Author : Bhadresh Bundela
Acne treatments target causes
Each hair follicle is connected to sebaceous glands, which secrete an oily substance known as sebum to lubricate the hair and skin. Sebum normally travels up along the hair shaft and then out through the opening of the hair follicle onto the surface of your skin.
When your body produces an excess amount of sebum and dead skin cells, the two can accumulate in the hair follicle and solidify as a soft plug. As the plug grows, the follicle wall can rupture, allowing more oil and skin cells to accumulate. This is the underlying cause of acne. Bacteria can trigger additional inflammation and infection resulting in complications of acne.
Acne treatments usually work by reducing oil production, speeding up the growth of new skin cells and the removal of dead skin cells, or fighting bacterial infection. Some acne treatments, especially combination therapies, work by doing two or three of these.
Laser and light therapy
Laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Some laser systems are thought to damage the oil (sebaceous) glands, causing them to produce less oil. Other laser and light therapies target Propionibacterium acnes (P. acnes), the bacterium that causes acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars, so they may be good treatment choices for people with both active acne and acne scars.
Several types of laser and light therapies show promise in acne treatment. These include:
Blue light therapy. Exposing the skin to a low-intensity blue light source is believed to destroy P. acnes. This painless procedure is usually done through a series of sessions. P. acnes multiplies rapidly, however, so ongoing treatment is necessary for best results. Possible side effects of blue light therapy include temporary redness and dryness in the treated areas. A newer type of light therapy that includes a combination of blue and red light may be more effective than blue light alone.
Pulsed light and heat energy therapy. Together, pulsed light and heat energy is thought to destroy P. acnes and shrink sebaceous glands, which decreases the oil production. The Food and Drug Administration approved an acne therapy that combines pulses of green-yellow light and heat to treat mild to moderate acne, including inflammatory acne. Side effects of this therapy include temporary redness in the treated areas.
Diode laser treatment. Diode lasers can destroy sebaceous glands in the dermis, the thick middle layer of skin, without harming the outer layer of skin. Laser treatment may be painful, but the pain can be controlled with analgesics applied to the skin before treatment. Side effects of diode laser treatment include temporary redness and swelling of the treated areas.
Still unknown is who would benefit the most from laser and light therapies, the effectiveness of these treatment options and what the long-term risks or benefits might be. Furthermore, laser and light therapy acne treatments can be expensive and may not be covered by your insurance company.
Cosmetic procedures
Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures — which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars — are most effective when used in combination with other acne treatments.
Chemical peels. Chemicals, such as glycolic acid or salicylic acid, applied to your skin help remove dead skin cells, unclog pores, remove whiteheads and blackheads, and can generate new skin growth. These chemical peels are often used with acne creams or gels for better penetration of the medication. Depending on strength of the chemical, side effects of chemical peels range from temporary redness, blisters, scaling and crusting to scarring, infection and abnormal skin coloring.
Microdermabrasion. This type of treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or "polish" the skin's surface. Then, a vacuum tube removes the crystals and skin cells. The procedure exfoliates and unclogs pores. Similar to chemical peels, microdermabrasion is often used with other acne treatments to increase their effectiveness.
These procedures are best done by a doctor. Trying these treatments at home could cause infections, acne flare-ups or scars. If your skin tends to form scar tissue, chemical peels or microdermabrasion could make your complexion worse.
Photodynamic therapy
Photodynamic therapy (PDT) is one of the newly available treatments. PDT uses a topical photosensitizer liquid that is applied to the skin and a light to activate the sensitizer. Levulan (aminolevulonic acid) and blue light, commonly used to treat pre-cancers (actinic keratosis) and acne vulgaris, can also be used to treat some rosacea patients. The use of PDT in rosacea is considered off-label use to some extent, since it is primarily designed for regular acne. PDT is thought to work at reducing the inflammation, pimples, and also improving the skin texture. PDT is an in-office procedure performed in your physician's office. The treatment takes anywhere from one to one and a half hours to complete. Strict sun avoidance for approximately one to three days is required after the treatment. Mild discomfort during the treatment and a mild to moderate sunburn appearance after the treatment is common. Some patients have experienced remissions (disease free periods) of several months to years from these types of treatments. Other patients may not notice significant improvement.
Combination therapies
Combination therapies, for example, using prescription creams and oral antibiotics, target all the causes of acne, which makes the treatment plan more successful. Several combination therapies have been shown to be effective in controlling acne:
Retinoids and oral antibiotics. Prescription products derived from vitamin A (retinoids) can be combined with oral antibiotics for better treatment of acne. Retinoids work by promoting cell turnover and preventing the plugging of the hair follicle. Oral antibiotics kill P. acnes bacteria and reduce inflammation.
Benzoyl peroxide and topical antibiotics. Benzoyl peroxide is most effective if it's combined with antibiotics applied to your skin (topical antibiotics). Benzoyl peroxide can dry up the oil, kill bacteria and promote sloughing of dead skin cells. Topical antibiotics can kill bacteria on the skin's surface and fight inflammation.
P. acnes can become resistant to a particular antibiotic, especially if that antibiotic is misused or overused. Bacterial resistance makes treating acne difficult because the antibiotic is no longer effective in killing the bacteria. Combination therapies, especially those that include benzoyl peroxide, are less likely to lead to bacterial resistance.
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