Acne Treatments

• • Blu-U
• • Photodynamic Therapy
• • Laser Therapy
• • Zeno

Latest Treatments for Acne

We now have the latest treatments available for people suffering from mild to moderate inflammatory acne, pustular acne and acne scars. We are proud to announce that we have been using the BLU-U (blue light) for acne with or without the addition of Levulan (delta-amino levulinic acid) which acts as a photosensitizer, resulting in faster results. We also use the 1319nm laser to treat acne.

The Cause of Acne

Before we tell you about how these treatments work, let me explain a little about why people get acne. First of all, acne has nothing to do with sweat glands. If you exercise and get hot, you sweat; the sweat fluid comes from glands in your skin and reaches the surface of the skin via the sweat ducts.

The glands that are involved with acne are the sebaceous glands. If your face feels a little greasy by the middle of the afternoon, it is due to the lubricating effect of the sebaceous glands. The sebaceous glands drain out onto your skin along the hair shaft, in the hair follicle. The lining of the hair follicle has epidermal cells. In people with acne, there are changes which cause these cells to become sticky; the sebaceous glands secrete a greater than normal amount of sebaceous fluid(sebum) and clog the duct so the sebum can't get out. There is a bacteria that resides in the sebaceous gland called Proprionibacterium acnes, frequently referred to (for obvious reasons) as P. acnes.  These bacteria start to proliferate and cause infection in the clogged duct.

Skin Changes with Acne

When you see a whitehead on your skin, you know that the duct is blocked and filled with sebum.

When you see a blackhead on your skin, you know the opening of the previously clogged duct is open and the enviornment has caused a chemical reaction with the sebum, turning it black.

When you see a reddish, swollen, inflammed lesion on your skin, you know that there is a small focal area of infection in a duct, caused by P. acnes bacteria.

Standard Treatments for Acne

Most people have tried a variety of treatments for acne. These include cleansers, toners, and benzoyl peroxide. The usual cleanser for acne includes salicylic acid. Benzoyl peroxide is also used and acts on the P. acnes by delivering oxygen to the bacteria; since this bacterium is micro-aerophilic, it doesn't like that much oxygen and is injured or destroyed.

Antibiotics have frequently been used for acne with varying degrees of success. Retin A also known as Accutane, is also used. It is a very powerful and effective drug. Unfortunately, it has some very serious potential side effects.

Many people would like to get off the merry-go-round of repeated antibiotic treatment.  Also, the Journal of the American Medical Association has reported an increase in the incidence of breast cancer with more than 100 days of antibiotic use during one's lifetime.

New Light-based Treatments for Acne

There are three new light-based treatments for acne. These include the use of blue light alone (417nm wave-length) or blue light in conjunction with a photosensitizer (Levulan). These act on the P. acnes bacteria. We can also use  a laser (1319nm), which treats the sebaceous gland.

Many people have probably noticed an improvement in acne during the summer. This fundamental observation led to the hypothesis that sunlight was beneficial for acne sufferers. Subsequent studies have shown that certain portions of the visible light spectrum have a definite beneficial effect on acne. Blue light specifically the 417nm range has this effect. It has been studied in the laboratory and in patients. It has been found that blue light activates certain chemicals within the P. acnes bacterium, called porphyrins, most specifically, coproporphyrins.  These porphyrins become activated and damage the bacteria, causing them to self-destruct.

BLU-U

We now can treat patients with mild to moderate inflammatory acne using blue light, specifically the BLU-U light. A series of 8 treatments, two treatments per week for 4 weeks are required. You sit under the blue light wearing special goggles-they look like yellow swimmers goggles-for 1000 seconds each session.  You can wear headphones and listen to your I-pod if you wish. Not every patient will experience a positive response, but many do, on the order of 60-80 percent. It is also important to begin or maintain a daily skin care program.

Photodynamic Therapy with BLU-U

 A more aggressive approach uses the photosensitizer Levulan (d-aminolevulinic acid). This is applied to your cleaned skin and left in place a specific length of time, after which your face is exposed to the BLU-U for 1000 seconds. After each treatment it is imperative to avoid sunlight for 36 hours to prevent a very pronounced reddening of your face like a sunburn. These treatments are given once a week, every two weeks for a series of three treatments. You can expect some peeling a couple of days after the treatment.

Laser Treatment for Acne

The treatments using blue light treat the active infection of acne. The beneficial effects last at least 6 to 9 months or even longer. They do not treat the underlying cause of the acne flare-up. Laser treatment focuses on the sebaceous gland and has a 98-99% response rate after three treatments. The beneficial effect seems to be quite durable. The discovery of this effect was a beautiful example of serendipity. A new laser was designed with a target of water. Its goal was to stimulate production of collagen in the deeper layers of the skin in order to treat the presence of fine wrinkles. Dr. Mark Blair, who was serving at the San Diego Naval Base, performed skin biopsies on patients in a clinical trial. He noted that there was a direct effect on the sebaceous glands and thus the laser treatment for acne was developed. I have seen photos of service men whose backs were treated for acne. One side was treated with laser; the other side was not treated, using it as a control.  The results were striking.  I have heard Mark lecture recently and have spoken with him personally. He has made a great contribution to acne sufferers.

The down-side of laser treatment is that it is somewhat uncomfortable. The back is not very senstitive and is easily treated. Our laser has a continuous contact cooling using a sapphire window connected to a chiller, which has a digital control to choose the precise degree of continuous cooling.  Some lasers have cooling by means of a cryogen spray.  This sprays just before the laser fires. It can also be used after the laser fires, but most physicians don't use it in that mode.  The face can be treated, but if active lesions are present, they are more uncomfortable-just ask my two daughters. We can use a topical anesthetic as well, but if a reddened, inflammed zit is present, it simply absorbs more laser energy.

Two Step Treatment for Active Acne

Therefore, if a patient has significant inflammatory acne on the face, I recommend the BLU-U first to decrease the acute inflammation. Then we can follow up with the laser to treat the sebaceous glands with minimal discomfort.  Since we are a physicians' office, we can always prescribe analgesic medications for patients who are sensitive to pain.

Laser for Acne Scarring

The same laser that we use for active acne can also be used to treat certain types of acne scars. Rolled, soft-edged or boxcar scars are best for laser treatment; ice-pick scars to do not respond as well. As I mentioned above, this laser was originally designed to stimulate collagen growth.  That is what the flattened out scars need to look better. A series of treatments is required, and you have to be patient because it is a slow, gradual process.  It can take from 6 to 9 months to see the full effect after 6 treatments. These treatments do not involve acutely inflammed skin and are very well tolerated using just the normal continuous cooling with the sapphire window and chiller.