Acne starts in the oil gland which gets plugged when certain bacteria form a biofilm at its opening and plug it. The same bacteria penetrate inside the plugged oil glands and digest the trapped oil. This digested oil is not recognized as “Self” by the immune system and therefore it has to be rejected, through pustules (pimples), papules (bumps), nodules, cysts, etc. Our acne treatment is directed at removing the plugs, killing the bacteria that form the plugs and digest the trapped oil, reducing the inflammation and (by using certain la
sers) shrinking the oil glands.During acne treatment, your skin may become irritated and need a moisturizer (oil free). Since the treatment aims both toclear acne and to prevent acne, you will have to use the prescribed products on a daily basis. Once clear, a maintenance regimen is given to continue to keep your skin clear of acne.
Important news in acne research
A small OBJECTIVE study on the effect of diet in acne has been published in the August, 2008 issue of the Journal of the American Academy of Dermatology. A low glycemic load diet (i.e. whole cereal, low sugar, etc) caused a measurable reduction in the number of acne lesions.
This study confirms a previous study done in 2002 in Paraguay which showed that the native inhabitants had NO SIGNS of acne. The natives diet was definitely low glycemic.
Acne is caused by plugging of the opening of oil glands. As a result, the oil is trapped inside. Certain germs penetrate into the trapped oil and digest it into irritating chemicals. The skin tries to reject these chemicals through pustules (pimples), papules (bumps) and cysts.
Washing the affected areas more than once or twice daily will not prevent the germs from penetrating into the plugged oil glands. It will cause dryness, irritation and further plugging of the oil glands. Thus, excessive washing aggravates acne. Wash gently with Dove or Purpose soap, one or twice daily.
Acne scars may develop in the skin after the actual acne lesions disappear. Scarring is more common with the more severe types of acne, but may accompany any type, especially if the patient has picked at or squeezed the pimples. Typical acne scars appear as indentations in the skin of variable depth that do not improve substantially over time. This should be distinguished from skin discoloration in the areas of former pimples that does improve over weeks to months.
Recent studies have found that the bacterium that digests the trapped oil in and beneath the plugs in oil glands (Propionibacterium Acnes) is also involved at an earlier stage of pimple formation.
It has been found that this bacterium is capable of forming a biofilm that acts as a cement between the cells. As a result, these cells, which are supposed to die and passively get pushed out of the oil gland ducts, remain attached to each other and to the walls of the said ducts (Journal of the American Academy of Dermatology, 2007 Oct;57(4):722-4).
Thus, Propionibacterium Acne is involved in both the comedone formation (non-inflammatory acne) and in the pustule formation (inflammatory acne).
Recently, it has been noticed that Photodynamic Treatment with an intense pulsed light, especially the Isolaz, can clear severe cases of acne. In Photodynamic Therapy, a solution of aminolevulinic acid (Levulan) is painted on the patient’s skin.
The patient waits between 30 and 60 minutes (some authors have obtained good results even with 10 minutes wait). During this time, the aminolevulinic acid is absorbed preferentially into the fast dividing cells of the oil glands and the Propionebacterium Acnes bacteria. Then, the intense pulsed light transforms the aminolevulinic acid into a toxic compound (Protoporphyrin) which damages the oil gland and its ability to produce oil. At the same time, the pores are opened by the suction, the biofilm plug is pulled out and the protoporphyrin also kills the remaining Propionebacterium Acnes bacteria. None of the other devices presently on the market have the vacuum power of the Isolaz.
The blue lights (Blu-U, Omnilux, etc.) even though more specific in wavelength than the Isolaz, don’t penetrate as deeply, due to the shorter wavelength and do not have any vacuum. Nowadays, with the Isolaz and Levulan, severe cases of acne can be cleared in 3 visits, 2 to 4 weeks apart.
Topical Therapy for Acne in Chicago
Acne is a chronic and relapsing inflammatory condition of the oil glands. Drs. Eugene and Steven Mandrea have treated for many years numerous patients with all types of acne and all grades of severities in Chicago and suburbs.
Topical therapies have been used in the treatment of acne for a very long time. We shall only mention the ones commonly used at the present time:
Benzoyl Peroxide, used alone or in combination with an antibiotic such as Erythromycin or Clindamycin, is an important item in the treatment of acne.
The Propionibacterium Acnes is ananaerobe (It thrives in Oxygen poor areas). Benzoyl Peroxide releases Oxygen and easily kills the P. Acnes. Thus, Even though the P. Acnes can and does become resistant to antibiotics, it can never become resistant to Oxygen.
Topical Erythromycin and topical Clindamycin (both antibiotics) are often used singly in mild cases of acne or in combination with Benzoyl Peroxide in moderate to severe cases. P.Acnes is largely resistant to both, but their anti-inflammatory action still helps make them useful agents to combat acne.
Topical Azelaic Acid (Azelex™, Finacea™), has proved to be a very useful topical agent to combat acne, in that it has an anti-inflammatory action and also kills the P.Acnes.
Topical Sulfur/Sulfacetamide combinations are still popular, after close to 50 years of continuous use. They are anti-inflammatory, suppress P.Acnes and exfoliate the plugs.
Retinoids (Retin-a™, Differin™, Tazorac™ are very important topical products in that they stimulate a more rapid turnover of cells and thereby help the skin shed the acne producing plugs and also discourage plug formation.
Recently, a combination of Benzoyl Peroxide and Clindamycin topically in A.M. and a Retinoid at bedtime, has been shown to be very beneficial in the treatment of moderate acne. We use this combination extensively and also add an Azelaic Acid product in A.M.A new, very effective topical cream, containing a Sulfone derivative, Aczone has recently been approved. Sulfones have a strong anti-inflammatory actions in certain conditions, including acne.
Comedone extractor:
There are two types of comedones: Open (Blackheads) and Closed (Whiteheads).
In the 1930’s, Dr Jay F Schamberg devised a blackhead extractor: The Schamberg Comedone Extractor, which is still used at the present time. Some other comedone extractors are on the market, but we prefer the Schamberg, as it is less traumatic to use than the others. We have found that in about 10% of cases, comedone extraction may actually cause some papules and pustules to develop. Therefore, the first time we extract comedones, we do it on one side of the face (or back or chest) and compare the two sides on the next visit. If the treated side is better, we continue the procedure, otherwise we don’t. We also use the comedone extractor to extract whiteheads (closed comedones) after gently opening them with a No. 11 scalpel. Again, we do it on one side only the first time. Comedone extraction should be performed only by a well trained person.
Systemic Therapy for Acne in Chicago
Systemic Antibiotics including Tetracycline and its derivatives Doxycycline and Minocycline have been used to treat acne for many years (since the 1950-s). They are still being used to-day, mainly for their anti-inflammatory actions. Other antibiotics, such as Penicillins and Cephalosporins are used more rarely.
Nicotinamide, a Vitamin in large doses, has also been used for a long time to treat acne, again for its anti-inflammatory actions.
For women with resistant acne, Spironolactone, a diuretic with some anti-androgen activity, has been used for several years. Caution must be exercised in following the Potassium level and in absolutely avoiding Pregnancy.
Birth Control Pills have been used with variable success to fight acne.
If everything fails, Accutane is extremely effective, but it has some unpleasant side effects.
Some patients prefer the Photodynamic Treatment with the Isolaz machine as described above, to the Accutane treatment for acne.
For treatment of