Acne is a disease of the pilosebaceous units (hair follicles and their associated sebaceous glands). Sebaceous glands secrete a thick, fatty material called sebum and patients with high sebum production have a greater risk of developing acne.
P. acnes is a normal human skin bacterium and is the dominant microbe in sebum. If this bacteria overgrows in sebum, it changes the consistency of the material leading to plugging of the duct. This results in a comedone. If the duct opening is closed, the comedone appears white and is referred to as a “whitehead.” If the duct is open, exposing the sebum to the air, the material turns black and is called a “blackhead.”
Frequently, P. acnes also irritates or inflames the lining of the hair follicle. The follicle may become a red and tender bump called a papule. Papules may progress to pustules that have red bases with puss in the center. If the follicle wall ruptures, it can form a large, painful, solid nodule or puss-filled cyst and often lead to scarring.
Acne can be divided into two general types: inflammatory and non-inflammatory. Non-inflammatory acne is limited to “whiteheads” and “blackheads.” Inflammatory acne is classified as mild, moderate or severe based on the number of lesions present and severe inflammatory acne includes cystic acne. Some patients can have both types of acne at the same time.
Although acne is usually considered a problem for adolescents and young adults, it is also not uncommon for older adults, especially women, to have acne. Adult acne can be troublesome and aggravating because treatments that may have worked as a teen, no longer help and different approaches must be taken.
Women are more likely to get adult acne than men. It can be related to hormonal changes related to the menstrual cycle, menopause, or changing contraceptives. It may also be due to stress or a strong family history of acne.
Adolescent acne usually runs a course of several years and passes on its own. The main purpose of acne treatment is to control the disease and reduce permanent scarring.
There are many over-the-counter products for acne treatment and these may be adequate for many patients. However, if acne is not controlled by OTC products, treatment by an experienced medical practitioner is needed. There are many medical treatments for acne depending on the severity of the disease.
Basic treatments for acne
Basic medical care for acne usually begins with topical retinoids and/or topical antimicrobials. Benzoyl peroxide is also a common early treatment usually combined with retinoids and topical antimicrobials. In the past, long term oral antibiotics were routinely used to control acne. Today we try to avoid the overuse of oral antibiotics due to antimicrobial antibiotic resistance.
Female patients have additional options not available to males. The oral medication spironolactone, an antiandrogen, and/or oral contraceptives may be beneficial in controlling acne in some women.
At Déjà Vu, we have some high-quality products that can help with acne. These include Refissa (a retinoid), Jan Marini Benzoyl Peroxide, and the Obagi Clenziderm System.
Advanced treatments available at Déjà Vu
We have additional treatments for acne not available in all doctor’s offices. These treatments can often help patients get their acne under better control.
Acne extractions and HydraFacial MD®
We usually combine medical acne extractions with the HydraFacial MD system to speed the resolution of existing acne whiteheads, blackheads and inflammatory lesions to help prevent future lesions. We use special acne tools to safely empty acute acne lesions without scarring.
We then do a complete HydraFacial MD procedure using its patented 4 in 1 vortex technology. The treatment begins with vortex cleansing and hydropeel to clean the skin and exfoliate the stratum corneum of dead skin cells. Next, we apply salicylic and glycolic acid to chemically exfoliate the skin and help prevent new lesions. Then, vortex extraction sucks out debris and sebum plugs to open pores. Finally, vortex fusion infuses the skin with antioxidants, peptides and hyaluronic acid to detoxify, rejuvenate and restore the skin.
We usually recommend acne extractions with HydraFacial MD every two weeks for three sessions and then monthly to maintain its effect. Milia removal and acne extractions are covered by most insurance plans. When we perform acne extractions we add the HydraFacial MD treatment at no additional charge. HydraFacial MD and acne extractions can be performed on all skin types. Click here to learn more about HydraFacial MD.
Sciton broad band light treatment
The Sciton BBL™ system can help acne patients by reducing acute acne lesions, reducing post-inflammatory hyperpigmentation (the redness that lingers for months after acne lesions have gone away), and helping to put acne into remission. The treatment uses a precise pulse of light that penetrates the skin resulting in controlled heating of the skin. The pulse duration and intensity limit the heat to a uniform thin layer at the epidermal-dermal boundary. The treatment leads to collagen remodeling, proliferation of active fibroblasts, and treating overactive sebaceous glands resulting in the reduction of acne.
BBL treatment cannot be done on tanned skin or on patients with dark skin. The treatments are usually performed without the need for anesthetics by using a cool conductive gel. A series of pulses are used to treat all of the affected areas. Patients usually need 4-6 treatments at about 2 week intervals for optimal results. BBL treatments are not covered by insurance.
We often use the ForeverClear BBL™ protocol as developed by Dr. Patrick Bitter, Jr. His program uses a three-step process not available on other IPL devices. It is very effective in eliminating acne-causing bacteria, target redness and initiate the body’s natural healing process. Click here to learn more about Sciton BBL.
This is an effective method of treating acne in some patients by using a physician’s professional line of products combined with a proprietary peel. The system we prefer is the Jan Marini Skin Research® Clarify Peel.
Before the peel, patients are treated for a period of time with the Jan Marini line of products for patients with acne. In addition to acne, the peel helps address skin texture, age spots, fine lines & wrinkles, skin tone and overall sun damage. Patients usually get a series of three peels at one-month intervals. After the peel, patients continue on their Jan Marini acne products for long-term benefit. Click here to learn more about Jan Marini Skin Research products.
Radio frequency micro-needling
One of our most effective treatments for acne is the Fractora micro-needling system. These treatments are done with a pattern of tiny 24 or 60 needles that penetrate the skin (after application of anesthetic). Once the needles are pressed into the skin down to the dermis a pulse of radiofrequency energy heats the deep skin. When used on patients with active acne it heats and clears many of the plugged sebaceous glands. A series of 3-5 treatments at monthly intervals is often very effective improving active acne. It can be used in combination with some other acne treatments.
The same Fractora system is very effective in clearing acne scars. Click here to learn more about Fractora.
Intralesional injection of steroids
Patients may sometimes have large, painful acne nodules (cysts) that persist. We can speed their resolution with a tiny injection of cortisone.
The only medication that can stop acne, usually for good, is Accutane.
Accutane is reserved for patients that cannot get their acne under control no matter what treatment they use. Patients with uncontrolled severe acne with nodules (cysts) or scarring are eligible for treatment with Accutane. It is only used when other treatments have failed.
The medication has potentially serious side effects, especially birth defects if a patient takes the medication when pregnant. Due to these risks, the FDA has a special program to help ensure the medication is safely used called iPledge. We meticulously follow all of the prescribing rules for Accutane. Contact our office located in Newburgh, IN and servicing the Evansville region to schedule a consult now!
We have very good results with Accutane. During treatment and for at least six months after treatment with this medication patients cannot be treated with HydraFacial MD, BBL, Fractora or other similar treatments.