Acne can be treated with multiple modalities including topical and oral antibiotics, benzoyl peroxides, sulfur compounds, retinoids, and oral hormonal agents, such as birth control pills or antiandrogens. When acne fails to respond to conventional treatments, oral isotretinoin (Accutane), is a highly effective prescription medication with significant side effects. A safe and alternative treatment to oral isotretinoin for recalcitrant acne patients is Photodynamic treatment (PDT).
In PDT, a chemical reaction activated by a light source is used to selectively destroy tissue. PDT works in acne by the destruction of P.acnes (a bacteria found in the pilosebaceous glands that is at the root of acne lesions) and the direct thermal injury to the sebaceous glands. Photodynamic treatment can consist of:
blue or red light alone
ALA (Levulan) and blue or red light
ALA and IPL (Intense Pulse Light)
ALA and PDL (Pulse Dye Laser; i.e. Vbeam Perfecta)
P. acnes produces porphyrins which when activated by visible light (especially blue light or red light) can destroy the bacteria that causes acne. ALA (aminolevulinic acid; Levulan) is a solution that is applied on the skin and activated by a light source to cause a direct thermal injury to the sebaceous glands and destruction of P. acnes. The light source to activate ALA can be blue light, red light, intense pulse light (IPL) or pulse dye laser (PDL).
Blue LED light only treatment produces variable responses. This is usually given 2x/week for 4 weeks for a total of 8 sessions. Red light penetrates deeper but can cause more side effects and down time. ALA and blue light is more effective than blue light alone. The ALA solution is left on the skin for 1 hour then activated by a blue LED light for approximately 5 minutes.
ALA and IPL treatments are more effective with a 50-70% response rate. The treatments are performed q2weeks for 8 weeks, repeat in 4 weeks and 12 weeks. The solution is left on the skin for 30-60 minutes before activation with 1 pass of the IPL light source.
ALA and PDL (Pulse Dye Laser) have been shown to be the most effective PDT protocol for the treatment of acne. After incubating for 1 hour with ALA (Levulan), the long pulse dye laser (595nm; Vbeam Perfecta) is used to treat active acne lesions, red post-inflammatory changes and scars. Treatments are done at monthly intervals for 1-4 sessions. Generally, there can be 100% of acne clearance in 3 sessions with long term acne remission (up to 13 months). ALA and PDL also can target blood vessels and cause an anti-inflammatory effect and decrease erythematous acne lesions and scars. Side effects are mild, consisting of mild erythema for 1-2 days.
In conclusion, PDT is a safe and effective treatment for resistant acne. This treatment is also an excellent alternative to oral isotretinoin (Accutane).
Please call us at 904-400-7772 to schedule consultations for a customized treatment plan.
What is acne?
Acne is a disorder of the pilosebaceous unit (follicle and oil gland). Acne usually occurs whenpores are blocked by oils, skin cells and normal bacteria. This usually leads to the development of a comedone. A comedone can be opened to the surface (a blackhead) or closed (whitehead). Bacteria and oil surrounding the pilosebaceous unit causes inflammation which can lead to red bumps (papules) and pustules. These lesions can increase in size to cause red painful nodules and cysts. The greater the inflammatory response the more likelihood hyperpigmentation (dark spots) or acne scars can develop.
Acne is usually a disorder of adolescent but post adolescent acne is increasingly more common. 40% of women with acne reports that their acne occurred after the age of 25. Adult acne tends to be more hormonally related and is distributed more commonly in the lower 1/3 of the face (lower cheeks, jawline, neck). Lesions usually consists of inflamed lesions but can present with black heads and whiteheads. If acne is associated with excessive hair, abnormal menstrual cycles or significant flare with your menses, or deepening of your voice, lab work may be needed to test for androgen excess or abnormal hormones. Non traditional acne treatments utilizing anti-androgens may be necessary.
Is diet related to acne?
Recent studies revisited the link between diet and acne. There is now evidence to suggest that a “Non-Westernized Diet” may help to improve acne. This type of diet can consist of a low glycemic load (virtually no processed foods/refined sugars), high Omega-3 (seafood and fish), minimal dairy, high in antioxidants, and high in fibers. A diet similar to the “South Beach Diet” has a low glycemic load.
Dairy appears to be weakly associated with acne. Skim milk is most strongly correlated with acne. Alternative suggestions include almond or soy milk.
There may be a possible role for antioxidants in the treatment of acne. Useful oral and/or topical antioxidants include green tea, lycoprene, reservatrol (found in the skin of red grapes, red wine, peanuts, mulberries, etc.), Vit C, Vit A, Vit E or nicotinamide. Selenium and zinc supplements may be of value in acne. As with any balanced diet, excessive ingestion of any of the times should be avoided secondary to detrimental side effects.
How can acne and acne scarring be treated?
Treatments for Acne:
- Treat excessive oil (salicylic acid, sulfur/sulfacetamide, Clinac OC and other oil absorbing ingredients)
- Treat comedones with retinoids (tretinoin, retin-A, Tazorac, Differin, Atralin) or combination products (Epiduo, Ziana, Veltin). Clarisonic home care system for deep pore cleaning.
- Treat bacteria and inflammation (antibiotics, benzoyl peroxide, Aczone)
- Accutane (oral isotretinoin) suppresses sebaceous (oil) gland activity and is very effective for acne but has many potential serious side effects. Monthly visits and labs are recommended.
- Photodynamic Therapy (PDT) involves a topical medication applied to acne prone skin. This medication is activated by a light source (blue light, red light, IPL Photofacial, Vbeam Pulse Dye Laser) to target the pilosebaceous unit. This treatment improves acne by inhibition or destruction of sebaceous glands. PDT may induce anti-microbial and anti-inflammatory effects. PDT is considered as a treatment option in individuals who do not want to take oral antibiotics or Accutane.
- Treat post inflammatory hyperpigmentation (hydroquinones, azelaic acid, kojic acid, arbutin, soy, vit C, Melaplex/Perle, oligopeptide/Lumixyl, chemical peels, microdermabrasion, Silk Peels)
- Treat scarring with non ablative and ablative fractional resurfacing (Fraxel laser, Nd:YAG laser or CO2RE CO2 fractionated laser).
Many of these products and procedures can treat one or more causes of acne or its sequelae. Usually a combination of treatments gives the best results.
Successful treatments aim to target inflammatory lesions (nodules, cysts, papules or hard bumps) and non-inflammatory lesions (blackheads or whiteheads). Post inflammatory hyperpigmentation can cause skin discoloration or if the lesions are deep can cause significant scarring.
Our professional staff will work with you to develop a comprehensive program to treat your acne, post-inflammatory hyperpigmentation and scarring.
Amanda’s husband Mike wants her to remove the tattoo that reads, “Amanda loves Bob”.
Steve wants a job as a state trooper but is not permitted to have tattoos that are visible.
Jane always has to cover her neck tattoo in meetings with her boss and clients.
One in 5 Americans has a tattoo but many regret their decision. They want to have them removed but the conventional tattoo removal laser offers an average of 10-20 treatments, 2-3 months apart, and it can be painful with a risk of scarring. With a new breakthrough technology in laser tattoo removal, the tattoo boo-boo can disappear with the PicoSure™ laser.
The PicoSure™ laser is the world’s first picosecond laser for safe and effective removal of tattoo. This FDA approved laser treats tattoo with an average of 4.2 treatments 4-6 weeks apart. Conventional tattoo lasers use many wavelengths to target each different color in a tattoo and the resulting heat can damage surrounding tissue leading to risk of scarring. The PicoSure™ laser uses photomechanical pressure to blast the ink dyes into tiny particles that are safely absorbed from the skin. This laser does not create surrounding heat so there is less a chance of scarring. Because it is so effective at treating pigment dyes there are less treatment sessions leading to lower costs. The PicoSure™ laser is great at removing old tattoos that conventional lasers were not able to treat effectively.
Southside Dermatology is proud to offer this innovative technology.
Please call us at 904-880-0622
to schedule your PicoSureTM laser consultation.
Laser for Cellulite (Cellulaze™)
Cellulaze™ is the first long term, one time, minimally invasive treatment to reduce the appearance of cellulite. This procedure actually treats the causes for the dimpled appearance of the cellulite. Cellulite is a problem due to a structural abnormality under our skin. The dents in the skin are caused by the fibrous bands, the bulges are caused by the fat deposits and thin skin is a contributing factor. This laser procedure melts the bulging fat, lyses the fibrous bands and thickens the collagen and increases skin thickness. The release of the fibrous bands that pull down on your skin results in a reduction of the orange peel look associated with cellulite.
The Cellulaze™ treatment is performed by inserting a very small cannula (size of tip of pen), with the proprietary SideLight™ laser fiber inside of it, under your skin. Local tumescent anesthesia is used to numb the area. The laser energy is directly focused on the fibrous bands and fatty deposits. It is also proven to increase the thickness of your skin by 25% and increase elasticity by 29%. Thicker skin can help smooth the surface and therefore improve the appearance of cellulite.
After the treatment, there will be some swelling and a little soreness. For the first 24 hours there may be some fluid leaking out of the tiny incision sites. Most patients return to normal daily activities within a few days.
Only one treatment is needed and you will see some immediate results but final results may take 3-6 months. Cellulaze™ is backed by several years of clinical research and 100% of patients surveyed were satisfied or very satisfied and would recommend the procedure to a friend. The results should be long lasting since new collagen is formed, the fibrous bands are released and the fatty deposits are treated. It is still important to follow a healthy diet and exercise program to maintain results.
Please call to consult with Dr. Pentel to see if Cellulaze™ is the right procedure for you.
Dr. Pentel speaks about Thermage and Ultherapy treatments on First Coast Living
You may have recently seen Ultherapy featured on The View! We are proud to announce that we are one of the few practices in Jacksonville, Florida who offer this innovative procedure! Ultherapy is the only non-invasive procedure FDA-cleared to lift skin on the neck, chin and brow. This device uses ultrasound technology that bypasses the surface of the skin and targets the foundational support structures stimulating collagen generation and remodeling. Because Ultherapy bypasses the surface of the skin, there is no down time. As the collagen heals over the next 30-90 days, the skin naturally and gracefully lifts and tightens. Although Ultherapy is not intended to replicate surgery, it does provide natural, noticeable results perfect for those seeking a non-invasive way to lift and tone these hard to treat areas. To learn more about this amazing procedure, please contact our office today! We are offering FREE Ultherapy consults with our Nurse Practitioner and laser specialist for the month of December. Leave the turkey necks to the turkeys! Don’t hide behind your scarf this holiday season!
We will also be offering FREE consults for Liposonix in the month of December. Don’t wait! Call our office and schedule yours today at (904) 880-0622.
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Both from a medical and cosmetic standpoint, I have been most pleased with knowledge, efficiency and courtesy of Dr. Pentel and all support staff.
Congratulations to this year's honored business!
Featured in Folio Weekly.