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Acne/Acne Scars/Rosacea
Puberty, genetics, and infection can all play a role in active acne and can present at any age. Unfortunately during puberty, most pre-teens and adolescents suffer from painful and aggressive acne. Most outgrow their acne problems by their 20's, but 75% of middle-age adults have occasional acne breakouts. Breakouts are commonly associated with hormonal menstruation, environmental or daily stressors, pregnancy, diet, and misuse of skin care products.
Acne Vulgaris has many variations, and is the most common type of acne.
The most common types of lesions associated with this condition range
from mild to severe and present as Cystic, Pustular, Papular,
and Comodones. The more obscure types include: infantile and
neonatal acne, acne rosacea, perioral dermatitis,
drug induced acne, hidradenitis suppurativa, keloid acne,
and Favre-Racouchot syndrome.
Causes of Acne
Clogged or overactive sebaceous glands result in active acne. A lesion forms in a holocrine gland and fills with pus and bacteria creating a "white head". The bacteria often found in these pores is known as Proprionibacterium and is activated in the inflammation process starting the formation of pimples. If the filled gland becomes oxidized, it may become dark and waxy creating a plug. This plug is also known as a "black head".
Treating acne early is key to preventing acne scars. Teens are often left with severe scarring after puberty and often need treatments such as microneedling or chemical peels after active acne has subsided. Continue reading to find out more about acne scarring treatments. The key is to treat your acne as soon as possible to minimize scarring.
Treatment of Acne
Dr. Atkins and her medical team will create a custom daily skincare regiment to topically treat acne. Sometimes oral treatments are necessary depending on the determined cause. After your medical visit, Dr. Atkins will manage your treatments and will schedule you for regular follow-ups. Oral medications can sometimes be necessary to treat stubborn, persistent acne, but minimizing the period of time that you are on the medication will reduce side effects. IV therapy is available to improve your overall health during your treatments.
Oral
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Antibiotics: Reduce bacteria and sebum production
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Isotretinoin: Controls keratinization, balances sebum production, and available in topical & oral form.
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Oral Contraceptives: Reduces the production of sebum and balances hormones.
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Nicomide: A vitamin supplement with an anti-inflammatory agent made to support healthy skin
Topical
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Benzoyl Peroxide: Kills bacteria and helps break down fatty acids.
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Salicylic Acid: Unclogs pores and chemically exfoliates dead cells.
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Azelaic Acid: Kills bacteria and is often used to treat Rosacea
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Retinoids (Tretinoin, Adapalene, Tazarotene and others): Stimulates collagen while increasing cell turnover. The chemical exfoliation lifts off keratinizing cells allowing the skin to breathe.
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Topical Antibiotics (Erythromycin, Clindamycin and others): Reduces the bacteria and sebum production
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Benzoyl Peroxide plus Antibiotics: Breaks down fatty acids and reduces sebum production
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Microdermabrasion with or without chemicals: A treatment that is performed in the office to mechanically exfoliate and suction keratinized cells and sebum.
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Blu-U Light: Destroys bacteria through intense blue LED therapy
Rosacea
Redness on the face, commonly on the cheeks, is commonly known as Rosacea. This normally begins to form after the age of 30 and tends to worsen with aging and exposure to the sun. Broken blood vessels are typically present in the more advanced stages. After blood vessels show, skin then thickens and infection can begin to form. While there is no specific cure, a physician may prescribe topical, oral, or laser treatments to prevent and limit flare-ups. IPL may be a more prolonged treatment for overall redness and broken capillaries.
Myths and Updates in Rosacea Treatments
1- Just because all of your family has pink cheeks does not mean it not Rosacea. When the redness bothers you, come get treatments and stop the trajectory of the disease.
2- Believe that all products like Benzoyl Peroxide are the same and you can save money by getting those over the counter. The problem is patients with Rosacea have very sensitive skin and more times than not these products produce burning and stinging to the patients. Patients with Rosacea need a slow releasing benzoyl peroxide encapsulated with microencapsulated silica.
3- Rosacea is an inflammatory disease and should not be treated just like acne. Many times taking tetracycline for Rosacea may lead to an increase in inflammatory bowel disease. Topical minocycline foam, in the same family as tetracycline, helps with Rosacea but does not have the link to inflammatory bowel disease. The FDA is looking at low dose Minocycline in a delay release form to help with Rosacea but does not have the hyperpigmention issues as the usual Minocin.
Acne Scarring Solutions
Acne scarring treatments depend on the severity and depth of each person's individual needs. Scarring can be treated at the absence of active acne. These treatments will also increase collagen and elastin production creating smooth, plump skin.
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Dermal fillers may be used to lift and fill divots and indentions, using a subcision approach, left behind after cystic acne. Acrylic (PMMA) or hyaluronic acid fillers may be used based on the damage.
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Microneedling mechanically creates channels in the skin and breaks up scar tissue. The procedure yields minimal downtime and requires few treatments.
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Fraxel is similar to microneedling in that it creates channels deep into the skin, but the Fraxel creates channels with energy. The Fraxel has more downtime, but is able to break up more scar tissue quicker.