Medical Dermatology

Acne Therapy

Acne vulgaris

Acne is an inflammatory disease of the skin, caused by changes in the pilosebaceous units (skin the hair follicle and sebaceous gland).

  • The typical acne lesions are: comedones, papules, pustules, nodules and inflammatory cysts.
  • After resolution of acne lesions, prominent (but temporary) hyperpigmentation is common and permanent scarring may also occur.
  • Several factors occur in combination to cause acne, including hormonal changes, plugged pores and secondary bacterial overgrowth in the hair follicle and sebaceous gland units.
  • Further research is necessary to establish whether reducing the consumption of high-glycemic foods (such as soft drinks, sweets, white bread) can significantly alleviate acne.
  • There is no way to predict how long it will take for acne to disappear entirely.
  • Current treatments for acne (these are often used in combination for best results):

    • Exfoliation therpies (creams, toners, masks)
    • Topical antibacterial medications
    • Oral antibiotics
    • Hormonal therapies (oral contraceptive pills, spironolactone, cyproterone acetate)
    • Topical retinoids (tretinoin, adapalene, tazarotene)
    • Isotretinoin (an oral retinoid medication)
    • Blue light phototherapy (Levulan-Blu-U (Photodynamic Therapy)) with or without aminolevulinic acid (Levulan)
    • Laser therapy

Types of Acne Scars

  • Hypertrophic scars: raised, firm thickenings of skin, sometimes red, most commonly occur on back and shoulders.
  • Atrophic scars: depressed skin (lower than surrounding skin).
  • Pitted scars: deep, narrow scars that are nicknamed “ice pick scars” due to their appearance.
  • Acne scars are not the purple, brown or red discolorations that are noticed on the skin immediately after a pimple heals. These marks are called post-inflammatory hyperpigmentation (PIH). PIH resolves gradually over months, and it does not leave scars in most cases.

Before Treatment

After Treatment

 

Tools Used to Improve or Clear Acne Scars

  • Subscission - a needle is used to break underlying scar adhesions.
  • Chemical peels can smooth textural abnormalities if they are mild.
  • CROSS technique (Chemical Reconstruction Of Skin Scars) with tricarboxylic acid (TCA) is a local (applied only to the scar) treatment that is useful for pitted scars.
  • ThermaScan laser (1319nm) helps to reorganize and regenerate collagen and other connective tissue in the dermis in a nonablative (no wound) fashion.
  • Resurfacing lasers (Erbium, CO2, Fraxel) also smooth the skin surface. They are ablative and semi-ablative lasers that do create a skin wound. The depth of wound and healing time depend on the device that is used.