ACNE

dawn picAcne is not just for teenagers.  Men and women of any age can be affected by the nuisance of break outs.  There are numerous triggers and break outs can be intermittent and minor or, for some, more severe without periods of clearing.  Although the face is the most common area people seek treatment for any body area can be affected.

Acne is the result of the sebaceous glands which are attached to the hair follicle either producing too much sebum or the sebum becoming trapped.  There are 3 general types of acne:

  • Comedonal Acne (white heads, black heads)
  • Inflammatory Acne
  • Cystic Acne

The goal with acne treatments is to decrease sebum production, increase cellular turnover, fight bacteria and decrease inflammation.  Addressing the underlying triggers is also very helpful.

Triggers can include:

  • hormonal
  • diet (food sensitivities or allergies, dairy being a big culprit)
  • stress
  • cosmetics
  • chronic exposure from touching ones face or from phones

Treating acne can include managing any of the above triggers and treating with OTC or prescribed treatments to minimize the outbreaks.  Treatment is really based on the severity of ones acne.  Minor acne can usually be managed with OTC products.

What to try first?  Look for products with:

  • Benzoyl Peroxide (BPO)  which is an antimicrobial (can ruin/bleach fabric)
  • Glycolic Acid which is an AHA (alpha hydroxyl acid) derived from sugar cane
  • Salicylic Acid which is a BHA (beta hydroxyl acid) derived from willow tree bark
  • Sulfur

There are numerous products available with the ingredients listed above.  A well known line for acne, ProActiv, utilizes most of the above ingredients. However, there are numerous products available at the drug store or pharmacy section of the grocery store with the same ingredients.  Ideally, when treating with over the counter products the skin also remains hydrated with an oil free moisturizer as drying out the skin can make matters worse by trapping more sebum under the dry skin.  It is always best to give a skin care treatment at least a month (if not several months) to determine its efficacy.

If the above does not help alleviate the breakouts it is advised to see a dermatologist who can prescribe medications or treatments  to help.  Common treatments at a dermatologist office can include:

  • The use of BCP for women to address hormonal triggers.
  • Oral and/or topical antibiotics to target (most commonly) P. Acnes Bacteria, including Doxycycline, Tetracycline, Minocycline or Erythromycin.
  • Tretinoin (Retin-A, Differin, Renova, Tazorac) to decrease sebum production and increase cellular turnover.
  • Lasers (such as CoolTouch, IPL or Pulsed light) to decrease sebum production and target bacteria.
  • Blue light therapy which targets the P. Acnes bacteria.
  • Photodynamic therapy which combines topical photosensitizing agents with light therapy to target the bacteria.
  • Photopneumatic therapy which uses a vacuum like device to exfoliate and extract excess or trapped sebum with the addition of light therapy.
  • Steroid injections into cysts.
  • Chemical peels to increase cellular turnover and decrease sebum.
  • Microdermabrasion to exfoliate.
  • LHR (laser hair removal)  to treat pseudofolliculitis which is acne triggered by the hair growth.  (commonly seen on the lower face and neck)

As a “last resort” for acne which does not respond to other treatment options a dermatologist can prescribe Isotrentinoin (Accutane).  This is  an oral version of tretinoin (a Vit A derivative) and decreases the production of sebum considerably.  This is a medication that requires close monitoring (including pregnancy tests)  while  on therapy.

Another “last resort” for some patients is the use of Spironolactone (Aldactone).  This is a diuretic with anti-androgen (think testosterone) side effects which help to clear chronic breakouts.

Common mistakes when trying to treat break outs is being too harsh and causing more inflammation and drying the skin out which leads to more sebum production and trapped sebum.  Additionally,  not giving a treatment enough time to be effective is a problem.  There are no overnight “cures”.

Although it is very tempting, self extraction should be minimized.  Not only do we introduce bacteria when we pick we also can cause a lesion to implode to surrounding tissues. (making it worse)  A regular facial with a skin care specialist who can extract and drain acne under the proper conditions with the proper tools is preferable.

Most treatments can make you  more sensitive to the sun so sunscreen is imperative.  Sun exposure can also lead to post inflammatory hyperpigmentation. (PIH)

Acne can be stubborn.  It can be a life long struggle or an intermittent issue.  Hope the above information helps to address those annoying zits!

HYPERPIGMENTATION

Hyperpigmentation is a condition affecting both men and women of all skin types.  I want to break it down for you and offer a few viable solutions.

Let’s start with how pigmentation is formed.  Our melanocytes deep in our skin are the source of melanin. Melanin is what shows up as pigment in our skin.  There is a whole cascade of events leading to the appearance of that melanin on the surface of the skin.  Essentially (and slightly simplified)  a trigger stimulates tyrosinase (an enzyme) within the melanosome and converts the amino acid tyrosine into melanin.  Then melanogenisis occurs where the melanin migrates to other cells and shows up towards the surface as a brown spot or hyperpigmentation.  There are different types of hyperpigmentation, including;

  • Solar Lentigines (age or liver spots)
  • Ephelides (good old fashion freckles)
  • Melasma (mask like, mostly affecting women and the most difficult to treat)
  • Chloasma (the mask of pregnancy, can also occur on abdomen, similar to Melasma)
  • PIH (post inflammatory hyperpigmentation)

The key to treating hyperpigmentation is a combination of prevention and correction.

There are multiple triggers for hyperpigmentation and pinning down the triggers is key.  The biggest culprit is UVA/UVB exposure. (sun exposure) But there are other culprits as well, including;

  • Medications (such as BCP, HRT, antibiotics and certain seizure medications)
  • Genetics
  • Skin injury leading to PIH (post inflammatory hyperpigmentation)
  • Thyroid dysfunction
  • Excessive picking at skin
  • Hormone imbalances

Identifying if any of the above are contributing to your hyperpigmentation is helpful.

So now let’s talk about how to treat it once it is there.  There are numerous approaches and  combination therapy works best.  Treatments and key ingredients can work synergistically together.

  • SUNSCREEN, SUNSCREEN, SUNSCREEN  (a must)
  • Topical antioxidants
  • Wearing a hat when prolonged exposure is unavoidable
  • IPL (or photofacial)
  • Peels
  • Laser resurfacing (for example Fraxel Dual)
  • Microdermabrasion
  • Topicals that are tyrosinase inhibitors or interrupt the formation of melanin

Let’s talk about that last one a bit.  There are numerous ingredients which inhibit tyrosinase (remember that enzyme converts the amino acid tyrosine into melanin)or interrupt somewhere else on the pathway leading to pigmentation.  There are both over the counter and prescription options.

  • Hydroquinone (this is a tyrosinase inhibitor) is available both OTC in a 2% solution or as a Rx, 4% or higher.  It is a proven ingredient that has been successfully used for years.
  • Tretinoins-  These Vit A derivatives help to turn over the skin cells and hyperpigmentation fades as the skin exfoliates. (Retinoids/Retinols)
  • Kojic Acid- also helps inhibit tyrosinase and helps other products penetrate deeper.
  • Niacinamide- Stops melanosomes from transferring melanin to surrounding cells. (melanogenisis)
  • Arbutin- An alternative to hydroquinone.  It is derived from bearberry plants.
  • Antioxidants- Vit C (ascorbic acid), Vit E (tocopherol), Green Tea, Resveratrol
  • Glycolic Acid- also helps with cellular turnover.
  • Licorice Root- A chemical called galbridin inhibits tyrosinase.
  • Kligman’s Solution- This is a very effective prescription combining hydroquinone, Tretinoin and a steroid.  Your provider can determine what % of each active ingredient would be appropriate for you.
HP Products
A few product options to target your hyperpigmentation – available at Toccare Medical Spa.

A popular line carried in doctor offices for pigmentation is the Obagi line.  In most states the line includes several products with 4% Hydroquinone and a Tretinoin cream.  This is a very effective and popular line for fading pigment and renewing the skin.  Here in Texas, however, we are unable to sell prescription strength Hydroquinone or Tretinoin OTC so we carry the Fx version of the Obagi line which utilizes a high percentage of arbutin in place of Hydroquinone.

OTC products include Neocutis Perle and Nouvelle which have their Melaplex non-hydroquinone skin brighteners  Melaplex is a proprietary blend of four ingredients which help fade pigmentation (Phenylethy Resorcinol, Leucine, Undecylenoyl Phenylalanine and Sodium Glycerophosphate).  The Skinceuticals line has Phyto + which utilizes arbutin and kojic acid to help with pigmentation.  Additionally, they have the Metacell Renewal B3 with a high percentage of niacinamide (one of my current faves!)  which also assists with the fading of pigment.  These are just a few of the OTC products available for pigment. Always look for the key ingredients to help choose products to fade pigment.

When a patient comes in wanting to address their hyperpigmentation we often prescribe a combination of therapies. A common combination is a series of IPL’s, peels or microdermabrasions with topical therapy to maintain the results.  It really depends on the individual and how much downtime they can afford and how much they want to invest in their treatment.

I hope this helps give you an idea of how hyperpigmentation can be addressed.

Please feel free to ask any questions:-)