What is Acne?

Acne is a common skin condition in which the pores of the skin become clogged with debris made up of dead skin cells and sebum (oil). Bacteria acting on this debris cause irritation and inflammation, resulting in a blackhead, whitehead, pimple or nodule. While it is thought that hormones play a role in the cause of acne, the other factors that promote blockage of pores include bacteria, cosmetics, oil, and detergents. Acne treatments are designed to modify and control these factors.

Treatment of Acne

We want to degrease the skin. We want to unplug the pores. We want to "dry up" the blemishes. We want to prevent the bacteria from multiplying. We will help you restore beautiful, healthy skin. To do this, we recommend the following:

• Wash your face gently two times a day with a mild cleanser (such as DCL BProx 10 Wash, DCL Active Cleanser or Glytone Acne Cleanser). Use your hands to make a lather then rinse well with lukewarm water and pat dry.
• Cosmetics may aggravate acne and should be avoided. This includes most moisturizers, liquid make-up (foundation), blemish sticks, and blush. "Water-based" foundations are not necessarily safe. Ask for "non-comedogenic" cosmetics if you choose to use them.
• Picking and squeezing should be avoided. Deeper lesions and scarring may result. As a general rule, try to keep hands off your face altogether.
• Avoid stress and fatigue. Get enough sleep, fresh air and exercise. Eat a well-balanced diet and drink plenty of water. Even though studies have shown that diet does not directly influence acne, it will contribute to your general well being. However, if you find that a certain food aggravates your blemishes, it should be avoided.
• Do not irritate your skin. Keep hair away from your face and back. Do not wear wool or rough materials on your skin. Do not use any facial scrubs or loofahs. Do not wash your face more than 3 times a day.
• If you are pregnant, please inform us. Many acne treatments are contraindicated during pregnancy.

Topical acne products include Vitamin A (Tazorac, Retin-A Micro, Retisol, Differin) and Benzoyl Peroxides (Solugel, Panoxyl, Benzac). With all of these agents, at least four to six weeks is required before results can be adequately assessed. Do not attempt to hurry up the results by applying these products more than recommended. These products may cause some dryness and irritation of the skin. Washing the face 15 m(txt)inutes or more before applying these preparations lessens the irritation. These products will increase sun sensitivity so it is important to avoid the sun or wear sun screen (SPF 30) during the day. Topical combination products may also be prescribed. These products combine an antibiotic called erythromycin with benzoyl peroxide (Benzamycin) or with Vitamin A (Stievamycin). Another product combines an antibiotic called clindamycin with benzoyl peroxide (Clindoxyl).

Oral antibiotics may be prescribed. Antibiotics inhibit the acne-causing bacteria. It is important to follow the instructions carefully and to remember that antibiotics make you more sensitive to sunlight.

Hormone Therapy for women includes certain birth control pills with proven beneficial effects on acne (Diane-35, Tricylen, and Marvelon).

In cases of very severe acne, Accutane (isotretinoin) may be recommended. This medication has several side effects and requires close physician monitoring.

Intense Pulsed Light (IPL) therapy utilizes very high intensity light energy to destroy acne-causing bacteria. In addition, IPL therapy shrinks sebaceous glands that are over-active in acne-prone skin. While improving acne, IPL will also treat red facial veins, pigmented lesions, uneven skin tone and facial lines and wrinkles. Initially, the acne may worsen but within 2 to 4 weeks, the skin will begin to improve dramatically.

The Blue-U acne treatment is non-invasive and pain free. This high intensity blue-violet light activates porphyrins in the skin. The porphyrins start a chemical reaction that produces peroxide which destroys the acne-causing bacteria.

Best results are seen with a series of treatments. We recommend weekly 30 minute treatments for 5-8 weeks. Patients sit close to the light for 30 minutes. The Blue-U is very safe to use with oral or topical antibiotics. Patients typically see improvement in their acne after 3 or 4 treatments. The acne will continue to improve for 2-3 months after completing the recommended treatments.

Photodynamic Therapy is a special treatment performed with a topical photosensitizing agent called Levulan (5-aminolevulinic acid or ALA) activated with the correct wavelength of light. This is also known as "ALA/PDT treatment". These treatments remove sun damaged pre-cancerous zones and spots called actinic keratoses. Sun damage, fine lines, and blotchy pigmentation are also improved because of the positive effect of Levulan and the light treatment. ALA/PDT treatment also has the unique ability to minimize pores and reduce oil glands, effectively treating stubborn acne vulgaris, acne rosacea, and improve the appearance of some acne scars.

Recovering from acne is a process in which the skin will get worse before it gets better. Many people notice improvement after two to three weeks of treatment. Do not be discouraged if results are taking longer than expected. It is very important to be consistent with your prescribed treatment and return for follow-up appointments.

Photodynamic Therapy for Acne

A new procedure is now available that treats active acne as well as older acne scars leaving your skin smoother and clear of blemishes. The procedure is called Photodynamic Therapy (PDT) using Levulan.

Photodynamic Therapy is a process by which a photosensitizing agent (Levulan) is applied to your skin. The Levulan is then activated with a specific wavelength of light, which turns it on. Levulan has been used extensively for the treatment of a variety of different skin conditions, and it is approved by the FDA and Health Canada for the treatment of sun damaged skin.

Levulan is a 20% solution of Aminolevulinic Acid (ALA). ALA is a natural substance found throughout your body, as it is a precursor for hemoglobin synthesis. You would be unable to make red blood cells to carry oxygen without ALA in your body. Consequently, it is a natural product found in all humans.

Acne results from the obstruction and inflammation of the sebaceous glands, and it affects 80% of the population. Acne typically begins in adolescence with hormonal changes. However, there are many older individuals who suffer from adult acne.

There are several different presentations of acne ranging from comedonal (blackheads and whiteheads), papular, pustular, and cystic acne. In many cases, many of these presentations of acne can be present simultaneously.

Prior to Photodynamic Therapy, the best available treatment option for cystic acne was Accutane. However, with Accutane there are many systemic side effects including birth defects, liver abnormalities, mood depression, and virtually all patients get dryness and night vision changes. PDT now provides a viable alternative for all types of acne.

Photodynamic Therapy is performed as follows:

The Levulan is applied to the skin and left on for 30-60 minutes. Levulan is a clear solution and painless. Levulan is then activated with a specific wavelength of light called BLU-U. This takes about 8 minutes. The Levulan targets active cells. Acne sebaceous glands are comprised of active cells. These cells preferentially absorb Levulan, and these cells are targeted by the Levulan once it is activated. The Levulan will also target sebaceous hyperplasia (which are those small (1-3 mm), benign bumps on the skin) and the papules of acne rosacea. Skin oiliness is decreased and the appearance of pores is minimized. The entire skin texture improves following Photodynamic Therapy.

The downside of Photodynamic Therapy is that the treated area will be red and have some skin peeling and crusting for several days after the treatment. Usually, the first 1-2 days are the worst. We advise remaining indoors the day following treatment to avoid sun exposure, as the treated area is photosensitive for about 24 hours after PDT. Most patients are able to resume normal activities in 2 or 3 days. The downside of this procedure is clearly outweighed by the dramatic improvement in skin complexion.

Photodynamic Therapy for Photodamage

What is Photodynamic Therapy?

Photodynamic Therapy (PDT) is a special treatment performed with a topical photosensitizing agent called Levulan (5-aminolevulinic acid or ALA) activated with the correct wavelength of light. This is also known as ALA/PDT treatment. These treatments remove sun damaged pre-cancerous zones and spots called actinic keratoses. Sun damage, fine lines, and blotchy pigmentation are also improved because of the positive effect of Levulan and the light treatment. PDT also has the unique ability to minimize pores and reduce oil glands, effectively treating stubborn acne vulgaris, acne rosacea, and improve the appearance of some acne scars.

How much improvement can I expect?

Patients with severe sun damaged skin manifested by actinic keratoses, texture and tone changes including mottled pigmentation and skin laxity may see excellent results. You may also see improvement of large pores and pitted acne scars. Active acne can improve dramatically.

How many treatments are required?

To achieve maximum improvement of pre-cancerous (actinic keratoses) sun damage, skin tone and texture, a series of three treatments 2-4 weeks apart is most effective. Some patients with only actinic keratoses are happy with just one treatment. More treatments can be done at periodic intervals in the future to maintain the rejuvenated appearance of the skin.

What are the disadvantages?

Following PDT, the treated areas can appear red with some peeling for 2-7 days. Some patients have an exuberant response to PDT, and experience marked redness of their skin. Temporary swelling of the lips and the area around the eyes can occur for a few days. Darker pigmented patches can become temporarily darker and then peel off leaving normal skin. This usually occurs over seven to ten days. Repeat treatments may be necessary as PDT is not an exact science.

What are the advantages?

• Easier for patients than repeated topical liquid nitrogen, Efudex (5FU), or Aldara because the side effects are minimal, the healing process is rapid, and only 1-3 treatments are required.
• PDT is painless verses liquid nitrogen, 5-FU, and Aldara.
• Reduced scarring and improved cosmetic outcome compared with cautery, surgery and Efudex. Liquid nitrogen can leave white spots on the skin.
• PDT improves the whole facial area treated resulting in uniform color and improved texture and tone as opposed to spot treatment with liquid nitrogen, cautery and surgery.

In summary, PDT is the ideal treatment for photodamaged skin. The procedure is well tolerated, painless and non-invasive. The downtime is minimal and the cosmetic results are excellent.

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