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 your free consultation today.
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.
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