The medical term for acne is acne vulgaris which affects both males and females starting in puberty; but acne can continue through adulthood. This condition occurs in areas of the skin that are densely populated with sebaceous follicles, such as the face, back and upper chest area. Acne can manifest in various levels of severity, from occasional pimples to chronic breakouts and inflammation. Thus, the approach to acne treatment may be different for each person. The acne bumps themselves fall into five basic categories:
Comedones (whiteheads & blackheads)
Nodules (large pupules)
Cystic lesions (deep large pimples)
Acne can negatively affect one’s self concept, especially in social situations. But to know the cure, one must know the cause
CAUSES OF ACNE
Acne occurs when follicles become blocked. Sometimes these blockages are formed from environmental factors such as dirt and makeup. However they can also originate from processes at the cellular level.
Hyperkeratization is a disorder within the interior lining of the hair follicle. Normally these cells slough off and exit the follicle as the hair shaft grows. Excessive levels of keratin cause these cells to clump together, forming a mass that blocks the sebaceous duct, resulting in acne. Los Angeles acne treatments vary in methods of stopping hyperkeratization.
Role of Hormones
In addition to adolescence, hormones also trigger acne breakouts in later years. Examples include:
-Polycystic ovary syndrome
The two types of hormones that are causally associated with acne include:
- Dehydroepiandrosterone sulfate (DHEAS)
2. Insulin Growth Factor (IGF-1)
When the body produces more androgen, this causes sebaceous glands to enlarge and secrete more sebum. The sebum traps dead skin cells and clogs the sebaceous duct, resulting in acne. This environment is conducive to bacterial growth, namely proprionibacterium (p. acnes) which occurs naturally in the body. The proliferation of bacteria leads to inflammation and even lesions, redness and scarring of the skin.
In a similar fashion, IGF-1 also stimulates sebaceous glands promoting higher levels of oil secretion. This process is triggered by dietary factors. The predominant consumption of grains and sugars increases the glycemic load (GL) index. The body reacts by producing greater quantities of insulin, which in turn, increases the level of IGF-1, inducing sebum output. In Los Angeles, acne treatments to restrict hormonal causes are available.
The predisposition for developing acne is largely genetic. The influence of genes is apparent when the condition occurs in multiple family members. It is interesting to note that familial patterns of acne are marked by a high number of lesions and earlier onset.
According to research, stress leads to “increased acne severity.” Documentation by the National Institutes of Health specifies that stress is one of the causal factors of acne flares. Furthermore a study of teenage adolescents in Singapore revealed a positive correlation between stress and acne.
ACNE TREATMENT IN LOS ANGELES
Acne can be addressed topically, internally and through laser therapy.
1. Benzoyl Peroxide
Benzoyl Peroxide is an acne treatment available as a liquid cleanser, lotion, cream and gel. It is effective for mild to moderate acne and works by killing the P acnes bacteria without the risk of any resistance. Effective concentrations are documented at 2.5%, 5.0% and 10%
Antibiotics for acne include:
They can be administered topically or orally. P acnes is developing stronger resistance to antibiotics on a widespread level, making them less effective in treating acne. This acne treatment is reserved for more severe cases.
3. Hormone treatments
Hormone treatments in the form of oral contraceptives are used to reduce androgen levels which contribute to the enlargement of sebaceous glands. The specific combination of antiandrogen cyproterone and Diane 35 oestrogen has shown to give significant results in combating acne.
4. Topical reinoids
Topical retinoids like tretinoin (Retin A), adapaline (Differin and tazarotene (tazorac) are used to normalize the follicle life cycle. This helps to minimize the conditions that cause blockages to occur in the sebaceous glands.
5. Oral retinoids
Oral retinoids, including isotretinoin (Vitamin A derivative) work by reducing oil secretion. Brand names include Accutane, Amnesteem, Sotret and Claravis.In Los Angeles, acne treatment with retinoids is done only in very severe cases such as cystic acne that has failed to respond to other therapies. This intervention is very toxic with multiple side effects and potential complications. Also, it is considered to be quite teratogenic, invariably resulting in birth defects if taken by women who are pregnant.
In the United States, acne treatment invloving isotretinoin obliges the patient to enroll in the iPledge program by law. This is a computer system for healthcare providers and patients of any age or gender. The objective is to prevent any unborn child from being exposed to this drug. Women of childbearing potential who are members of this program, must undergo monthly pregnancy tests and submit regular blood tests as well.
Phototherapy is a treatment that uses blue and red light (405-420nm) to generate free radicals within the bacteria cell bodies, causing the organisms to self destruct. This intervention reduces acne lesions by 64%. A combination of blue and red light, using a wavelength of 660 nm yields a 76% reduction in acne lesions.
Dr. Umar, a Los Angeles dermatologist uses Photodynamic light therapy as an acne treatment. It is ideal for patients whose lifestyles don’t allow them to keep up with frequent and regular applications of creams, lotions and oral medications. A treatment series is recommended for the course of 4-8 weeks.
Photodynamic therapy (PDT) for clearing acne requires a photosensitizer called Levulan. This is a topical drug made of molecules that are sensitive to light. In Los Angeles, this acne treatment requires Levulan to be applied 30-45 minutes before the light therapy that uses blue light or the VBeam laser, which gives more effective results. It is common for a reaction that is similar to a sunburn to occur. This requires some downtime for the skin to heal, which can be restrictive for some patients.
Levulan in combination with blue light is done at intervals of 7 days for a total of four treatments. Levulan, in combinationn with 585-595nm laser is given at intervals of 4 weeks for a total of 3-4 treatments. In addition to treating acne, photodynamic therapy carries an additional benefit of facial skin rejuvenation.
Laser is another form of acne treatment that works by burning away the follicle sac and sebaceous gland so that eruptions cannot occur. The light waves also induce the formation of oxygen within the bacterial cells, leading to their destruction.
Dr. Umar uses the Spectra VRMIII laser to make this happen. This laser has been found to be effective in even severe and cystic forms of acne. Typically a treatment is given every 2-4 weeks for a total of 3-4 treatments. Signs of improvement typically occur with the very first session. After the acne clears by the 3rd or 4th treatment, a single maintenance treatment is done every six months to prevent recurrence.
Acne treatment using laser therapy is particularly ideal, as it is great for on-the-go patients whose lifestyles don’t allow them to keep up with frequent and regular applications of creams, lotions and oral medications.
Because the processes involved in causing acne breakouts are relatively clear, various forms of treatments have evolved to address the core causes. It is therefore important to speak with a medical specialist who can provide the right recommendation. Dr. Umar, who serves the greater Los Angeles area provides consultations for acne treatments and effective solutions for many types of skin objectives.