All of us who have ever had an acne sore or Comedone have found it very distressing. It is even more distressing for people who have many acne lesions which keep coming back. People who go on to develop acne scars are troubled by them for many years as scars left by acne are very difficult to conceal.
The good news is that modern medical methods of acne control are very good and can reduce outbreaks and lessen the chance of acne scarring.
However, you will need to follow the skin care program fastidiously. You will also need to consult an expert dermatologist or plastic surgeon that is up to date and knows how to treat acne. You will need prescription medications. You will also need to have monthly exfoliation treatments by a medical aesthetician who is experienced in acne control treatments.
You also need to start early, at the first sign of an acne outbreak. Delaying treatment only gives the comedones the chance to worsen and possibly cause an acne scar.
What Causes Acne
Acne is caused by obstruction and infection of the oil glands in our skin. Our skin contains oil glands called Sebaceous Glands which secrete normal oil called Sebum which helps moisturize and protect our skin.
If Sebum production is too high, for example during adolescence, or skin debris like dead skin blocks the pore that drains the Sebaceous Gland, the Sebaceous Gland can become distended and obstructed so that oil builds up and distends the gland.
An obstructed, distended Sebaceous Gland provides an ideal place for bacteria to grow and create an infection. Once the Sebaceous Gland becomes infected, the skin overlying the gland becomes red, swollen, and painful, an acne lesion. A whitehead can form on the skin, which is essentially a small skin abscess, called an acne pustule.
Acne tends to occur most commonly in areas where oil glands or Sebaceous Glands are most plentiful, the area around the nose, forehead and chin, called the T zone, and the back.
What Causes Acne Scars
Visible scars are caused by destruction of the Dermis, the deep layer of the skin. When the Dermis is damaged and tissue is lost, a visible depression or scar appears.
Because the Sebaceous Glands extend deep into the Dermis, the infection in the Sebaceous Gland or Comedone causes infection and destruction of the surrounding Dermis. After healing a deep depression or scar forms because the supporting Dermis tissue has been lost.
How to Control Acne Outbreaks
The basic requirements for control of acne involve:
• Reduce oil production of the Sebaceous Glands
• Remove skin debris to prevent obstruction of the Sebaceous Glands
• Treat and prevent infection of the Sebaceous Glands
Topical Benzoyl Peroxide is an anti-bacterial agent and a skin drying agent. It is marketed as Brevoxyl Cream or Brevoxyl wash. It is the most commonly used product to control acne and is very effective. Benzoyl Peroxide reduces oil and helps prevent infection.
Vitamin A (retinoic Acid) derivatives reduce skin oil production by inhibiting the Sebaceous Gland cells. Products that are commonly used are Differin (adapalene), Retin A, Tazorac, and Accutane (isotretinoin). These prescription drugs are very effective but do have side effects like skin irritation dryness and other potential problems, thus they must be used under the direction of a physician.
Topical Clindamycin is the most effective antibacterial agent for controlling skin infection in my experience. It comes as a gel or cream or small wipes called Clindets, which I use most frequently.
Microdermabrasion is the most effective minimally invasive, no down time deep exfoliation method. Microdermabrasion treatments are essential to remove debris, open pores and prevent obstruction of the Sebaceous Glands and the development of a Comedone.
Oral Antibiotics like Minocyclene and other Tetracycline derivatives are widely prescribed for acne control. They can be effective, but my own prejudice is that it is very hard, if not impossible, for an oral antibiotic to reach a skin abscess like a Comedone. The skin abscess forms a thick wall of inflammation that is almost impossible for the oral antibiotic in the bloodstream to penetrate.
That is why I place so much emphasis on topical care to reduce oil production, deep exfoliation to remove debris and allow the oil out of the gland, and topical Clindamycin applied directly to the infected oil gland or Comedone.
IPL, Diode Laser and Blue Light Treatments can kill the bacteria Propionibacterium acnes (P. acnes) which cause the infection or Comedone and some can reduce oil or Sebum production. These therapies are effective when used properly.
Acne Control Program
The control program depends on the severity of the acne.
Mild Occasional Outbreaks
• Monthly professional medical grade microdermabrasion treatments
• Topical Benzoyl Peroxide-(Obagi Clenziderm MD penetrates the best)
• Clindamycin- Clindets for acute lesions
Moderate to Severe Acne
• Monthly to bi-weekly microdermabrasion
• Obagi ClenzidermMD Benzoyl Peroxide
• Topical Clindamycin-Clindets
• Retin A Derivative-in increasing order of strength-Differin, Retin A, Tazorac, Accutane
• Consider IPL, Blue Light or Diode Laser Therapy
Severe Cystic Acne
• Obagi Clenzidrm
• Topical Clindamycin Clindets
• IPL, Diode Laser or Blue Light treatments
How to Remove Acne Scars
Traditionally dermabrasion or surgical excision was used to remove scars. However, with the advent of laser resurfacing in the mid 90”s, laser resurfacing with the CO2 laser became the most common method. However, CO2 laser resurfacing required prolonged recovery, often caused the skin to lose color, and CO2 laser resurfacing only smoothed the surface of the skin and did little to improve deep acne scars caused by destruction of the Dermis by the acne infection process.
Deep ice pick scars still require a special surgical procedure called floating grafts followed by CO2 laser resurfacing for effective removal. During this procedure, under local anesthesia, a small circular punch or trephine is used to cut around, but not remove the ice pick scar. The punched area floats up above the surface of the surrounding skin. After 2 weeks, the protruding graft has taken, which means it has new blood supply and will survive. At this point, the CO2 laser is used to plane down the protruding grafts flush with the surrounding skin. The new graft closes the ice pick scar. This is the only method I have seen that effectively corrects ice pick acne scars.
New fractional non-ablative laser skin resurfacing lasers are able to significantly improve deep acne scars by building new collagen to replace the collagen lost in the Dermis by the Comedone infection.
These new fractional non-ablative skin resurfacing lasers do not break the skin thus no healing time is required. You will need at least 4 treatments scheduled 4-6 weeks apart. The laser energy is fractionated, that is broken up into many small beams that pass through the skin without injuring it, and heats the deep dermis to build new collagen to actually plump up the acne scar.
The fractional non-ablative resurfacing laser is a revolutionary advance in scar removal treatment.Above: Before and after acne scar removal with Starlux 1540 fractional laser skin resurfacing scar removal (Palomar.)
Where Do You Find a Good Acne Care Program?
First, re-read this article and be armed with the facts about acne skin care. Many physicians just prescribe Minocyclene and do not understand the importance of a comprehensive approach to acne skin care.
I recommend that you consult two board certified dermatologists or plastic surgeons that have an interest in acne skin care. Check their websites, do they offer all acne related services.
It is important to find a doctor who offers microdermabrasion treatments and laser therapy in their office. That means they are up to date on current technology.
I also believe that it is essential that the physician have an excellent experienced medical aesthetician in their office. Most of your contact and the most important person in your program will be the medical aesthetician, and she needs to know what she is doing.
You are very unlikely to find the expertise you need in a walk in Medical Spa without a board certified doctor present to examine you and recommend a course of therapy. Physician supervised in the Medical Spa world usually means the doctor is actually at an office some distance from the Medical Spa and provides his/her supervision in the form of a phone call when something goes wrong.
Do your homework.
For more information on acne control or acne scar removal call 978-369-44999 or email us. Read our free newsletter to keep up on the latest information on laser and non-surgical skin care. Read Save Your Face to learn how to prevent facial aging.