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Acne
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Edmonton's Cosmetic Surgery Clinic
ACNE AND ITS TREATMENTS
What is Acne?
Acne (medically known as acne vulgaris and commonly known as blackheads, whiteheads pimples or zits) is a very common skin condition mostly seen in teenagers (for some people it can persist into adulthood). Acne continues to be the most common skin problem affecting up to 99% of teenagers as well as, to a lesser extend, young adults. Although acne eruptions are temporary, lasting anywhere from months to years, the disfigurement persists for life. Although mostly seen on the face, it can also occur on the neck, scalp, chest and back. Prevention of acne scarring and improvement of unsightly acne lesions is the most common reason for patients to seek medical attention. In addition, while not life threatening, acne can have a profound impact on social and psychological functioning. Early and appropriate therapy is needed to prevent long-term scarring and dyspigmentation from occurring.
There are many causes of acne including the following:
- Increased oil (sebum) production
- Presence of bacteria in the oil glands
- Plugging of the hair/oil gland units
- Inflammation
There are many types of acne. Just beneath the surface of the skin lie many tiny glands called sebaceous (oil) glands. Their function is to collect and excrete the oily substance called sebum, to keep the skin healthy. Acne is an inflammatory condition of the hair follicle/oil gland (pilosebaceous unit) and it happens when oils (sebum) are produced by active or overactive sebaceous glands. However, the tiny pathway for the sebum to escape often becomes clogged, and a bacterium grows inside. In a short time, the area swells up, and forms a pimple on the skin. This mostly happens during puberty under the influence of changing hormone levels.
In the presence of bacteria, especially propionibacterium acnes (P. acnes) the oils are converted to more inflammatory substances that lead to the development of blackheads (open comedones), whiteheads (closed comedones), red-inflamed bumps, pustules or cysts. When not treated properly, these changes can lead to permanent acne scarring and significant psychological effects.
Dr. Sapijaszko believes that the effective treatment of acne requires a thorough examination and history. Acne is a medical condition and it deserves to be treated in a professional manner deserving of expert care and attention. Appropriate therapy to ensure prompt improvement will help lead to long-term remission and minimize scarring and improve self-esteem.
Acne is treatable. Scarring is preventable. Treatment options need to be tailored to each patient. You and your face deserve the best care available and Dr. Sapijaszko and his team are ready to help.
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Edmonton's Cosmetic Surgery Clinic
ACNE TREATMENTS
What Acne Treatments Are Available?
The treatment of acne depends on the type of acne that a patient has. Since there are many different acne types, thorough assessment by Dr. Sapijaszko would be needed before specific therapy is recommended. It is important to have acne examined by a dermatologist as poor diagnosis and lack of experience can lead to inadequate therapy and resulting scarring.
Generally speaking, acne can be treated by one or the combination of the following modalities: washes, creams and lotions, chemical peels, oral medications (antibiotics, accutane or birth control pills) and light based technologies (laser, IPL, Blu-U or Aktillite). The choice of treatments depends on many factors including the type of acne that the patient has, prior treatments tried, age of the patient as well as individual preference.
- Topical therapies are usually the first treatment option as they can be used for the vast majority of acne patients. Topical retinoids such as tretinoin (e.g. Retin-A®, Tazorac®, Differin®) have been documented to help reduce the acne lesion count (both inflammatory [red bumps] and non-inflammatory [skin-colored or brown spots]) and severity of individual lesions. Their side effects are related to local irritation and can be decreased by introducing these preparations slowly and by controlling the amount of drug applied to the skin at each time.
- Topical antibiotics, particularly in combination with benzoyl peroxide or salicylic acid, are also very effective in the treatment of mild to moderate acne. It is advisable to use this drug combination (topical antibiotic with benzoyl peroxide), as this will greatly reduce the development of bacterial drug resistance. Furthermore, using topical antibiotic/benzoyl peroxide combination in the morning with topical retinoids at night will address most of the causes of acne. It will deal with bacterial component, altered skin desquamation and inflammation. It is because of these attributes that such a treatment combination is so effective.
- Chemical peels and topical salicylic acid are effective treatments against both comedonal [black and white heads] and inflammatory acne [red bumps and cysts]. These can also be very effective for early acne scarring.
- Systemic [oral] therapy is reserved for patients with moderate to severe acne that can result in scar formation. Oral antibiotics are mostly effective against inflammatory acne. They have both antimicrobial as well as anti-inflammatory properties. It is not advisable to maintain patients on prolonged oral antibiotic therapy limiting their continuous use.
- The most effective therapy for acne, and reserved for appropriate patients with severe acne, is oral retinoid, isotretinoin (Accutane®). It is a naturally occurring metabolite of vitamin A. It inhibits the sebaceous gland secretions and normalizes follicular epithelial desquamation. It is a teratogen and as such all women of child bearing potential require adequate pregnancy prevention measures during and for at least six weeks after the treatment.
Photodynamic therapy [such as Blu-U] is the newest modality to treat acne. It involves exposing the skin to special form of light. This form of light can be used either alone or in combination with a photosensitizer (preparation that makes the skin more sensitive to light) or not. This specific light exposure leads to the improvement of acne lesions over several treatment applications.
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