Acne is the overall single most common reason for a visit to the dermatologist.
Acne affects 80% of people at some point in their life.
It afflicts 30% to 85% of adolescents and aggravates 12% of adult women between the ages of 25 to 44, many of whom have never had a blemish before.
Traditional acne treatment includes:
- Restoring normal behavior in the cells lining the pores, so they won’t plug up, with a retinoid i.e. tretinoin, tazarotene or adapalene.
- Keeping bacterial population down with benzoyl peroxide and surface and/or internal antibiotics.
- Loosening pore contents with alpha hydroxy acids.
- Reducing oil gland size and activity with hormones, such as birth control pills, and/or Accutane.
- Acne surgery, comedo extraction, peels, intralesional injections, dermabrasion.
New therapeutic approaches:
- The combination of a retinoid (tretinoin, tazarotene, adapalene) with a benzoyl peroxide and/or a topical antibiotic is now considered to be the standard of care rather than monotherapy.
- Solubilized benzoyl peroxide (BPO) gels are showing better follicular penetration, better bioavailability and greater reductions in acne lesion counts than traditional BPOs. Both non-inflammatory i.e. blackheads and whiteheads, as well as inflammatory lesions (i.e. pustules), small and larger cysts, showed improved lesion counts. BPO is a 1 billion dollar a year product and a major player in the treatment of acne.
- Combination products containing a topical antibiotic and a BP have shown to decrease the risk of antibiotic resistance. Some combine a retinoid and an antibiotic.
- Topical retinoids are still considered the gold standard in the treatment of both comedonal and inflammatory acne. Because of their irritation potential, we have always advocated a “step-up” dosing schedule as well as the use of a gentle moisturizer interface. Newer, less irritating formulations have made them easier to tolerate.
- Melatonin and Kabuchiol are the newest kids on the block, helping acne via their anti-inflammatory and Retin-A like activity without irritation.
- A series of gentle peels can help unroof some acne lesions and enhance absorption of actives deeper in the pores.
- At Greenwich Dermatology, we make every effort NOT to use internal antibiotics. Considering all the recent information concerning their negative effects on our gut microbiome, we avoid them at all cost.
- The FDA approval of the low dose contraceptive YAZ for acne has made an enormous difference in patients whose acne is hormone influenced. We have witnessed repeated cases of very diligent treatment-resistant acne patients respond dramatically within a month or two of starting YAZ.
- Accutane has gone generic and remains THE MOST EFFECTIVE and the most rapid way to clear acne. We feel this drug should be the standard of care for most moderate and all severe acne conditions if possible.
- A sub-antibiotic dose of doxycycline, has been added to our armamentarium, allowing us to gradually taper antibiotic regimens and not worrying about antibiotic side effects. This dosage provides an anti-inflammatory effect only and is thus very helpful in mild to moderate inflammatory acne as seen in rosacea.
Laser and light treatments:
- PDT or Photodynamic Therapy or Blue Light Treatment has been shown to provide results equivalent to oral antibiotics.
- Isolaze has been very helpful in improving and controlling mild to moderate acne. It also works well in conjunction with topical treatments. Isolaze has helped many acne sufferers avoid more aggressive treatments.
- Home use LED devices can give patients a sense of control in the management of their acne.
- During the latter half of 2019, we are promised a novel technique using gold particles rubbed on the skin,
which penetrate the pores and are then activated by a simple CO2 laser. Very exciting! Stay tuned.