Acne Treatments

Acne vulgaris is a common skin condition that presents at any age but is particularly common in teenagers. Sixty to seventy percent of Americans will develop acne during their life time and twenty percent will develop severe cases of acne. Even occasional pimples can be painful and emotionally distressing, but those who suffer from full blown acne can be left with a lifetime of pits, pigmentary skin changes and deep scarring.

Acne refers to various types of red, black and white heads that occur on the skin when excessive oil, called “sebum”, clogs the skin follicles and pores and traps dead skin cells. As this oil festers, the common bacteria present on the skin (Propionibacterium acnes) multiple within the clogged pores and cause further inflammation which may present as papules, pustules, and nodules that cause local tissue damage. Most commonly occurring on the face, trunk and extremities, acne breakouts are at their worst during periods of hormonal changes such as puberty, menstruation and pregnancy. In people with genetic predisposition, simple pimples can become highly inflamed and turn into cystic acne which may result in deep, unattractive scars. The causes for acne are multifactorial and involve genetic predisposition for obstruction of the follicles in the skin, excess sebum, bacteria and inflammation.

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Early preventative measures to avoid development of acne and acne scaring are the key to success. Acne formation may be initiated or worsened by cosmetic and hair products that have a greasy or waxy consistency, medications such as: steroids, lithium, antiepileptics, and iodides, disorders associated with excess androgens, mechanical occlusion of the pores with headbands or under-wire bras as well as excessive sunlight. There have been some studies relating to eating habits that implicate unhealthy consumption of fast food to a harmful impact on general skin health. The studies have shown that a low-glycemic diet reduces the negative effects of high – carbohydrate and insulin levels on skin health and development of acne.

The diagnosis is clinical but some test may be done in the work up of acne such as: hormone levels, skin lesion cultures and others.

There is no cure for acne but treatments generally consist of topical (topical retinoids, antibiotics, benzoyl peroxide, salicylic acid) and/or oral acne medications (tetracycline group of antibiotics, trimethoprim – sulfamethoxazole, azithromycin, macrolide antibiotics, hormonal agents, spironolactone, isotretinoin (accutane)) and remedies used at the early stages of acne formation to reduce the frequency and severity of acne outbreaks, thus reducing scarring.

However, once acne has erupted, there are surgical alternatives for minimizing their appearance; manual extraction, chemical peels, steroid injections, microdermabrasion, light therapy (red, blue and photodynamic) and laser therapy can be highly effective, reducing redness and bumps, and restoring skin to a more healthy appearing texture.

A chemical peel uses acidic chemicals to remove the top layer of skin, revealing healthier skin beneath after full healing; the healing time varies significantly depending on how deep a peel was done. Similarly, laser resurfacing uses a laser to remove the top layer of skin, usually leaving smoother, healthier skin behind in 3-10 days but has a longer down time. Microdermabrasion uses a spinning metal brush to actually buff away the top layer of skin, forcing a new layer of skin to replace it; it takes up to three weeks to completely heal from this surgery, but the results can be dramatic. Fractional laser therapy (ablative and non-ablative) is a newer technology which treats the deeper layers of the skin and stimulates collagen and elastin production. The production of new collagen and elastin restores a healthier appearance of the skin and treats deep scars formed by acne. The fractional pattern leaves areas of healthy skin behind resulting in a faster healing time and a shorter down time.

PREPARATION

Prior to treatment with the non-ablative fractional StarLux®1540 ™ laser hand piece for acne scaring a free consultation with Dr. Roudner will take place. Dr. Roudner will evaluate your skin type and the degree of scaring present. A course of antibiotics or/and antiviral medication may be initiated prior to treatment and continued after the treatment for a limited time depending on a previous history of herpetic skin lesions and the frequency and severity of acne outbreaks if still present ( if sever the treatment may be deferred). Sun exposure should be limited with appropriate protection 6 weeks prior to the treatment. Other specific instructions will be given prior to the treatment. In order to obtain the best results the instructions should be followed carefully.

WHAT TO EXPECT

Dr. Roudner or his staff will apply the topical anesthetic to the area treated one hour prior to the treatment. If local anesthesia is used it will be administered right before the treatment. Dr. Roudner will determine the energy and timing of the laser pulses needed at the time of the treatment to match the desired results, as well as the type of skin you have. The non-ablative fractional StarLux®1540 ™ laser hand piece is unique due to a special cooling system with a crystal that is built into the laser to assist in cooling the skin during the treatment and reduce any discomfort during the treatment. The laser will then be used in a special sequence to obtain maximal efficiency on the skin of your face, back, arms and/or chest according to your needs.

ANESTHESIA

Non-ablative fractional StarLux®1540 ™ skin resurfacing can be performed under topical or local anesthesia. A prescription may be given to you, to take prior to the procedure in order to help with pain and anxiety. In under very rare circumstances, the procedure is performed with IV sedation.

LENGTH OF TIME

The procedure usually last between 30 to 60 minutes depending on the area and severity of the scars.

POST TREATMENT

Prior to the treatment you will receive a sheet with post treatment instructions. You will be able to go home right after the treatment. After the treatment you will notice swelling and redness in the areas treated. In most cases this will resolve in 1 to 3 days. The area treated will feel warm for a few hours after the treatment. Topical moisturizers and sun block will be used to help protect and heal the skin post treatment. In order to obtain the best results the instructions should be followed carefully.

RECOVERY TIME

Most patients are able to return to work soon after the treatments with minimal down time. On average 1 to 3 days are needed for recovery. Due to the nature of the non-ablative fractional StarLux®1540 ™ skin resurfacing laser the outer layer of skin remains intact and assists in the no to minimal down time after treatment. The treatment targets the deep layers of the skin. No or minimal skin peeling will be noticed. Makeup can be applied the next day if needed or wanted. Over a period of a few weeks the old skin will be exfoliated and will be replaced by the new formed skin from within. Gentle skin cleansing with mild soap will facilitate the process. You will see some improvement early after the treatment, although the improvement in the scars will be most noticed over a period of 4 to 6 months after the treatment.

NON-ABLATIVE FRACTIONAL STARLUX® 1540 ™

How do I know if I’m a good candidate for the non-ablative fractional STARLUX® 1540™ laser for acne scar treatment?

Laser skin resurfacing treatments work on many skin types, including very light and very dark skin. Different resurfacing options can improve the most challenging scars, and help correct a wide variety of other skin imperfections. After the free consultation, Dr. Roudner will be able to decide if you are a good candidate for the treatments and will discuss treatment options with you.

How does it work?

Dr. Roudner uses a fractional laser from the company that invented and patented micro-fractional laser technology. Fractional skin resurfacing with Palomar non-ablative fractional starlux® 1540™ laser uses micro-beam light energy in a pixilated fashion to create areas of coagulated tissue (tissue from a solid to semi-solid state) that extend through the epidermis into the dermis. The body’s natural healing process creates new, healthy tissue to replace the areas of affected tissue, resulting in healthier, younger skin. The untreated tissue around the treated areas helps with the generation of cells that replace the old scar tissue with newly formed collagen and elastin which are important building blocks of the newly generated skin. The Palomar non-ablative fractional starlux® 1540™ laser, as opposed to the other ablative fractional and non fractional lasers (CO2, 2940 Erb-YAG), does not remove the epidermis and part of the dermis. This decreases the red, raw skin, risk of infection and prolonged downtime seen with the other laser. The Palomar non-ablative fractional starlux® 1540™ laser micro-beams send light pulses with energy into the skin that reach up to a depth 1 mm. Most other laser treatments are limited to about 10-70 microns. The Palomar non-ablative fractional starlux® 1540™ laser allows the treatment of the deeper levels of the skin and scars and is advantages over the other lasers. Another advantage of the Palomar non-ablative fractional starlux® 1540™ laser is the integral cooling system with a contact crystal that is applied to the skin while the treatment is taking place reducing the discomfort during the treatment.

TECHNIQUES USED

Fractional skin resurfacing with Palomar non-ablative fractional starlux® 1540™ laser uses micro-beam light energy in a pixilated fashion to create areas of coagulated tissue (tissue from a solid to semi-solid state) that extend through the epidermis into the dermis. The Palomar non-ablative fractional starlux® 1540™ laser micro-beams send light pulses with energy into the skin that reach up to a depth 1 mm. The coagulated tissue (controlled injury to the old tissues) is then replaced by new tissue with fresh collagen and elastin produced by fibroblasts (cells that produce collagen and elastin). The new collagen and elastin helps replace the old tissue and improve the smoothness of the skin surface.

REASONS FOR ACNE TREATMENTS

To stimulate the production of new collagen and elastin the main building blocks of our skin and improve on the pitted scaring of the skin after acne break out by giving a smother skin with improved texture.

WHAT CAN ACNE TREATMENTS DO FOR ME?

The body’s natural healing process creates new, healthy tissue to replace the areas of affected tissue, resulting in healthier, younger skin. The untreated tissue around the treated areas helps with the generation of cells that replace the old scar tissue with newly formed collagen and elastin which are important building blocks of the newly generated skin.

WHAT ANESTHESIA DO YOU RECOMMEND?

Non-ablative fractional StarLux®1540 ™ skin resurfacing can be performed under topical or local anesthesia. A prescription may be given to you, to take prior to the procedure in order to help with pain and anxiety. In under very rare circumstances, the procedure is performed with IV sedation.

WHO IS A GOOD CANDIDATE FOR ACNE TREATMENTS

Any patient that has sustained skin deformities from acne and does not have active acne breakout and has no contraindication to undergo laser treatments is a good candidate for acne scars treatments.

HOW LONG WILL I NEED TO RECOVER?

Most patients are able to return to work soon after the treatments with minimal down time. On average 1 to 3 days are needed for recovery. Due to the nature of the non-ablative fractional StarLux®1540 ™ skin resurfacing laser the outer layer of skin remains intact and assists in the no to minimal down time after treatment. The treatment targets the deep layers of the skin. No or minimal skin peeling will be noticed. Makeup can be applied the next day if needed or wanted. Over a period of a few weeks the old skin will be exfoliated and will be replaced by the new formed skin from within. Gentle skin cleansing with mild soap will facilitate the process. You will see some improvement early after the treatment, although the improvement in the scars will be most noticed over a period of 4 to 6 months after the treatment.

IS THE RECOVERY PROCESS PAINFUL/DISCOMFORTING?

The recovery process right after the treatment is not painful or discomforting.