Back to School - Putting your best face forward

We think about fresh starts, new teachers, new friends, and making the best first impression we possibly can. As a teenager or young adult, our complexion can become one of those things, which despite all efforts, does not cooperate. This can be emotionally and physically distressing for our children, and ultimately, as parents. We try to do all the right things. Proper diets, the right cleansers, the latest in anti-acne solutions and yet the breakouts continue. If only it was as simple as the advertisements would suggest, but it simply is not so. Let’s face it, acne and acne flair ups are a right of passage for most adolescents, but it can be managed in ways to minimize disruption, embarrassment and long term scarring. The best approaches to acne care are very individualized.

There are many faces of acne. It can range from the occasional blemish to distressing cystic conditions. Most of us fall somewhere in between these extremes, with the occasional breakout of pimples commonly referred to as white heads and black heads based on appearance. These are in fact closed and open skin pores. Fortunately, these forms of acne are very treatable.

While we do not know exactly why some people get acne and others don’t, we do know that people have many misconceptions about it. These misconceptions can be a source of unnecessary self blame and anxiety. For starters, acne is not the result of poor hygiene. In fact, too much cleaning of the skin can be detrimental. There is also not evidence that acne is the result of eating too much chocolate or a diet rich in carbohydrates. Naturally, the best advice is to eat in a sensible and balanced way. What we do know, however, is that hormones and heredity do play a role, and several external factors can exacerbate the condition including a stressful environment.

Acne results from the combination of over production of oils by glands in the skin and inadequate outflow from the pores through which these glands ultimately drain. The build up of oils gets secondarily infected by bacteria commonly found on the skin’s surface. This leads to inflammation. The characteristics of these lesions including redness, swelling, tenderness, and discharge. Treatments for acne target one or more of the steps in this cascade.

Over the counter products are generally our first attempt at treatment. There are dozens of brands out there, with fancy packaging or over inflated claims. The issue is that the active ingredients are all very similar. For decades the mainstay of these remedies has been a combination of salicylic acid and benzyl peroxide. Salicylic acid helps correct the abnormal shedding of skin cells and unclog pores to resolve and prevent new lesions. It has no effect on oil production or bacteria. Benzyl peroxide works to treat acne by dislodging dead skin cells and it is also toxic to bacteria. These products are most effective when used in combination as part of a comprehensive system. Remember, the results are not instantaneous as they work on a cellular level. This means that objectively it takes weeks to months to see sustainable improvement.

Two other main classes of topical preparations used in the treatment of more advanced forms of acne, include antibiotics and vitamin A derivatives (Retin-A, Differin, Tazarac). These are prescription medications and require a doctor’s supervision. Antibiotics such as doxycyline and tetracycline have both antibacterial and anti-inflammatory properties. Topical retinoic acid compounds are powerful drugs with remarkable effects on skin cells. Their most relevant impact on acne is the ability to up regulate skin cell turnover, or shedding, that leads to more effective function of pores and glands. Retinoic acid can be irritating and certainly makes the skin more sensitive to sun exposure.

Another sequence of acne treatments are oral agents such as antibiotics. Oral antibiotics, over time, can help suppress sever acne through both bacterialcidal and anti-inflammatory properties. Often times these are taken for months to achieve maximum benefit. Long term, we are concerned about developing resistances which reduce their effectiveness. Isotretinoin (Accutane) is a treatment of last resort, but for some individuals it can be the difference between a lifetime of acne and cure. It is a potent suppressor of skin cell metabolism, which can be very beneficial , however, as a systemic medication it has a host of serious side effects. It can include disturbances in mood, blood disorders, and risks of birth defects in pregnant woman. It must be monitored very closely by a dermatologist. Many people cannot or do not wish to be on this medication and seek alternative solutions.

Lasers and light source technology now offer remarkable alternative treatments that provide target specific options for acne conditions. These treatments can be done in short sessions and with little down time. They offer distinctive alternatives to drug therapy. It is commonly noted that acne tends to improve in the summer when individuals are exposed to sunlight. The blue spectrum of visible light plays a beneficial role in skin clearance. What happens is this: controlled exposure to blue light kills bacteria that live on the skin surface which results in decreased acne lesions. Additionally, lasers with effective wavelength to target sebaceous glands are used to disrupt and hence inactivate these glands. Less gland activity means acne is better controlled. It is important to understand that lasers are not a magic bullet. They are best considered as another tool to be used in combination with more conventional topical treatments.

When acne has finally runs its course, there can be residual scarring. This scarring is well characterized. It can look like deep gouges which go by the name of ice pick scaring or ripples on the surface of the skin, called atrophic scarring. Fortunately, these skin surface texture can be dramatically improved with a new class of lasers referred to as fractional lasers. This technology essentially creates tiny holes in the skin which rapidly heal leaving a smoother, healthier appearance to the skin. These treatments are performed with minimal down time, with effects that are immediate and progressive.

It is important to realize that acne and acne scaring are treatable conditions. Both the physical and emotional side effects can be dramatically minimized if appropriate treatments starts before the condition becomes severe. When conventional treatments fail to deliver, there is a place for supplemental lasers and light based therapies. Combined treatments will offer the best solutions. Putting our best face forward can make all the difference in a happy, successful school year!

The Center for Facial Plastic Surgery and Laser Skin Care

518.262.7193

www.aboutfacedoc.com

1 West Avenue, Saratoga

35 Hackett Blvd., Albany