ACNE

Acne is the most common skin condition in America.  It is estimated that 85% of teenagers and 20-30% of adults combat acne sometime during their life. It is also recognized that there is no single disease that causes more feelings of insecurity and inferiority, greater maladjustment between parents and children, and more long term psychic suffering than acne. Only recently have the psychosocial effects of acne become fully understood and reckoned with.  It has become very obvious that acne can have a significant impact on a person’s overall emotional well-being. Acne is a life-long problem that can affect people of all ages. 

Acne – What Causes It? 

• Overactive sebaceous glands (oil glands)
• Pores that are plugged with dead skin cells
• Buildup of p. acnes bacteria resulting in inflammation

Acne Lesions by name and definition:

• Comedo (comedones – more than one)  This is a sebaceous follicle plugged with dead cells, tiny hairs and bacteria.  These are commonly called blackheads when open.  When closed they are called whiteheads.
• Papule – This is a small (5 millileters or less) solid lesion that is slightly elevated above the skins surface. A group of very small papules and microcomedones may be almost invisible but feels like sandpaper to the touch.
• Pustule - This dome-shaped lesion is fragile and contains pus - consisting of a mixture of white blood cells, dead skin cells and bacteria.  If it forms over a sebaceous follicle there is usually a hair in the center.  Pustules that heal without progressing to cystic form usually leave no scars.
• Macule - This is a flat, temporary red or pinkish spot, with a well-defined border that is left behind by a healed lesion. It may persist for days to weeks before disappearing, and when a number of macules are present at one time they can contribute to the “inflamed face” appearance of acne.
• Nodule – Similar to a papule, a nodule is a solid, dome-shaped or irregularly shaped lesion – usually characterized by inflammation. It extends into deeper layers of the skin and may cause tissue destruction resulting in scarring.  A nodule may be very painful and is a severe form of acne that may not respond to therapies other than isotretinoin.
• Cyst – Larger than a pustule, this sac-like lesion is filled with liquid or semi-liquid material composed of white blood cells, dead cells and bacteria. A cyst may be severely inflamed; it extends into deeper layers of the skin and can result in scarring.  Cysts and nodules often occur together in a severe form of acne called nodulocystic.  Systemic therapy with isotretinoin is sometimes the only effective treatment for this type of acne.

There are several treatments available today that are both safe and highly effective.  Dr. Levine will review those with you and design a treatment plan that will ensure your best outcome.

1. Topical Antimicrobials – these topical treatments work to inhibit p.acne populations in mild to moderately severe acne cases.  There are different formulas available for treatment depending on skin type and other treatments involved. Dr. Levine will determine what is appropriate for your personal needs.
2. Topical antibiotics – work to decrease inflammation caused by p.acnes bacteria.
3. Topical Retinoids – are a derivative of Vitamin A and are considered to be a cornerstone in acne treatment.  They work to unclog pores and prevent whiteheads and blackheads as well as to reverse many of the other causes of acne.  They are also helpful in decreasing pigment changes and scarring.
4. Oral antibiotics – used for treatment of moderate to severe and persistent acne.  Different antibiotics and doses will be used based on your particular condition.
5. Oral Contraceptives – used for women as long-term treatment such are hormonal imbalance which can be a major cause of acne in some individuals.
6. Corticosteroid Injections – to reduce inflammation and promote proper healing.  These are very helpful in speeding up the recovery of a pimple before an important event.
7. Accutane (Isotretinoin) – a potent oral retinoid used to treat severe cystic acne and acne that has proven resistant to other treatments.  Considered a savior by many people.
8. Physician Directed skin care products and chemical peels.  Dr. Levine believes in treating acne and acne scarring from the very start.  A chemical peel regimen will not only decrease dead skin cells that clog pores and lead to acne, but will start your faces own healing process and reduce your risk of long term scarring.
9. Laser and Light based treatments – the proper laser can shrink sebaceous glands and improve acne scarring.  LED treatment can target and kill p.acnes.  Photodynamic therapy is another weapon in our armamentarium against acne.
10. Anti-acne facials – Dr. Levine will discuss the appropriate one for your condition.
11. Sun protection – Dr. Levine stresses the importance of sun protection in acne treatment and to avoid scarring.  This is taught from the earliest age to help prevent damage in later years.

Non-surgical Treatments

• Retinoids
• Chemical peels
• Fillers
• Physician Directed skin care products
• Microdermabrasion
• Non-ablative Laser treatments

Surgical treatment options

• Subscision
• Laser peel and resurfacing
• Dermabrasion
• Deep chemical peels
• Punch grafts