What is Acne?

Acne is the term used to describe clogged pores or comedones (blackheads, whiteheads), pimples and deeper lumpes such as cysts or nodules that usually occur on the face, neck, back, shoulders and upper arms. 

There are so many types of acne.  The most common is called acne vulgaris.  Almost everyone goes through a period of acne at one time or another.  Just beneath the surface of the skin lie hundreds of tiny glands called sebaceous glands.  Their function is to collect and excrete the oily substance called sebum, to keep the skin healthy. 

However, the tiny pathway for the sebum to escape often becomes clogged, and a bacterium called p. acne grows inside.  In a short time, the area swells up, and forms a pimple on the skin.  At certain times of life, this process becomes very active, troublesome and hard to control.   

 

Acne Myths

- Not to worry, “You will grow out of it”
-Acne is caused by poor hygiene
-Acne is caused by something in your diet
-Vigorous washing helps
-Treatments don’t work

 


Treatment Options 

Acne Treatments

Blue Light Treatment
Photodynamic Therapy
Acne Treatment

If you have acne, it can be embarrassing and lead to low self esteem. Without treatment severe cases of acne can be disfiguring, leaving permanent scars. New techniques are available to treat acne and minimize outbreaks.

Acne is an equal opportunity condition, afflicting teenagers, young adults, and occasionally even more mature adults. Blue Light Acne Treatment uses light – without drugs or antibiotics – to treat hard to control acne, including acne vulgaris. The special blue light kills the p. acnes bacterium that grows inside clogged pores that swell up and form pimples on the skin.

Light treatments involve sitting with your face close to the light for a short time (typically 8 to 16 mins 40 secs) about once or twice per week for a period of about five weeks or so. The procedure is safe, not painful, and not hot. Over the course of the treatments, most patient experience noticeable control or clearing up of their acne for a very long period.

 

- Acne Facial Treatment

Popular acne treatments include a deep pore cleansing that may include a glycloic peel, manual extractions, acne healing mask, microdermabrasion  and a cool refreshing slush.  It is designed to help with acne, pigmentation, rough skin, blemishes and rosacea.   

Facial Steps

  • Glycolic and or salicylic peels  
  • extractions using 30g needle or lancet and comedone extractor 
  • slush ( light cryotherpay on swab)
  • Microdermabrasion
  • steam, high frequency

- Acne Products

Glycolic Gly/Sal Acne Wash

Medicated cleanser with glycolic and salicylic acids to treat acne.  A gentle wash with immediate results. 

Benzoyl Peroxide Wash 5% or 10%

Therapeutic wash with benzoyl peroxide for the treatment of acne prone skin.  Excellent for thoes fighting acne on the face and body. 

Glycolic Acne Pads

Toning pads with 5% glycolic acid and 2% salicylic acids for exceptional toning and exfoliation.  Great for teens in sports.


Personalize your Acne Treatment ( Your Dermatologist or Doctor will typically recommend one of these choices for your skin type)

1. Wash AM and PM: Wash your face twice daily with:

  • Alternate Benzoyl peroxide wash and Glysal wash or Salac Or DHL Sal Shampoo-Use one wash in AM (shower) and in the PM (by sink).  
  • Acne soap (DHS sal shampoo, Salac, Neutrogena oil-free acne wash, Panoxyl Bar 5%, Benzac wash, Brevoxyl wash, TRIAZ, Brevoxl).
  • Ovace face wash, Plexion Cleanser, Rosanil, Clenia.
  • Mild Soap/ Cleanser (Dove, Purpose, Basis, Cetaphil, Oil of Olay)
  •  Obagi Cleanser ( Step 1) and then apply Obagi Toner ( Step2)  

2. AM: Apply the following each morning:

  • Cleocin (clindamycin) lotion, clindet pledget (wipe), clindagel
  • Benzoyl peroxide- (Benzac,Brevoxyl, Triaz), Triaz Pad
  • Klaron Lotion, Metrogel, Metrolotiom
  • Benzaclin, Duac gel spot treatment

3. PM: Please apply the following each evening:
(if too irritating, use every other night)  Use these all over face- don’t spot treat, but DO avoid crevices like corners of mouth, nose, and eyes (All OF THESE MAY BE IRRITATING)

  • Differin gel/cream pledgets to all over face 
  • Retin A  (tretinoin)
  • Tazorac every night  / only every other night to  face, back, chest, arms
  • ­­­­­­­­­­Benzaclin, Duac gel spot treatment, Finacea gel   

4.  Take the following pill: (follow the proper directions for all medications)

  • Tetracycline
  • Minocin/ Minocycline/ Dynacin/ Doxycyline/ Adoxa
  • Amoxicillin
  • Zithromax

5.   AM or PM: If your skin gets dry, you can use non-comedogenic moisturizers                                                                            

  •   Oil free moisturizer sunscreen or glycolix elite facial moisturizer 
  •   Cetaphil or Eucerin lotion for face with sunscreen 
  •   Desowen lotion- once or twice a day ONLY for red itchy rash, dry areas- (don’t  use regularly)                

6.  AM: Use Sunscreens Daily  

  • Moisturizing sunscreens like Physician’s Complex SPF 30 sunscreen with zinc
  • Gel(non oil) suncreens- Ombrelle, Presun clear gel, solbar liquid, Ti-Screen

7.  If you wear cosmetics make sure they are oil-free and try to avoid powders.  

8. If you have any allergic reaction, stop the medication and call our office. STOP ALL MEDICATIONS IMMEDIATELY IF DECIDE TO BECOME PREGNANT OR THINK YOU MAY BE PREGNANT.   

9.   Return for a follow up appointment when suggested by your physician 

Your personalized acne program MAY include:

  • Facials/ Acne Treatments   
  • Glycolic Gentle Peels series every 2-4 weeks to begin       
  • Medium TCA/Jessner Peel (Blue peel) (1 hour appt )7 days downtime: Face, Neck or Chest
  • Blue light or laser precision peel (15-30 min appt)  
  • Acne Extractions
  • Photofacial/ Photo rejuvenation for brown spots, freckles, age spots, red areas, broken vessels, wrinkles- This may include several treatments. 



An Overview:
Acne & Related Inflammatory disorders
ACNE & Inflammatory Disorders
  • Acne Vulgaris      

  • Acne Rosacea

  • Perioral Dermatitis

  • Hidradenitis Suppurativa

  • Keratosis Pilaris

  • Folliculitis

  • Acneiform Dermatitis

     

Who is Affected?

  • Everyone at some time in their life

  • From babies to seniors

  • high prevalence

  • Often under treated or self treated

  • Atypical presentations of common disease

  • May lead to permanent scarring

  • Controllable

 Why Treat Acne?

  • Psychosocial impact
  • self esteem, confidence, job, social status
  • Untreated may lead to permanent scarring
  • Emphasis in teenagers -classic occurrence

Dispelling Acne Myths

  • Acne is not caused by poor hygiene or diet
  • Vigorous washing will not remove comedones and may worsen inflammation
  • Topical therapies should be applied to all potential acne areas, not just to lesions, because they work by preventing the formation of new lesions (they do little to shrink existing lesions)

ACNE TRIAD: What makes acne?

  • Follicular plugging (pores closed)
  • Sebum production ( oil production)
  • Bacterial colonization

•   Acne is disease caused by 4 interrelated processes affecting the pilosebaceous unit

–  altered follicular hyperkeratinization

–  sebaceous gland hyperactivity

–  Propionibacterium acnes (P acnes) proliferation

–  Inflammation/immune hypersensitivity to
P acnes

TRIPLE THERAPY IS KEY!

 1. Retinoid (unplugs)

 2. Benzoyl peroxide (antibacterial, unplugs,etc)

 3. Antibiotics (decrease bacteria)- oral or topical

 Combine one product out of each category .


Current Treatment Options

Topical

Retinoids

Benzoyl Peroxide

Antibiotics

Azelaic Acid

Salicylic Acid

Comination treatments

Benzoyl Peroxide + Antibiotics

 

Oral

Antibiotics

Isotretinoin

Corticosteroids

RETINOIDS

  • Adapalene (Differin)
  • Tretinoin (Retin A, Renova, Avita)
  • Tazaratone (Tazorac, Avage)

-Do not use in pregnant, breastfeeding, or trying to become pregnant.

-May be irritating, use small amount, avoid around the eyes, apply every other night


Severe Acne: Techniques to minimize irritation

–  gradual introduction of medication; initiate use with low concentration formulations

–  no scrubbing

–  adequate moisturization

–  brief application followed by gentle washing

ANTIBIOTICS: topical

  • Clindamycin ( Clindets wipes, or clindagel)
  • Erythromycin
  • Metronidazole ( Metrogel)
  • Sulfa ( Klaron)

ANTIBIOTICS: Oral

  • Amoxicillin
  • Tetracycline
  • Doxycycline
  • Minocycline
  • Azithromycin

 

Antibiotic Resistance

•   Clindamycin and erythromycin have become less effective topical acne therapies in the past 20 years

•   Loss of efficacy is due to the acquisition of resistance by P acnes

•   The addition of BPO dramatically reduces resistance to erythromycin and clindamycin

Other Oral Prescriptions 

  • Oral Contraceptives
  • Spironolactone ( anti-androgen)
  • Accutane
Practical ACNE Review: Top 10 List

1. Benzoyl Peroxide

2. Topical Retinoids

3. Topical Antibiotics

4. Salicyclic acid

5. Glycolic acid

6. Combination topical products (Antibiotics & BP)

7.  Oral antibiotics

8. Oral Retinoids

9. Oral Contraceptives

10. Oral Antiandrogens ( Spironolactone)

Differential Diagnosis:

  • eczema
  • folliculitus
  • drug reaction
  • rosacea
  • delusions of parasitosis
  • neurotic excoriations
  • furuncluosis
  • hidradenitis suppurativa

 

Acne if Pregnant or Breastfeeding

SAFE:

  • Erythromycin gel
  • oral amoxicillin/ampicillin

NOT SAFE:

  • Retinoids (Retin-A, Differin, Tazorac)
  • Oral Tetracylines

 

Lasers

  • Different targets based on laser source
  • Some target bacteria, some redness, others collagen 
  • usually multiple treatments needed 
  • No guarantees 
  • Generally cosmetic/ non- insurance

 What is Rosacea?

  • Primarily Red
  • Located on Cheeks and Nose
  • more in Caucasians (Scottish, Irish)
  • Inflammatory

 How to Treat Rosacea

  • Sulfa Wash as directed
  • Metrogel
  • Oral Antibiotics
  • Lasers or Photofacial

 

Postacne Scarring -Treatment option:

  • Dermal fillers ( collagen)
  • Laser therapy
  • Surgery ( punch removals)
  • Facial peels 

 

Therapy for Postacne Scarring

Postacne Scarring

The “ACNE SAMPLER”

In office adjunctive treatment :      

  • Glycolic  and or salicylic peels
  • extractions using 30g needle or lancet and comedome extractor
  • slush ( light cryotherapy on swab) 

 

Summary

  • Acne affects many ages from infancy to geriatric
  • “Triple therapy” very effective:

          -topical retinoid

          -topical antibiotic &/or benzoyl peroxide

          -oral antibiotic

  • Accutane for severe, cystic, or refractory acne
  • Acne is a common condition
  • Acne may persist into adulthood in some patients (mostly women)
  • Patients with acne commonly experience both physical and psychologic impairment

Photodynamic Therapy

  • Uses  a photosensitizer compound
  • Apply to skin and leave on for a time
  • Expose skin to controlled amount light
  • Levulan ( part of porphyrin system)
  • Has downtime 2-7 days- red/sunburn
  • Works by oxygen free radical formation

 


Information in this publication and site is not intended to serve as medical advice. Individuals may use the information as a guide to discuss their treatments with their own physicians. This site does not promote nor endorse the unauthorized practice of medicine by non-physicians or state licensed health care providers.
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of these artciles have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert.