Acne Treatments

What Are Acne Treatments

Acne is a symptom of an imbalance deep within the skin’s pores that doesn’t necessarily disappear after adolescence, unfortunately. When oil or sebum and bacteria are clogged in the skin with dead skin cells, a pimple surfaces. That pimple is an inflammatory response that attempts to heal the skin, and when there is excessive inflammation the resulting infection can become more difficult to manage.

Think all pimples are the same? Not necessarily. The cause of the flare-up actually determines how the pimple will form. Once you and your doctor have identified the type of acne you have—mild, moderate or severe—a course of acne treatments will be determined.

Your physician has a variety of options to treat your acne. They include:

• Laser and light treatments
• Medication
• Topical Agents
• Chemical peels

 Early laser treatments designed to address acne used UV light to eliminate blemishes, but these have fallen out of favor due to skin-damaging side effects. Today’s most popular light-based acne treatments harness the power of light to safely and painlessly treat inflammatory acne without the harmful side effects.

Blue light kills bacteria in the pores to heal inflammatory acne, particularly on the face and chest. Some doctors choose to couple blue light treatments with Levulan (a topical medication that treats precancerous cells) to maximize the bacteria-busting effects. It’s important to know that once you stop treatment, the bacteria will resume flourishing so your breakouts may return—commitment is essential to maintain good results. According to Phoenix, AZ, dermatologist Dr. Mark Blair, “One of the ways blue light improves acne is by creating heat that causes the bacteria to produce ‘suicide’ proteins, so they essentially kill themselves.”

Red light is a low-level, short-pulsed light treatment that helps bring down inflammation without damaging the skin. “Red light treatments are good for fighting acne since one of the main components of breakouts is inflammation,” says Washington, DC, dermatologist Elizabeth Tanzi, MD. The red wavelengths also cause the skin cells to produce energy and stimulate new fibroblasts to help heal the skin.

Another option is Isolaz, a virtually pain-free 10-minute procedure that first suctions out the pores to clean them, before pulsed light is used to diminish oil and bacteria. The Light-Emitting Diode (LED) laser can also be used. It employs blue and/or red light to kill acne-causing bacteria, in turn decreasing inflammation.

“Isolaz is great for acneic skin because it targets just the sebaceous glands to help clear up blemished skin,” says Miami dermatologist Flor Mayoral, MD.

Radio frequency is a relatively new treatment for acne. Radio frequency (the same technology used in the skin-tightening treatment Thermage) uses heat to inhibit oil gland activity. It is often used in combination with blue light and red light therapy to treat bacteria and inflammation. Elös is just one of these treatments, and it uses radio frequency and blue light.

Prescription oral medication works on an internal level to do one of two things: inhibit the enzyme that leads to blemish-causing actions or to reduce the bacteria in pores.

Spironolactone is a diuretic that was originally intended to treat high blood pressure, hyperaldosteronism (when the body produces too much of the hormone aldosterone) and low potassium levels. As an acne treatment, spironolactone is known to block dihydrotestosterone, which basically means it works to block the follicular enzymes (5-a reductase) from reacting with androgen receptor sites. When there is an overproduction of testosterone, or there is a testosterone sensitivity, it can cause increased resistant adult breakouts, especially nodules and cysts on the chin and jawline.

Often used to combat hormonally based acne—painful nodules and cysts along the jawline, chin and lower part of the face—spironolactone should be taken in low doses, and probably indefinitely, too, to keep breakouts from returning. But a low dose is considered safe.

Birth control pills can also help regulate hormone levels by absorbing the extra testosterone making it less likely to bind with the receptors that relay messages of increased oil production. For those who don’t want to take an oral contraceptive, spironolactone acts similarly.

A wide variety of oral and topical antibiotics are prescribed to treat acne, including tetracycline, erythromycin, minocycline, doxycycline and clindamycin. Many factors come into play when choosing the antibiotic, including a patient’s age, allergies and if they are pregnant or nursing. Seattle, WA, dermatologist Dr. Jennifer Reichel explains that minocycline is often her first choice, because “It’s an easy once-a-day dose and it’s well tolerated by most patients.”

Antibiotics decrease the number of bacteria present in the pores. In addition, they help hinder the inflammatory response once a pore is clogged, thus reducing the telltale redness and swelling associated with blemishes. Kansas City, MO dermatologist Dr. Audrey Kunin says, “No matter the therapy, it takes six to eight weeks to see improvement.”

Beverly Hills, CA, dermatologist Stuart Kaplan, MD, often recommends more aggressive acne prevention with oral antibiotics, since healed pimples may leave dark spots (post-inflammatory hyperpigmentation) on pigmented skin, which are more difficult to treat than dark spots in lighter skin. Solodyne is an FDA-approved oral antibiotic specifically dosed to treat mild to severe cystic acne.

Adult acne is not a problem that once it clears, it is gone forever. Which is why once you get acne under control, it’s important to maintain your results. If your breakouts return, most likely you’ll have to start from scratch with treatment. Your dermatologist may prescribe these topical agents during and after your bout with breakouts:

• Benzoyl peroxide. While it can be somewhat drying, benzoyl peroxide suffocates the bacteria so it can’t thrive. Use it allover or as a spot treatment. Probiotics and oxygen products work toward the same goal.
• Salicylic acid. In a wash, cream or pad, Salicylic acid can be used daily to maintain the keratinization cycle of skin cells. “Salicylic acid prevents the pores from plugging up and can help even out the skin tone,” says Beverly Hills, CA, dermatologist Debra Luftman, MD.
• Retinoids. Your doctor may suggest you stay on a prescription-strength retinoid like Retin-A or Tazorac, even after your acne has cleared up, since it keeps pores clean by prohibiting dead skin from accumulating. Plus, retinoids help minimize fine lines and wrinkles and encourage proper cell turnover.
• Sulfur. This powerful skin clarifier unclogs pores and minimizes oil.

When applied to the skin, chemical peels remove dead skin cells and clean out clogged pores, reducing inflammation in the deeper layers of the skin and shrinking the breakout and amount of oil in the pores. The treatment can be performed in less than 30 minutes, and you may be red and flaky for a few days following the peel.

To address breakouts, light- to medium-strength chemical peels have been a staple in most aestheticians’ and dermatologists arsenals for years. Chemical peels use a chemical solution that causes dead skin to peel off. With a handful of different peeling agents to choose from light peels can be done as frequently as every few months, or whenever the complexion needs refreshing. Many different types of peels can be used to alleviate acne as well as scarring, but glycolic acid—a type of alphahydroxy acid—is the most common. Salicylic acid—a betahydroxy acid—may be more suitable for sensitive skin, and yet another type, polyhydroxy acid, is among the latest generation of acids that results in the least irritation. Your doctor will decide which type of peel and concentration based on your skin.

Regardless of the peeling agent used, the end goal of all chemical peels is the same: to leave the skin regenerated, smoother and with a dewy youthful glow.

With chemical peels, you can expect some stinging to occur, as well as post-treatment flaking and peeling, which subside in a few days.

Generally speaking, lighter laser treatments feel like virtually nothing, while deeper treatments are more intense. There are so many variables, however, that it can be difficult to accurately predict just how much pain you’ll feel. The discomfort felt by the patient depends greatly on the anesthesia used, but every patient has a different threshold for pain. While some are perfectly fine with 30 minutes of a topical anesthetic, others find they need oral medication to feel comfortable. If you’re concerned about pain, make sure you ask the doctor about which cooling measures will be used to maximize your comfort, and if he or she can recommend anything else to make the laser treatment more tolerable.

Anyone who is suffering from acne of any type.

Anyone who is not experiencing recurring acne.

Rejuvenating procedures like laser treatments and chemical peels can help eliminate the acne; but keep in mind that, because of traumatized tissues, they can also leave your skin red for days (and, in some cases, weeks). After a noninvasive procedure, like a light peel, you skin may be slightly red for a few hours to a few days. But if you've undergone something deeper, you can expect the redness to last upwards of a week. If your skin is still red weeks after your procedure, it’s best to seek out the advice and treatment of your doctor.

Directly following and at least one week after getting a peel, it's important to protect your skin from the sun, avoiding it at all costs. The new skin that’s emerging is fresh and extremely vulnerable to damage. If you find yourself with a sunburn after a peel because you didn't take proper precautions, there are few steps you can take to help your skin heal more healthfully. You'll need to lock in moisture with an intense, emollient-rich moisturizer for at least 24 hours, since the skin is in a state of trauma. Use a product with green tea, which is rich in the antioxidant EGCG, known to have anti-inflammatory power and the ability to reduce UV-induced DNA damage. 

• If you suffer from breakouts and you need to use lightening products, look for azelaic acid as an active ingredient. Not only will it lighten freckles and age spots, it has the ability to hinder the bacteria responsible for acne, as well.
• Laser treatments may help to clear up acne and breakouts, but they can’t be viewed as a stand-alone treatment. Washington, DC, dermatologist Elizabeth Tanzi, MD says that you must couple the laser sessions with topical treatments and/or antibiotics, birth control or oral medications. “Lasers alone won’t work,” she says.

Before you have any sort of laser treatment, ask these questions

• What is your experience with different types of lasers and energy-based treatments?
• How many treatments will I require to achieve my results?
• Is this form of laser safe for my skin type? Will I experience changes in skin tone?
• What type of recovery will I require?
• Will you treat me yourself, or will a member of your staff?
• What are his or her qualifications?