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Acne & Rosacea

With the right treatment, you can keep acne under control. But what’s the best acne treatment for you? Many options are available, including prescription creams and antibiotics, which target the various causes of acne. But even with the wide range of acne treatments, chronic breakouts may still be difficult to treat. Promising new acne may be effective acne treatments when combined with other traditional treatments.

Targeted Treatments

Each hair follicle is connected to sebaceous glands, which secrete an oily substance known as sebum to lubricate the hair and skin. As physicians understand it, acne happens when oil (sebaceous) glands come to life around puberty, when these glands are stimulated by male hormones that are produced in the adrenal glands of both boys and girls. The oil glands, which are located just beneath the skin, continuously produce and secrete oil (sebum) through openings in the skin. The oil lubricates and protects the skin. Under certain circumstances though, cells that are close to the openings of the oil glands block the openings. This causes a buildup of oil underneath the skin. When your body produces an excess amount of sebum and dead skin cells, the two can accumulate in the hair follicle and solidify as a soft plug. As the plug grows, the follicle wall can rupture, allowing more oil and skin cells to accumulate. This is the underlying cause of acne. Normal bacteria that live in everyone’s skin feeds on the oil.  They start to multiply, and cause the surrounding tissues to become inflamed and infection results in complications of acne.

Acne treatments usually work by reducing oil production, speeding up the growth of new skin cells and the removal of dead skin cells, or fighting bacterial infection. The most effective acne treatments are often a combination of therapies that work by utilizing two or three of these.

Medical Therapies

  • Topical (externally applied) Antibiotics and Antibacterials: These include erythromycin, clindamycin, sulfacetamide, and azelaic acid.
  • Oral antibiotics: We typically start oral treatment with tetracycline or one of the related "cyclines," such as doxycycline and minocycline. Other antibiotics that are useful for treating acne are cefadroxil, amoxicillin, and sulfa drugs.
  • Topical Retinoids: Retin-A has been around for years, and has become milder and gentler while still maintaining its effectiveness. Topical medicines that contain vitamin A products (like Retin-A, Differin, and Tazorac) are agents that are particularly effective in treating whiteheads and blackheads. These newer retinoids are especially helpful for unclogging pores. For adults who suffer with acne problems, Retin-A also has a very nice anti-wrinkle effect.
  • Oral contraceptives: Modern contraceptives, which are low in estrogen to promote safety, have little effect on acne one way or the other. One pill, Ortho Tri-Cyclen, has been shown to help acne, but its effectiveness is only modest.

Laser Acne Treatments

Laser- and light-based therapies reach the deeper layers of skin without harming the skin’s surface. Some laser systems are thought to damage the oil (sebaceous) glands, causing them to produce less oil. Other laser and light therapies target P. acnes, the bacterium that causes acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars, so they may be good treatment choices for people with both active acne and acne scars. We will use the laser we feel most appropriate for your condition. Most patients require approximately 5 monthly treatments to see the desired improvement. Periodic re-treatments will be required as acne flares.

Several types of laser and light therapies are used for acne treatment. These include:

  • Blue light therapy: Exposing the skin to a low-intensity blue light source is believed to destroy P. acnes. This painless procedure is usually done through a series of sessions. P. acnes multiplies rapidly, however, so ongoing treatment is necessary for best results. Possible side effects of blue light therapy include temporary redness and dryness in the treated areas. A newer type of light therapy that includes a combination of blue and red light may be more effective than blue light alone.
  • Pulsed light therapy: Intense pulsed light is thought to destroy P. acnes and shrink sebaceous glands, which decreases the oil production. Side effects of this therapy include temporary redness in the treated areas.
  • Photodynamic Acne Treatment: This treatment combines amino-levulanic acid and light energy delivered to produce rapid results for clearing acne lesions. There is normally some redness and skin peeling for a couple of days following the treatment. We recommend 2-3 treatments at 2-3 week intervals to obtain optimal results.
  • Acne scar treatment:  After your consultation, we will select the laser option that will work best for your particular scarring problem.  Depending on the severity and depth of scarring, your plan may require from one to multiple treatments.

Cosmetic Procedures

Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures — which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars — are most effective when used in combination with other acne treatments.

  • Chemical peels: Chemicals, such as glycolic acid or salicylic acid, applied to your skin help remove dead skin cells, unclog pores, remove whiteheads and blackheads, and can generate new skin growth. These chemical peels are often used with acne creams or gels for better penetration of the medication. Depending on strength of the chemical, side effects of chemical peels range from temporary redness, blisters, scaling and crusting to scarring, infection and abnormal skin coloring.
  • Microdermabrasion: This type of treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or "polish" the skin’s surface. Then, a vacuum tube removes the crystals and skin cells. The procedure exfoliates and unclogs pores. Similar to chemical peels, microdermabrasion is often used with other acne treatments to increase their effectiveness.

Combination Therapies

Combination therapies, for example, using prescription creams and oral antibiotics, target all the causes of acne, which makes the treatment plan more successful. Several combination therapies have been shown to be effective in controlling acne:

  • Retinoids and oral antibiotics: Prescription products derived from vitamin A (retinoids) can be combined with oral antibiotics for better treatment of acne. Retinoids work by promoting cell turnover and preventing the plugging of the hair follicle. Oral antibiotics kill P. acnes bacteria and reduce inflammation.
  • Benzoyl peroxide and topical antibiotics: Benzoyl peroxide is most effective if it’s combined with antibiotics applied to your skin (topical antibiotics). Benzoyl peroxide can dry up the oil, kill bacteria and promote sloughing of dead skin cells. Topical antibiotics can kill bacteria on the skin’s surface and fight inflammation.
  • Microdermabrasion with Acne Peel: Microdermabrasion removes surface  dead skin cells and unroofs clogged pores. When combined with a salicylic acid peel, the treatment becomes more effective.

Acne Scars

Acne scars are stubborn, and no single treatment is best for everyone.

  • Dermal Fillers:  One option may be to inject Juvederm or Sculptra under the skin and into the acne scars. This fills out or stretches the skin, which makes acne scars less noticeable. Results are temporary, so you’d need to repeat the injections periodically.
  • Microdermabrasion/Dermabrasion: These are used to remove the cells on the surface of the skin or to completely remove the top layer of skin.
  • Laser Scar Treatments: After your consultation, we will select the laser option that will work best for your particular scarring problem.  Depending on the severity and depth of scarring, your plan may require from one to multiple treatments.
  • Surgical Excision:  In some cases, surgery to remove deeply indented acne scars is an option.

Long term Expectations & Care

Acne usually begins in the teen years, but can reappear at any age. It gradually worsens and after a time improves. How long you have acne is impossible to predict. Acne will periodically flare up and then improves. There is usually no explanation for these ups and downs, so do not assume that because your acne gets worse you have done something wrong. In women, acne frequently worsens about the time of their menstrual cycle.

Dirt does not cause acne, despite what you may have been told. The oil on the skin surface does no harm. Your face should be washed with a gentle nondetergent cleanser and plain water only as much as you need to keep it clean. Too much scrubbing of the skin can cause irritation and make the acne situation much worse. Never pick, squeeze, or otherwise manipulate your pimples, as this can cause long-term scars.  Instead, our aestheticians can gently perform extractions on whiteheads, blackheads, and inflamed acne lesions.

There are many excellent treatments for acne. At Sholar Center, we will formulate a specific treatment plan designed for your individual situation.

Keep realistic expectations

If you’re interested in new acne treatments, make a consultation appointment so we can help you create a treatment plan that’s right for you.

Regardless of the treatment you use, be sure to keep realistic expectations. Acne can’t be cured, only controlled. You won’t start seeing improvements from most treatments for six to eight weeks, and your acne might appear worse before it gets better. But if you stick to your treatment regimen, your patience usually pays off with clearer skin.

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