Treating acne

After disinfecting the skin, the comedones are extracted using a comedone extractor. The doctor will judge whether he prefers to extract all the comedones before the first of the four Easy TCA (ETCA) peels or to extract only some of the comedones before each peel - patients usually prefer the second option as it is less aggressive. 

As soon as the comedones have been removed, the ETCA solution is applied following the basic protocol (Chapter 15). The solution penetrates and disinfects the openings left by the comedones. This localized penetration has not been reported to have any negative effect. 

The irritation caused by extracting the comedones can, however, cause the ETCA solution to penetrate more deeply and produce cloudy rather than pinpoint frosting. To reduce the risk of cloudy frosting developing, the cotton buds should be squeezed out properly before applying the ETCA solution. 

The skin is cleansed once a month. The four ETCA peels are repeated once a year. For daily care, see below. 

The microcysts are opened and drained using the tip of a No. 11 scalpel blade. The doctor can choose whether to open all the microcysts before the first of the four ETCA peels or to extract some of them before each peel. Only the uppermost layers of the epidermis are cut there is no bleeding, no pain and no scarring. 

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The keratolytic analogue motretinide (53) is effective in treating acne and the excess epithelial growth characteristic... 

Salicylic acid is used to treat acne, warts, dandruff, psoriasis, and similar conditions. In the treatment of acne, it slows the shedding of skin cells in hair follicles, so they do not clog the pores and cause pimples. It also has a keratolytic effect—it causes dead skin cells to slough off— which removes the top layer of skin and clears existing pore clogs. 

Jessner s peels have been used to treat acne, melasma, post-inflammatory hyperpigmentation, lentigines, freckles, and photodamage (Figs. 3.2a,b, 3.3a, b and 3.4a, b). 

When treating acne vulgaris, topical and systemic therapies (if indicated) are initiated 2 to 4 weeks prior to peeling. Topical antibiotics and benzoyl peroxide based products can be used daily and discontinued 1 or 2 days prior to peeling. However, unless a deeper peel is desired, retinoids should be discontinued 7-10 days prior to salicylic acid peeling. Broad-spectrum sunscreens (UVA and UVB) should be worn daily (see Photo damage. Sunscreen section). 

Table ii.6 shows types of peels used to treat acne and their indications. Unfortunately there are no conclusive clinical trials comparing chemical peels with standard acne therapy in terms of efficacy and tolerability... 

Figure 2.4 Survey among patients treating acne with Cool Pearls BPO clearly points to improved customer satisfaction. (Source Sol-Gel Technologies Ltd.)...

Topical tetracyclines are sometimes used to treat acne and minor superficial pyogenic infections of the skin. Patients hypersensitive to one member of this class of antibiotics may also be hypersensitive to other tetracyclines. Photosensitization may occur. 

SAFETY PROFILE Poison by ingestion, intraperitoneal, subcutaneous, and intravenous routes. Experimental reproductive effects. Questionable carcinogen with experimental neoplastigenic and teratogenic data. Human mutation data reported. A human skin irritant. When heated to decomposition it emits acrid smoke and irritating fumes. Used to treat acne and other skin problems. 

Treat acne vuglaris by gently applying a cleansing agent to the skin several times a day. Administer antiacne medication, which dissolves keratin. Commonly prescribed antiacne medications are ... 

A young woman of about 20 asks for your advice on acne, She says that there are times in each month when her skin is perfect and others when she has sudden outbreaks of acne, She says that her mother also suffered in this way and that her acne faded when she started taking an oral contraceptive. She asks if oral contraceptives can be used to treat acne specifically, and if so can she get them over the counter ... 

Tretinoin (aU-trans-retinoic acid, ATRA) is the carboxylic acid form of vitamin A (retinol). It is one of the first-generation retinoids and has been used since the 1970s to treat acne complaints and dyskeratosis. It is important to know all about this molecule in order to obtain benefit from its actions. 

The use of AHAs (especially glycolic or lactic acid) in treating acne has often given good or even excellent results. Easy Phytic solution (see Chapter 11) is especially safe, effective and comfortable for this indication. Keratinocyte cohesion... 

General remarks on treating acne with peels... 

When treating acne, as with melasma, getting early results fast is a positive sign that could indicate exceUent end-results. If... 

The protocols established for treating acne with ETCA in no way take away the doctor s freedom to choose the treatment that is best for his patient based on his own knowledge and personal experience. 

Infections these can result from not cleaning hands and equipment properly, inadequate pre-peel disinfection or overlong occlusion (more than 24 hours occlusion usually causes infection). A pre-existing skin infection can also be the cause treating acne scars when there are lesions that are still active. 

Some authors prefer to treat acne scars with dermabrasion, on condition that the hand guiding the wheel is expert enough to be able to control the depth of skin abrasion precisely and to vary the depth depending on the area and the size of the scars being treated. Dermabrasion may be prescribed as monotherapy or in combination with other... 

Biotin deficiency can be caused by diets "with excess egg white, leading to dehydration and acidosis from accumulation of carboxylic and lactic acids. Retinoic acid is a "vitamin A derivative that can be helpful in treating acne but not vitamin D deficiency Leafy vegetables are a source of B "vitamins such as niacin and cobalamin. 

Combinations of erythromycin and BPO have shown greater efficacy in treating acne than a combination of erythromycin and tretinoin. Development of P. acnes resistance to erythromycin may be reduced by combination therapy with BPO. 

Hormonal therapy is useful in treating acne in women with elevated or normal serum androgens. It may also be warranted for female patients with severe seborrhea, clinically apparent androgenic alopecia, seb-orrhea/acne/hirsntism/alopecia syndrome, late-onset acne, and with proven ovarian or adrenal hyperandrogenism. ... 

Kaminsky A. Less common metiiods to treat acne. Dermatology 2003 206 68-73. 

Benzoyl peroxide is another powerful oxidizing agent. Ointments containing 5-10% benzoyl peroxide have been used as antibacterial agents to treat acne. The compound is currently formd in over-the-counter facial scrubs because it is also an ex-foliant, causing sloughing of old skin and replacement with smoother-looking skin. A word of caution is in order in sensi-... 

Resistant strains of P. acnes are emerging that may respond to jndicions nse of retinoids in combination with antibiotics. Commonly nsed topical antimicrobials in acne inclnde erythromycin, clindamycin (Cleocin-t), and benzoyl peroxide and antibiotic-benzoyl peroxide combinations (Benzamycin, Benzaclin, others). Other antimiaobials nsed in treating acne inclnde sulfacetamide (Klaron), sulfacetamide/sulfur combinations (Snlfacet-R), metronidawie (Metrocream, Metro-Gel, noritate), and azelaic acid (Azelex). Systemic therapy is prescribed for patients with more extensive disease and acne that is resistant to topical therapy. Effective agents inclnde tetracycline (snmycin, others), minocycline (MINO-CIN, others), erythromycin (ERYC, others), clindamycin (CLEOCIN), and trimethoprim-sulfamethoxazole (bactrim, others). Antibiotics nsnally are administered twice daily, and doses are tapered after control is achieved. 

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