ACNE WEBSITE: CAUSES OF ACNE

1. HEREDITY: Not all patients' parents, of course, can remember acne in their earlier days, but heredity often plays a strong role.

2. STRESS: Nervous tension, pressure, final exams, or a new job can often contribute to a worsening of acne.

3. HORMONES: Hormonal changes at puberty, either in males or females, can cause an outbreak of acne. In women, the monthly cycle, pregnancy, birth control pills, or menopause are often contributing factors.

4. BACTERIA: Skin bacteria plays a prominent role in acne. For this reason, oral or topical antibiotics are commonly used for therapy.

5. COSMETICS: No brands in the market (save one) are completely free of comedogenic or potentially irritating ingredients (The Regine Line at www.dermalinellc.com is the only line with all ingredients rated "0" on a master list of comedogenicity and irritancy).

THERAPY : TOPICAL MEDICATIONS

Benzoyl peroxide gel, or wash in strengths of 5%or 10%: benzoyl peroxide kills surface bacteria and tends to dry the skin slightly.

Azelex® or Finevin® (azelaic acid) can treat mild to moderate inflammatory acne on the face.

Sulfur compounds, such as Sulfacet® represent some of the older therapies that were used decades ago.

Retinoic acid (Retin-A® or Avita®) remove comedones (blackheads) from the pores allowing them to drain more freely. Retinoic acid, of course, also can be used to treat sun damage and wrinkling of the skin.

Differin gel® (adapalene) can have similar benefits to those from Retin-A although it is not quite as strong as retinoic acid.

Topical Cleocin® (clindamycin) is available in gel, liquid, lotion, or pledgetts (swabs). These kill surface bacteria.

Topical erythromycin is available in a gel, swabs, or solution. These also kill surface bacteria thought to cause acne.

REGINE® COSMETICS are non-comedogenic, non-acnegenic, hypoallergenic, and are simultaneously oil-free, fragrance-free, lanolin-free, and free of formaldehyde-releasing preservatives (See www.dermalinellc.com).

Oral antibiotics: Those that have been effective for various patients include:

Tetracycline
Erythromycin
Ampicillin
Amoxicillin
Vibramycin® (doxycycline) or Periostat®
Keflex (cephalexin)
Bactrim®/Septra® (trimethoprim-sulfamethoxazole)
Ciprofloxacin/Floxin®
Biaxin® (clarithromycin)
Zithromax®

Retinoids: These compounds actually shrink the size of the sebaceous gland and cause a permanent reduction in cystic acne (the standard oral retinoid is Accutane). Tazorac® is available for topical use in psoriasis but has not been completely evaluated yet for its role in acne. Accutane is taken for a standard four-month course. Laboratory tests are necessary while you are on this medication as it has been known to cause birth defects and other difficulties. However, it can have a significant benefit for patients suffering from cystic acne.

Birth Control Pills: Some of these have been promoted as treatments for acne but the results from this therapy alone has been inconsistent.

PROCEDURES

Dry ice cryotherapy (CO2-acetone slush) simultaneously helps to unplug your pores, reduce the red marks, treat the acne, and, if given repeatedly over a period of months, can reduce acne scars as well. This is a simple treatment performed in the office and taking only several minutes.

Comedone extraction (blackhead or whitehead removal) is performed by the dermatologist in the office.

Intralesional injections of non-absorbed cortisone can be used to rapidly shrink cysts, such as before an important social event.

Light chemical peels, such as glycolic acid or trichloracetic acid, can reduce the appearance of acne and also help to treat mild acne scarring.

Microdermabrasion is an exciting new resurfacing concept that can treat acne, large pores, and mild acne scarring.

Dermabrasion (or dermasanding) are used for deeper or fibrotic acne scars. This procedure has been in use for decades and has a significant benefit for patients with more severe scarring.

Ultrapulsed laser therapy (carbon dioxide) can be beneficial for large pores and milder acne scarring, especially on the cheeks.

Punch grafting or punch elevation can be effective for deep "pits" or "large pores" especially on the cheeks.

Subcision (undermining) can help to release soft, broad acne scars and help them to float closer to the surface of your skin, lessening the shadowed effect.

Dermal grafting involves the placement of your solid collagen under acne scars to permanently augment them and reduce the depressions in the skin.

Fat transplantation can be used for broad, soft depressions on the face, including broad acne scars to achieve permanent correction.

For further consultation, please contact Dr. Swinehart at the Colorado Dermatology Center by phone at 303-744- 1202, for an appointment, or by facsimile at 303-744-0418 for your questions.