Acne vulgaris is the most common skin problem, affecting approximately 80 percent of Americans and 20 percent of those experience more severe forms of acne. We all know teenagers and adult women who struggle with acne, both psychologically and for health reasons.
It is important to understand the problem so we can move forward with the best solution. In today's world we have many more options for the treatment and management of acne.
Acne is the result of bacterial infection, overactive oil glands, malfunction of the pore clearing mechanisms, hormonal disturbances, inflammation, and a genetic predisposition to the condition.
Active acne outbreaks cause inflammation leading to deposits of pigment and spots at outbreak sites. Unchecked, this inflammation is a major contributor to the characteristic scarring of the cheek or temple area.
Prescription strength skincare and facial peels are the basis of a proactive acne program. Although today's over-the-counter acne treatments are much better then years passed and can be helpful with mild cases, the sebaceous gland over-activity, hormonal component, and pigmentation issues are rarely addressed without prescription strength medicines. Treatment regimens that do not address each of these components predictably lead to early recurrence and disappointment.
A program that addresses all four causes is typically most successful in mild to moderate cases. Some of the medications typically used include retinoid-like medications for suppression of the sebaceous gland, benzoyl peroxide and topical and oral antibiotics for treating P. Acne, exfoliators like salicylic acid to address pore dysfunction, and spironolactone or oral contraceptives for hormonal imbalances.
In more severe cases, oral Accutane or photo-therapy treatments are useful. Recently, the side effects associated with isotretinoin use have led to diminished popularity with patients and doctors alike. High dose regimens of oral isotretinoin have been shown in recent studies to decrease recurrence without increasing side effects.
Phototherapies or lasers have risen in popularity to fill this gap. Photodynamic therapy combines various light wavelengths with Levulan to suppress the bacteria and oil glands.
Acne scarring, the long term result of poorly managed acne, is one of the most underestimated conditions in terms of its negative effect on self-esteem. The characteristic tethered, depressed or “ice-pick” scars can be very disconcerting to patients. In the past, aggressive resurfacing procedures such as dermabrasion or laser resurfacing were used to improve their appearance.
While effective, these treatments were associated with prolonged recovery and were not applicable in darker skin types.
Contemporary acne scar treatment and management utilizes fractional lasers to partially resurface the skin while reducing downtime. This treatment stimulates collagen production to improve scars while leaving areas of normal skin to accelerate healing.
This version of laser resurfacing is also well tolerated in darker skin types without the side effects of earlier resurfacing treatments. Experimentally, platelet rich plasma (PRP) is being used to reduce recovery time after a resurfacing procedure.
While still a challenging condition to treat, a concerted effort at addressing each of the components of acne can lead to significant improvement and patient satisfaction.