Innovative Treatments For Acne at All Ages

By Kimberly Moskowitz, MD

Are you among the 25 million Americans who prematurely breathed a sigh of relief thinking you escaped the acne plague of adolescence only to wake up one day in your 20s, 30s or even 40s with acne breakouts?  Acne is the most commonly diagnosed skin disorder in the United States and worldwide.  It affects approximately 90% of all adolescents and 25% of all adults.  This unwelcome four letter word plagues 40 million teenagers and 25 million adults.  In all, 80% of the population will suffer from this condition at some point in their lifetime.

Acne is the condition describing plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules) that occur on the skin.  It begins within hair follicles, which contain tiny oil-producing glands called sebaceous glands.  Sebaceous glands produce oily sebum that travels up the hair shaft to the skin’s surface where it coats the skin and serves as a natural moisturizer.  Sebaceous glands are found everywhere on the skin’s surface except the palms and soles.  They are most densely concentrated on the face, scalp, chest, and back, which explains why acne is most common is these areas.  Acne occurs when sebaceous glands become overactive and produce sebum quicker than the skin can shed it.  When this happens, sebum along with dead skin cells and the acne causing bacteria P. acnes (Pripionibacterium acnes) become trapped inside of the follicle.  As the follicle fills and expands, a pimple is born.

There are two basic types of acne.  The most common is non-inflammatory, comprised of whiteheads (closed comedones) and blackheads (open comedones).  Inflammatory acne is deeper and more severe and is often the result of picking or popping whiteheads.  This extrudes infected contents into surrounding tissues resulting in reddened pustules, cysts, and deep painful nodules.  If aggravated, both types of acne can lead to deep scarring and a lifetime of remorse.

Despite myth, legend and folklore, acne is not caused by eating chocolate (thank God), French fries, pizza, or bad hygiene. Rather, it is believed to be caused mainly by fluctuations in the level of androgenic (male) hormones in the body.  Although this notoriously occurs during puberty, both men and women have androgenic hormones that fluctuate and cause acne at almost any age.  These hormones stimulate the sebaceous glands to produce excess amounts of sebum, which causes dilation and obstruction of the glands, overgrowth of P. acnes bacteria, and inflammation of the follicles and surrounding skin.

Because the above processes are occurring simultaneously, effective acne treatments must target and cease each of these abnormalities.  For this reason, finding acceptable treatment options is often as frustrating as the disease itself.  In the United States alone, more than $1.4 billion is spent on acne treatments each year.  If you are like most acne sufferers, you have tried creams, pills, washes, lotions and potions and spent a small fortune on hopes of an immediate cure.  The truth is that medications don’t act quickly and each treatment has benefits and downfalls.  In mild acne, topical therapies are helpful at reducing bacteria & sebum and unclogging pores but usually take months to see results and often irritate the skin.

Oral antibiotics also decrease bacteria and inflammation but must also be used for two to three months before improvement can be expected.  For most medications, continued treatment is required to keep acne from re-appearing.  Furthermore, acne that initially responds to topical or oral medicines may cease to do so over time because of growing antibiotic resistance rates (up to 60%).  For women, several oral contraceptives decrease sebum production and reduce acne outbreaks.  Finally, Accutane, the most potent biological inhibitor of sebum production has long been used as the last resort and “big gun” for eradicating severe acne.  Although effective, its potential for serious side effects like birth defects and depression give physicians and patients pause before prescribing or taking it.

After years of agonizing over treatment failures and side effects of these medications, Laser and light treatments have become synonymous with cutting edge technology and so, they are lighting up the field of acne research.  Laser and light sources target the two main causes of acne – bacteria and sebum production.  Laser energy penetrates the skin where it decreases oil production by shrinking overactive sebaceous glands.  It also destroys and inhibits growth of the P. acnes bacteria.  A series of monthly or twice monthly treatments has been shown to reduce acne breakouts in more than 85% of patients.

Laser light treatments also stimulate new collagen growth, which improves acne scars and provides anti-aging benefits called photorejuvenation.  In patients with more severe acne, results can be enhanced by pre-treatment of the skin with a natural substance called ALA (Aminolevulinic acid).  With this treatment, known as Photodynamic Therapy (PDT), ALA is absorbed by structures in the skin such as sebaceous glands,      P. acnes bacteria, and precancerous cells.  Specific wavelengths of Blue light activate the ALA resulting in up to 85% clearance of acne, sun-damage, and pre-cancerous lesions.

Acne may be a rite of passage for adolescence, but one out of four individuals between the ages of 25 and 45 also experience acne breakouts.  At any age, acne can be devastating, leaving both physical and emotional scars.  Although topical and oral medications will likely continue to play a role in controlling acne, lasers are making treatments easier and more effective.  As laser and light technology continues to explode, acne sufferers are finally beginning to see the light at the end of the tunnel.

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