topical retinoids, which are applied directly to the sin. These prevent hair follicles from plugging up, and include the ingredients tretinoin, tazarotene or adapalene.
Mild to moderate—This includes comedones and inflammatory papules and pustules. Their treatment often involve a combination of one or more of the following: benzoyl peroxide, as well as certain prescription-strength products such as azelaic acid, an antibiotic gel or cream, prescription antibiotics or topical retinoids.
Moderate to severe—This type shows a greater numbers of comedones and papules as well as pustules. Treatment often includes an oral antibiotic (such as doxycycline or minocycline), in addition to benzoyl peroxide, a topical retinoid or other topical agent.
Severe—May involve comedones and inflammatory eruptions of papules, pustules, and cysts. Nodules are often present, as well as areas of scar formation. This requires treatment by a specialist trained and experienced with this form of acne. The use of isotretinoin may be discussed, as well as the previously described treatment options for the inflammatory components contributing to this nodulocystic type of acne.
For further information, please speak with your physician and visit the American Academy of Dermatology’s Acnenet, as well as the U.S. Library of Medicine and the National Institutes of Health.
By Dr. Rob for MSN Health & Fitness
