Acne, Part 3

The DERMAdoctor Skinstruction Manual
by Audrey Kunin, M.D., Bill Gottlieb

(Page 4 of 4)

Procedures

Dermatologists may include procedures in their approach to acne. Most commonly, "acne surgery" is performed. This essentially refers to the use of a comedone extractor being firmly applied around a blackhead to push it out of the skin.

Other options include chemical peels, microdermabrasion, and (an old-time procedure) the application of liquid nitrogen to an acne cyst.

In my approach to acne therapy, I have personally found procedures rather limited and turn to them only to supplement other treatments.

Shedding Light on Acne

Those who make their way to a dermatologist often credit summer sunlight as helpful in reducing acne severity, and studies support the benefits of sunlight in acne therapy. But with today's heightened concerns about skin cancer (not to mention wrinkles!), indiscriminate use of medical ultraviolet phototherapy is not the treatment du jour. Leave it to medical science to find another way to get that summertime-like improvement.

The Acne Blues. P. acnes bacteria produce natural by-products called porphyrins. Porphyrins are exquisitely vulnerable to a high-intensity, narrow band of visible blue light. When porphyrins are exposed to this light (or, to a lesser extent, natural sunlight, which contains a less intense form of blue light), a chemical reaction toxic to P. acnes takes place. Kill the P. acnes, improve the acne.

Commercially, this process is called Acne PhotoClearing and is marketed under the name ClearLight, which has been approved by the FDA for the treatment of mild to moderate inflammatory acne — small, red papules and pustules (whiteheads). ClearLight is unlikely to resolve blackheads or cysts, minimize pore visibility, or reduce oiliness.

Remission with ClearLight usually lasts between four and eight months. Repeated series of ClearLight may be required for maintaining a clear complexion. And not all cases of acne are triggered by P. acnes, so the procedure isn't for everyone.

Smoothbeam Laser

This laser takes aim at the literal root of the problem: the sebaceous gland. In a series of treatments, the heat of the Smoothbeam alters the structure and function of the glands.

Results are fairly impressive. Improvement can be seen as early as three weeks — and after four treatments some patients achieve 98 percent clearance! However, those results aren't permanent. In one study, at a twenty-four-week follow-up, 100 percent clearance was seen in just one of twenty-seven patients.

Future Treatments

Two candidates in the "acne pipeline" include topical versions of oral medications already used to treat severe cases of cystic acne.

Isotrex. Essentially Accutane mixed in a protective sunscreen base, Isotrex is available in Canada and Europe. (For more information on Accutane, please see the sidebar on page 9.) I have read mixed reviews from Canadian and European dermatologists. It will be interesting to see if this medication makes its way through the FDA and onto the U.S. market and how it will truly perform.

I have seen some first-time patients who had been given "homemade" forms of this product by other doctors, which consisted of them poking holes in the Accutane capsule and applying the liquidy gel straight to the skin. All this method accomplished was to locally irritate and dry the skin without helping clear the acne lesions.

Atrisone. The topical form of the oral medication Dapsone, Atrisone is typically used in the treatment of certain forms of blistering disorders and systemic infections. It has both antibiotic and anti-inflammatory actions. It is occasionally prescribed for severe cystic acne when Accutane cannot be used or has not been effective. Atrisone sounds promising in the initial reports and is currently in clinical trials. Should the FDA approve it, Atrisone would offer an entirely new category of acne therapy.

11 Important Points to Remember About Acne Treatment

1. Blackheads. For best results, use some form of topical retinoid.

2. Cysts. They respond best to pill therapy.

3. Consistency of treatment. Steady treatment results in a better outcome.

4. Six to eight weeks. That's the amount of time to allow for any therapy to take effect before you give up on it.

5. Don't pick. It can lead to scar formation.

6. Don't scrub the face or have facials. If you're acne-prone, these actions may traumatize sebaceous glands and lead to further flare-ups.v

7. Bangs. Keep them off your forehead.

8. Hands. Keep them off your face. Keeping hands and hair off your skin will help minimize distributing pore-plugging oils.

9. Apply products lightly. Don't apply an acne cream, lotion, or gel heavily, like a mask (unless it is one). There is no reason your product needs to be seen in order to work.

10. Heavy skin care products like cocoa butter. Avoid them. They will smother the skin and aggravate your acne.

11. Makeup. Remove it when you're at home. Let your skin breathe!

Everyday Skin Care for Acne Patients

Acne is not caused by a lack of cleansing, but removing pore-plugging, bacteria-nourishing oils, as well as surface cellular debris, goes a long way to minimizing breakouts.

Glycolic acid (an alpha hydroxy acid, or AHA) and salicylic acid (beta hydroxy acid, or BHA) help dissolve grease and grime, lifting away cells plugging the pores. Glycolic acid tends to be more versatile and can be found in cleansers, treatments, and toners. BHA often assists glycolic acid in AHA-BHA products.

Thanks to the plastic industry, polymers have been created to surround and lift core-plugging oils away from the skin, without causing irritation or parching. They help keep the skin free of shine all day long.

Here are the types of products dermatologists advise their acne patients to use in routine skin care:

• Glycolic acid (an AHA). Try M.D. Forté Glycare Cleansing Gel and M.D. Forté Glycare I.

• Salicylic acid (BHA). Try Peter Thomas Roth Beta Hydroxy Acid 2% Acne Wash or Sal Ac Wash.

• Combination AHA-BHA products. Try M.D. Forté Glycare Perfection Gel, Peter Thomas Roth AHA/BHA Acne Clearing Gel, or Peter Thomas Roth AHA/BHA Face & Body Polish.

• Oil control. Try DERMAdoctor Tease Zone Oil Control Gel with Sebum-Sequestering Micro-Particles or OC Eight Mattifying Gel.

Final Thoughts

Too many acne sufferers go untreated for far too long. No one need suffer with acne — today there are more effective therapy options than ever. If you have acne that doesn't respond to over-the-counter treatment, please see a board-certified dermatologist.

Ask the DERMAdoctor

QUESTION

I do a pretty good job of keeping my mild acne under control, but sometimes one or two pimples just pop up — particularly right before an important event like a presentation at work or a party! (Must be the stress.) What's the best way to camouflage a pimple?

The DERMAdoctor:

First, you need to treat it. I recommend dabbing on a product with acne-fighting benzoyl peroxide, like Peter Thomas Roth BPO Gel 10% and Sulfur. Another possibility is an AHA-BHA product, like M.D. Forté Glycare Perfection Gel.

For those who like to carry around their emergency "zit fix" in their purse, Cellex-C Skin Perfecting Pen is a great way to dab your way to an invisible blemish, especially when you start out early. The natural botanicals have a drying effect and create an environment hostile to the bacteria. If none of these is on hand, try spotting the blemish with toothpaste. Select one that is white, free of cinnamon flavoring, and not packed with tooth-whitening peroxide.

Once you've dried it out, it's time to cover it up. One of the trade secrets of makeup artists who work on movie stars is Visine. The same stuff that "gets the red out" of your eyes can help get the red out of your face. After you've done your best to dry out the pimple, soak a cotton swab in Visine. Then hold the swab to the affected area for about ten seconds. The redness will disappear.

Next, get out that concealer. Green-tinted concealers are great for camouflaging redness. One to try: T. LeClerc Liquid Concealer-Tilleul. The green works to neutralize the redness. Don't overdo it or you'll make the blemish more obvious that it was before you tried to get rid of it. Use a small amount and tap lightly. Apply a small (repeat: small) amount to the blemish; then, using your ring finger (it exerts the least amount of pressure of all your fingers), lightly tap the concealer into the blemish.

When you apply your regular makeup, be careful not to smear the concealer, and always set your makeup with loose powder. This will reduce the chance of removing the concealer. You want to make your face look as uniform as possible, so that the pimple doesn't stick out and announce its presence to the world.

Copyright © 2005 by Audrey Kunin, M.D.

About the Author

Dr. Audrey Kunin is a practicing, board-certified dermatologist, the founder, president and chief medical advisor of DERMAdoctor.com® - a dermatology education and e-commerce site, and the creator of DERMAdoctor Specialist Skin Care.

Bill Gottlieb, a writer and editor specializing in health, is the former editor in chief of Prevention Magazine Books an Rodale Books. He is the author of Alternative Cures and the coauthor of the Calcium Key. He lives in Lake County, California.