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acne 
Acne is the term for clogged pores (blackheads and whiteheads), pimples, and cysts that occur on the skin. Acne affects the majority of teens but it is not restricted to this age group as many adults also suffer from this condition. At any age, acne is quite upsetting, especially when it results in scarring. Acne is caused when high levels of specific hormones in the body stimulate the sebaceous glands to produce an overabundance of sebum (oil). These secretions get clogged in the glands and bacteria set in, leading to inflammation and what we recognize as pimples. What are Pimples? 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 begin to grow. Both whiteheads and blackheads start out as a "microcomedone". What causes acne? Acne is caused by overactive sebaceous glands in the skin. The sebaceous glands, triggered by the hormone androgen, produce sebum (oil) in the skin. Although androgen is a male hormone, and its level is highest during puberty, it is present in both men and women. When androgen levels increase, the sebaceous glands release sebum. Ordinarily this oily substance spills onto the skin. When cells from the lining of hair follicles shed too quickly—clumping together and clogging pores—sebum is trapped beneath the skin causing whiteheads and blackheads. Sebum can then mix with the trapped cells and cause Propionibacterium acnes (P. acnes)—bacteria normally found on the skin–to grow in the clogged follicles. P. acnes can cause inflammation and pus and can result in papules or pustules. When the follicles expand as much as they can, bumps called nodules are formed under the skin. Microcomedones become skin blemishes called comedones--either a whitehead or a blackhead: What causes acne? Acne is caused by overactive sebaceous glands in the skin. The sebaceous glands, triggered by the hormone androgen, produce sebum (oil) in the skin. Although androgen is a male hormone, and its level is highest during puberty, it is present in both men and women. When androgen levels increase, the sebaceous glands release sebum. Ordinarily this oily substance spills onto the skin. When cells from the lining of hair follicles shed too quickly—clumping together and clogging pores—sebum is trapped beneath the skin causing whiteheads and blackheads. Sebum can then mix with the trapped cells and cause Propionibacterium acnes (P. acnes)—bacteria normally found on the skin–to grow in the clogged follicles. P. acnes can cause inflammation and pus and can result in papules or pustules. When the follicles expand as much as they can, bumps called nodules are formed under the skin. Microcomedones become skin blemishes called comedones--either a whitehead or a blackhead. Either way, blackheads and whiteheads are filled with trapped sebum and bacteria. The treatment advice for how to get rid of blackheads and how to get rid of whiteheads is therefore the same. Types of Acne Lesions Acne lesions range in severity from comedones (blackheads and whiteheads) to nodules and cysts. Here is a brief definition and photographs of typical acne lesions: Comedones Comedones are sebaceous follicles (oil glands) plugged with sebum (oil), dead cells from inside the sebaceous follicle, tiny hairs, and sometimes bacteria. When a comedo is open, it is commonly called a blackhead because the surface of the plug in the follicle has a blackish appearance. A closed comedo is commonly called a whitehead; its appearance is that of a skin-colored or slightly inflamed "bump" in the skin. The whitehead differs in color from the blackhead because the opening of the plugged sebaceous follicle to the skin’s surface is closed or very narrow, in contrast to the distended opening of the blackhead. Papules A papule is defined as a small (5 millimeters or less), solid lesion slightly elevated above the surface of the skin. A group of very small papules and comedones may be almost invisible but give a "sandpaper" feel to the skin. Pustules A dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria. A pustule that forms over a sebaceous follicle usually has a hair in the center. Acne pustules that heal without progressing to cystic form usually leave no scars. Macule A macule is a red spot left by a healed acne lesion. It is flat, usually red with a well defined border. A macule may persist for a long time. Nodule Like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule, a nodule is characterized by inflammation, extends into deeper layers of the skin and may cause tissue destruction that result in scarring. A nodule may be very painful. Nodular acne is a severe form of acne. Cyst A cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic acne. This is a severe form of acne that is often resistant topical and oral medicines and likely to leave scars after healing. What are the Acne Subtypes and Severities of acne? Mild acne is extremely common and describes rare acne breakouts that are mild, don’t leave scarring and don’t interfere with life in any way. These are generally hormone related. Moderate acne may include blackheads and whiteheads in addition to papules —inflamed lesions that appear as small, reddish or pinkish bumps that can be sensitive to touch—or pustules—inflamed, white-centered bumps that can be red at the base. Severe acne is characterized by nodules —large, painful, solid lesions that appear as lumps under the skin—and cysts —deep, inflamed, pus-filled lesions that can be very painful. Nodules and cysts are inflammatory and can cause scarring. Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms and legs. Acne Mechanica is a form of acne caused or aggravated by heat, covered skin, constant pressure and repetitive friction against the skin. Causes: Common sports-related causes of acne mechanica are:
Other common causes of acne mechanica are:
Blue Light therapy/LED light Solitone LED system is an advanced aesthetic device capable of delivering four groups of wavelengths, one for the treatment of mild inflammatory acne and the other for skin rejuvenation and wound healing. All treatment paradigms are safe, painless and require no downtime. Blue light therapy using LED light devices are a favorite among teens and adolescents. The Solitone LED system multiple wavelength device is commonly used during the recovery period from Portrait PSR or Erbium laser treatments but can also be combined with a series of Sapphire abrasions to enhance the results as well. Solitone LED light system Solitone LED system has a wavelength range from 405-420nm to 850nm works by killing the acne-causing bacteria, P. acnes, and is used to treat inflammatory acne vulgaris that has not responded to other acne therapies. In comparison with older devices LED light products do not contain ultraviolet (UV) light, which was a staple of former light therapy used to treat acne. UV light can damage skin and is no longer used to treat acne. LED light therapy is wonderful for teens and adolescents who come in regularly for these short, painless, no downtime treatments, giving them a chance to unwind and listen to their ipod while they lay comfortably under the light. The results of LED Light therapy alone are further enhanced with the addition of Levulan (Aminolevulinic acid) to the treatment. This procedure called Photodynamic therapy (PDT) or ALA PDT provides more long term acne reduction and is the preferred treatment modality for patients with severe, cystic acne. Vbeam Laser (Pulsed Dye Laser) for acne Vbeam Pulsed Dye Lasers is commonly used in acne therapy for a variety of reasons. It has proven very useful in rapidly bringing the inflammatory lesions of acne under control. In addition to the anti-inflammatory action, the Vbeam inactivates the acne forming bacteria. Furthermore, since it targets blood vessels, it is quite effective at reducing the appearance of chronic red blemishes and red acne scars left over when the acne clears. Though no formal studies have proven long term acne reduction when this laser is used by itself, their use in combination with other laser technologies as part of a laser acne treatment regimen provide a unique and important benefit. CoolTouch,Coolbreese 1320nm Yag laser fro acne and acne scars treatment. Cooltouch laser emits a wavelength of light that penetrates through the skin and is concentrated within the overactive sebaceous glands that are responsible for acne. The heating of the sebaceous glands causes a mild thermal injury that changes the activity and function of the glands, leading to prolonged reduction in acne breakouts. The Cooltouch can be used in combination with other laser technologies, and with topical or oral medicines as well. It is performed without any downtime and serious complications are very rare. The Cooltouch laser was the first laser to be cleared for the treatment of acne and is also used to treat acne scars. Three to six total treatments are performed, approximately one month apart. Because the Cooltouch laser is FDA cleared for the treatment of acne scars as well, this represents a great choice for patients who suffer from both acne and acne scars. How does the Cooltouch laser work? The Cooltouch laser delivers a gentle, but powerful beam of light that penetrates below the skin to target the overactive sebaceous (oil) glands, the root cause of acne. In addition to reducing the activity of the gland the Cooltouch kills the acne causing bacteria under the skin. The Cooltouch’s energy stimulates the body to produce collagen and this is responsible for the improvement in fine lines, wrinkles and acne scars we see after a treatment series. What does the treatment like and is there downtime? After pre-treatment photos are obtained, a topical anesthetic is applied to the skin for approximately 30 minutes to ensure a completely comfortable experience. The procedure takes about 20 minutes and is described as a warm snapping of a rubber band on the skin. The skin may become mildly red but this should not interfere with any planned social or work activities. Is there anything I should know before the treatment? Sun tanning and recent sun exposure is prohibited before a Cooltouch treatment due to the increased risk of a temporary pigment alteration in the skin called hyperpigmentation. Use of high SPF sunscreen is recommended after treatment as well. Males should shave their beard before treatments. It is not necessary to stop topical or oral acne medicines before Cooltouch treatment. For patients on Accutane, we advise waiting at least 6 months before having any laser treatment. Can Cooltouch treatments be performed on patients with darker skin? Yes, Cooltouch can be utilized in patients with all skin types. How many treatments are required and can this laser be combined with other treatments? We generally recommend 5-8 treatments performed at 3 weeks intervals and expect to see improvement in the acne after the third treatment and this continues to improve from there. Photodynamic Acne Therapy (PDT ALA, Levulan PDT) Photodynamic therapy (PDT ALA)is a procedure that can significantly improve moderate to severe acne, including cystic acne. Prior to photodynamic acne treatments, the best available option for resistant forms of the condition, including cystic acne, was Accutane. Photodynamic therapy uses a topical agent called Levulan (Aminolevulinic acid (ALA) in combination with specialized lasers and light sources. It provides a viable alternative to Accutane with no systemic effects. PDT ALA treatments inactivate the bacteria that trigger acne, exfoliate the skin to unclog pores, and decrease the activity of overactive sebaceous glands in the skin. With three mechanisms of action, it has a long lasting effect in the majority of patients. How many treatments are required and at what interval? An initial series of three treatments are advised at two to three week intervals. Depending on the response to these treatments and the severity of your acne, we will customize a follow up plan for you Photodyamic Therapy (PDT) + ALA (Levulan) = PDT ALA What is Levulan? Levulan is a 20% solution of Aminolevulinic Acid (ALA). ALA is a “natural” product found in all humans throughout the body. It is a precursor for hemoglobin synthesis. What do patients look for alternatives to the use of Accutane? Accutane is a useful drug for the treatment of severe acne but its use has steadily declined due to the risks associated with its use. Accutane may cause several systemic side effects including birth defects, liver abnormalities, mood depression, and virtually all patients get dryness and night vision changes. PDT Acne Treatment provides a viable alternative to Accutane as there are no systemic effects. PDT-ALA treatments inactivate the bacteria that trigger acne, exfoliate the skin to unclog pores, and decrease the activity of overactive sebaceous glands in the skin. With three mechanisms of action, it has a long lasting effect, even on severe acne, in the majority of patients. Topical acne medications can be used in between the PDT ALA treatments once the redness has settled down, usually over a period of a few days. Antiviral medicines should be utilized for a patient that has a history of recurrent cold sores. Photodynamic Therapy ALA Acne Treatment Procedure Details Skin should be free of all makeup, sunscreen and moisturizers. Antiviral prophylaxis is initiated in patients with history of recurrent cold sores. An acetone scrub or Microdermabrasion is done. The Levulan (ALA), which is a clear painless solution, is applied to the skin and left on for 30-60 minutes. It is absorbed by active cells like acne sebaceous glands. The Levulan is washed off with soap and water. The skin is exposed to a specific wavelength of light with either the Blu U, iClearXL. Vbeam laser, IPL or Gentlewaves. This takes about 8-15 minutes. At times multiple lasers or light sources are sequentially used to activate the Levulan which has been absorbed under the skin by the sebaceous glands. This combined interaction of the Levulan solution and the laser or light is what gives rise to the term "photodynamic therapy." Sun block is applied and a hat is worn out of the office. Sun exposure needs to be avoided for 48 hours after treatment. If possible, patients should remain indoors for the first 24 hours after treatment. Skin may become red with mild swelling and peeling for 3-7 days. 3-5 treatments are recommended at 2-4 week intervals A minimum of SPF 40 sun block should be worn for one week. Additional benefits of ALA PDT may include:
Microdermabrasion Microdermabrasion is a gentle skin resurfacing treatment that can rejuvenate and restore the natural glow to the skin, without the need for downtime. This technology has become a standard of care in aesthetics due to its predictable and safe results. The skill of the operator and the specifics of the device being used effect the outcomes. What is Microdermabrasion and what layer of the skin does it work on? Microdermabrasion is a general term for the application of tiny rough grains or crystals (aluminum oxide, sodium chloride or sodium bicarbonate) and suction to buff away the surface layer of the skin. Your skin is made up of two main layers, the epidermis and the dermis. The epidermis is the layer closest to the outside world. It's a set of skin cells on top of another layer of cells that are in the process of maturing. The topmost layer is called the stratum corneum. The stratum corneum mostly acts as a barrier between the outside world and the lower skin layers. It keeps all but the smallest molecules from getting through. When you put lotions or creams on your skin, some of the moisture passes through the stratum corneum, but some can’t penetrate it. This layer is home to many minor skin imperfections like fine wrinkle lines and blemishes. All of the action in microdermabrasion takes place at the level of the stratum corneum. If you remove or break up the stratum corneum, the body rushes to replace the lost skin cells with new and healthy ones below. And with the statum corneum gone, the skin's surface looks and feels smoother. Some of the skin's visible imperfections like fine lines and sun damage are removed. And without the stratum corneum acting as a barrier, topical products can now penetrate the skin more easily and be effective. What are the indications for treatment?
Topical & Oral Treatment Topical and Oral Acne Medicines Topical and oral medicines play an important role in the treatment of acne. At Reflections we believe that combining topical medicines should be combined with lasers to enhance results. Acne has many causes and if you attack it with modalities that each work differently, you have the best success in finally controlling this troubling disorder for the long term. Treatment must be tailored to the type of acne and acne lesions that someone has. The following section describes the desirable medical therapy for each type of acne lesion. Blackheads and whiteheads: Blackheads or Whiteheads are blockages of oil glands. The blackheads are more superficial than the whiteheads. Their black color is not dirt, but the oil and skin debris that accumulates in the opening of the oil gland and is visible on the surface. Treatments for Blackheads & Whiteheads Papules and Pustules Papules and Pustules are blockages of oil glands that have been inflamed. Papules are red pimples. Pustules are pimples with a central collection of white pus at their top. Treatments for Blackheads & Whiteheads
Cysts or Nodules Cysts or Nodules are blockages of oil glands that have burst open and produced inflammation and pus in the surrounding tissue. These lesions have the potential to produce long-term scarring. Treatment of these lesions can minimize or prevent subsequent side effects. Treatments for Blackheads & Whiteheads ORAL medications such as:
Acne surgery followed by a gentle flushing with a very dilute cortisone (usually, approximately 3 mg per cc of Triamcinolone Acetonide) through the drained cyst or nodule. Topical warm (NOT HOT) water compresses In situations where these treatments do not produce an improvement over the course of several weeks or months, oral Accutane can be discussed with the patient. Accutane is contraindicated in pregnant, possibly pregnant, or women contemplating pregnancy and should be used carefully or not at all in Acne MechanicaPrevention Wear a clean cotton T-shirt under a sports uniform. Cotton absorbs perspiration and reduces friction against the skin from the uniform. Shower immediately after athletic activities. Wash the chest, back and buttocks and areas that were under straps, padding or tight uniform. Liquid cleansers containing salicylic acid are useful for removing surface oils and unclogging pores. Avoid covering the forehead with a headband or cap for prolonged periods Treatment Applying a topical (applied to the skin) acne medication that contains salicylic acid or benzoyl peroxide to the lesions as soon as they appear is often effective. Another effective method is to eliminate the cause of acne mechanica. |
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