For many, home skin care does not control problem acne. If this is the case,
Chemical Peels:
Peels are helpful for most types of acne. They exfoliate and stimulate the skin. There is down time of peeling. Mild peels- 1-3 days of dry skin. Aggressive peels- 7-10 days of peeling.
Oral medications:
Antibiotics: I feel antibiotics should be limited to short term therapy; 2-6 weeks. They are best used for an acute outbreak or when starting a skin care program. Long term use can contribute to drug resistance and increased side effects.
Birth Control Pills: These are very helpful for those who suffer with hormonal acne. After age 35 side effects from BCP’s increase and other therapies may be safer. Smoking also increases risk of side effects with BCP’s, so smokers should consider other options.
Spironolactone: This medication has been used for years for treatment of hormonal acne and has a good side effect and safety profile. It can be used long term without resistance or other problems.
Accutane: This is discussed in the next Blog section.
Phototherapy:
Light based therapy has been found to help resistant acne. Certain wavelengths of light kill the P. acne germs, others calm vascular inflammation, and others contribute to cellular renewal.
Broad Band Light (BBL): BBL uses multiple wavelengths of light with each treatment to address several pathways of improvement in one treatment. The down side is that the treatment is associated with discomfort that some will not tolerate and a minimum of 6 treatments are required for optimum results.
Photodynamic Therapy with Aminolevulinic Acid (PDT with ALA): This treatment can be very effective even for severe acne. ALA is applied to the skin and allowed to penetrate for 30-60 min. It is then activated with blue and red light which causes improvement in the sebaceous glands. The treatment is very comfortable but must be repeated 4-6 times for optimal improvement. Each treatment is associated with sun sensitivity which requires the patient to stay out of the sun (indoors) the day following the treatment.
In my next blog, I will discuss my favorite treatment for severe, uncontrolled acne.
Mack Stewart, M.D.
