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Where looking good is understood!
OCTOBER NEWSLETTER
Fall has officially arrived. The days grow shorter and the air gets drier. As the seasons change so does your skin. Now is the time to watch your skin and implement needed changes in your skin care regimen.
As stated last month, this newsletter will discuss the treatment of the redness or inflammation associated with acne. It will also touch on the treatment of acne scars. This newsletter is the second installment of a two part series.
The Inflammatory Changes Associated with Acne and Their Treatment
Acne is a continuum of a pathologic process. The pore gets plugged up, bacteria invade, and inflammation sets in. The end result can be scarring. An initial step to take in the treatment of acne is to mechanically and chemically exfoliate the skin to unplug the pore. Once bacteria invade and inflammation sets in, the next step is to attack the process causing the inflammation. This step involves using antiseptics and/or antibacterials to attack the bacterium- P. acnes. One of the most common antiseptics used is Benzoyl peroxide. Benzoyl peroxide comes in 2.5%, 4%, 5%, 10% and 20% strengths (the active ingredient in Pro Activ is 10% Benzoyl peroxide). ISS recommends starting with the lowest concentration. It is applied once to twice daily. Beware that peroxides can bleach hair and clothes. Benzoyl peroxide can cause the skin to turn red and peel. Using Benzoyl peroxide, Retinoic acid/topical tretinoin/Retin-A, and chemical exfoliation simultaneously can make the skin more susceptible to sun damage. Make sure to wear a sunscreen with topical acne treatment.
Speaking of sunscreens and acne, any sunscreen you wear should contain an ingredient for UVA protection. UVA protection is afforded by physical blockers and chemical blockers. Physical blockers are zinc oxide and titanium dioxide. Physical blockers can tend to plug pores and aggravate acne. Chemical sun blockers include avobenzone/Parasol 1789, Helioplex™ (Neutrogena), and Mexoryl SX/Anthelios SX /Mexoryl XL (water resistant) (L’Oreal). A chemical sun blocker may be better for acne prone skin. You may have to try several sunscreens before finding one that is suitable to your skin.
Antibiotics are antibacterials that can be used in a topical or oral form to treat the inflammation associated with acne. A common topical antibiotic is 1% clindamycin used once daily. A common oral antibiotic is doxycycline and dosing schedules vary depending on the extent and severity of the acne. A combination topical product Duac contains both Benzoyl peroxide and Clindamycin. Salicylic acid is another topical agent that can help reduce the inflammation of acne as it has properties similar to aspirin. Many other products are available to treat acne including azelaic acid, sulfa products, etc.
Zeno is an electronic device that works by applying heat and killing the bacterium- P. acnes. A Zeno is used to treat isolated, early red acne lesions before a pustule forms. The device is applied to an acne lesion for a period of 2 ½ minutes two to three times over a 36-hour time period.
Cystic acne is the ultimate pathologic process in the continuum of acne. Cystic acne can lead to scarring and should be treated aggressively. A simple isolated cyst can receive a steroid injection. Cystic acne not responsive to other measures should be treated with Accutane provided there are no contraindications to its use. Accutane has many side effects and it requires counseling and testing before starting the medication and while taking the medication. Lower dosing regimens have been developed to reduce side effects e.g., depression and dry skin.
In addition to the above, light and laser based treatments exist to treat acne. These treatment methods provide an option to individuals who have a contraindication to, aren’t responding to, or can’t tolerate the treatment methods previously discussed. Unfortunately this newsletter will not be able to cover all the methods and products available to treat acne. The products listed above are mentioned to serve as a starting point.
Acne Scar Treatment
As a final result, acne inflammation can lead to scarring. Scarring is basically a fibrotic response as the inflammation subsides. Two types of acne scarring can occur: Atrophic (below the skin) and hypertrophic (above the skin). Atrophic scars come in three types: 1) Ice pick scars (ice cream cone shaped), 2) Boxcar scars (crater shaped with flat floor and 90 degree walls), and 3) Rolling scars (depression with curved/undulating walls). Ice pick scars are best treated by excision due to their depth in the skin. The treatment of boxcar scars depends on their depth and treatment can vary from resurfacing techniques (chemical peel, dermabrasion, laser peel) to excision. Rolling scars are best treated by subcision since these scars have tethers that can be disrupted by this surgical technique.
Hypertrophic acne scars usually occur in areas of skin tension. Areas of high skin tension include the chest and back. The best way to initially approach a hypertrophic scar is with a steroid injection. Surgical revision or excision of these scars is disappointing due to recurrence.
Pigment changes in the skin (dark brown or red) are seen early in the resolution of an acne lesion or in the early course of acne scarring due to post inflammatory hyperpigmentation. These pigmentary changes can be treated with topical agents (hydroquinone, a steroid to name a few) or with light/laser based treatments. Sometimes removal of the pigmentary changes can make a big difference in the appearance of a scar. Most pigmentary changes will usually resolve after a year.
That concludes the second installment of the two part series on acne. ISS hopes the information is helpful in dealing with this frustrating skin disease. We hope you enjoyed the information.
Sincerely,
The Staff at Integrated Skin Solutions- “Where looking good is understood!”
7424 NW River Park Drive (Hwy 9)
Parkville, MO 64152-5028
816.505.5550 Fax 816.505.4550
www.integratedskin.com
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