Acne Treatments
PDT – Photodynamic Therapy

Acne, also known by its medical name, acne vulgaris, is a skin condition that affects all ethnic groups and ages. It is most common in adolescents and young adults, affecting at least 85% of individuals between 12 and 24 years of age. Patients usually see gradual improvement in their 20’s and 30’s; however acne can persist into middle age and even old age. Acne is usually treated with topical preparations and antibiotics. When topicals and medicines are not effective, Timeless Laser & Skin Care offers PDT, Photodynamic Therapy, which is more aggressive and much more effective than topicals, especially at treating severe cystic acne.

What causes acne?

Acne does not result from poor hygiene, inadequate cleansing, eating chocolate, or indulging in fatty foods. It results from excessive production of skin oil (sebum) and abnormal shedding of superficial skin cells which together result in blocked pores, known as comedones (white heads and black heads). If bacteria, especially Proprionibacterium acnes, get into the blocked pore, inflammation can result. These inflamed pores can then develop into pustules and eventually into deep painful nodules and cysts.

Hormonal disturbances, especially an increase in androgens (male hormones that are normally present in both men and women, but at lower levels in women), can cause changes in sebum production that lead to acne. Levels of androgens are higher during adolescence, which may account for the higher rate of acne during the teen years. In women, there are other conditions which involve increased androgen levels, such as polycystic ovarian syndrome, which can be associated with irregular periods, ovulatory problems, and excessive hair growth.

What life-style changes can I make to improve my acne?

There are several life-style factors that can worsen acne and which can be controlled. Certain drugs, such as androgens (testosterone); lithium; neuroleptics (particular psychiatric drugs); and epidermal growth factor inhibitors (drugs used to treat certain cancers) can cause exacerbation of acne. If you are on any of these medications, do not stop taking them. Rather, consult the prescribing physician and ask about alternatives. Dairy products should be eliminated or at least reduced or you should switch to organic dairy products due to the hormones administered and fed to dairy cattle. If you eliminate dairy from your diet, it is important to make sure you get adequate calcium from other sources such as fortified orange juice and cereals, nuts, dried fruit, greens, or calcium supplements.

Acne can also be exacerbated by blocking pores with cosmetics, hair products, helmets, backpacks, shoulder pads, and swim caps. Cosmetics and skin-care products should be oil-free, non-comedogenic, and/or non-acneigenic. Patients with acne should also avoid hair care products that contain oils. Hair products can extend or transfer onto the forehead, jaw line, neck or back, worsening acne in these areas. It is important to position your hair off the face and back prior to sleep; and pillow cases should be washed frequently.

What are the common treatments for acne?

Acne is a chronic condition. It is unrealistic to expect a complete cure from acne; however, acne can be controlled so that you experience a significant decrease in lesions. Any treatment requires time to work. You MUST adhere to the acne treatment plan in order to have success.

The following are common recommendations for the treatment of acne and suggestions to help you through some of the initial challenges associated with various treatments:

• Gentle cleansing no more than twice per day: This helps remove excess oil, however does not clear up acne that is already present.
• Benzoyl peroxide (Benzacline): This has an anti-bacterial effect, preventing pimples and pustules, as long as you use it regularly. The effects stop as soon as you discontinue using the product. The challenge with BP is that it can bleach fabrics. We recommend you buy white washcloths and hand towels and use these for washing and drying your face. You might also want to invest in a couple of white sleep T’s. You should see the effects of BP by 6-8 weeks of regular use.
• Topical antibiotics (Benzacline; Cleocin T): These fight bacteria and decrease inflammation in superficial acne, but do not penetrate deeply enough to help with cystic acne.
• Salicylic acid: This helps unclog pores, fighting comedones, but only so long as you use the product regularly.
• Photodynamic Therapy, PDT: In this process, Levulan, a substance that occurs naturally in the body in small amounts and is concentrated into the oil glands of the skin, is applied to the affected area. One hour later, the skin is treated with IPL, a light-based treatment offered at Timeless Laser & Skin Care. PDT kills bacteria and shrinks the oil glands, thus having a more significant effect on acne than most other topical treatments. The challenges with PDT are an appearance and a feeling of having a sun burn which typically lasts from 8-48 hours. Patients are also usually very sensitive to the sun for 3 days after PDT treatment and should wear a hat and an SPF 45 sun block. Patients with severe comedonal, pustular, or cystic acne usually require 4-6 PDT treatments initially, followed by periodic maintenance treatments to keep up the benefits.
• Topical retinoids (e.g. Retin A; Tazorac; Differin): These are effective against comedones. The challenge with retinoids is that they can cause irritation, redness, and peeling. These side effects usually last about 2-4 weeks, and can be minimized by applying the retinoid to your clean, dry face after dinner and then washing off before bed. If you use it this way for 2 weeks, you will decrease the initial inflammation; then you can apply at bedtime and wash off in the morning. If, using this regimen, you still have too much irritation, try spacing the treatment out to every other night or every third night rather than every night. You have to get past the initial irritation to get the long term benefit from the retinoid. You should see the effects of retinoids by 6-8 weeks of consistent use.
• Birth Control Pills: Oral contraceptives cause an overall decrease in androgens circulating in the blood stream. Therefore, combination birth control pills can be very effective in the treatment of acne vulgaris. Spironolactone may also be used in the treatment of acne. Spironolactone prevents the production of androgens. Spironolactone is safer, more effective, and has fewer side effects (e.g. painful periods) if taken in combination with birth control pills.
• Oral antibiotics (Doxyclicline; Minocylcine): These are effective against deeper acne, however have more side effects than topical antibiotics and require 4-8 weeks to see results. They do not affect oil production or clogged pores, so are usually prescribed in combination with other treatments.
• Isotretinoin (Accutane): This pill affects all of the causes of acne and can often clear even severe acne. However, isotretinoin can cause severe drying of the skin and more importantly, can cause severe birth defects if taken by a woman who is pregnant or becomes pregnant while taking it.
• Chemical Peels:Chemical Peels remove a thin layer from the surface of the skin, which can help minimize the appearance of very mild acne scars.
• Laser Genesis: Laser Genesis Skin Rejuvenation helps smooth the appearance of mild to moderate acne scars. The gentle warming of the superficial dermis, the layer of skin immediately under the epidermis, causes an increase in collagen production, elevating the deep portions of the scar. Laser Genesis is not effective for “ice pick” type scars. Patients usually need 5-10 treatments scheduled 2-4 weeks apart.
• Injectable fillers (Juvederm, Restylane, Hylaform): These injectable forms of hyaluronic acid, a substance that occurs naturally in the skin, can help smooth out box scars and linear scars. They plump the skin under the base of the scar, raising it to be more even with the surrounding skin.

If medicines alone have not controlled your acne, don’t wait another day to find out about PDT. 

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