By George J. Hruza, MD
Xu LY et al. Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nmNd:YAG laser treatment.
Arch Dermatol 2010Sep 20; [e-pub ahead of print]. (http://dx.doi.org/10.1001/archdermatol.2010.245)
Aggressive treatment with hair removal laser such as Nd:YAG 1064 nm may have a positive effect on lesions of HS. Hidradenitis suppurativa (HS) is very resistant to both medical and surgical management — exacerbations, recurrence, and progression are the norm.
The observation that HS (aka Acne Inversa) may be related to follicular occlusion has led to attempts to treat HS with hair removal lasers. In this prospective, controlled clinical and histologic study,20 patients with Hurley stage II HS (skintype, Fitzpatrick III or VI) underwent treatment with a long-pulsed 1064-nm Nd:YAG laser.
Acne vulgaris (or acne) is a common term for comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples) and nodules. Large nodules are sometimes called “cysts” or “boils”, and the term nodulocystic is used to describe severe cases of inflammatory acne. Cystic acne affects deeper skin tissue than does common acne and typically appears on the buttocks, groin, armpit areas, chest, neck and back. Sometimes acne cysts may develop on the face. Aside from scarring, its main effects are psychological, and sever acne cases may seriously affect self esteem of the sufferers and the quality of life.
Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that involves dermis and subcutaneous heating with lasers for the purpose of inducing new connective tissue growth. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced to resurface acne scars.
Ablative skin resurfacing typical causes visible trauma to the patient’s skin. Aesthetic physicians who have both modalities can try to reduce complications and improve the results of ablative laser resurfacing (carbon dioxide, erbium or fractional lasers) by combining this treatment of acne scars with nonablative lasers.
For patients of skin phototypes III-V with atrophic facial acne scars, the combination of ablative laser resurfacing and nonablative laser resurfacing yields the best results with fewer complications.
Acne is the most common skin disorder known today. In United States alone, nearly 60 million people are infected with acne, where 85 per cent of teenagers suffer from it.
Skin experts and aesthetic practitioners recommend several natural acne treatments you can use for your regular home-based routines.
1.Wash your face twice a day (thrice at most) with gentle and unperfumed cleanser. Avoid using soaps as they contain harsh chemicals and ingredients that can damage your skin.
2. Avoid touching your face. Stop putting your hands by your face! I am often guilty of this resting my hand on the side of my head while reading. Also rubbing or bracing your chin is another common problem when thinking. Avoid rubbing, touching, or itching your skin with your hands. Your hands contain a lot of bacteria that can cause acne flare-ups. It is probably one of the most difficult things to avoid since much of the hand to face contact throughout the day we are unconscious of. Make it a habit to avoid hand contact and be conscious of it during the day to avoid bacteria.
3. Avoid the temptation to pick, prick and squeeze your acne. This will send the infection deeper into the skin and can cause severe scarring.
4.For mild to moderate acne, you can use over- the- counter topical ointments, solutions, lotions or gels that contain benzoyl peroxide, salicylic acid or azelaic acid as an alternative to benzoyl peroxide. Benzoyl peroxide is best at killing P. acnes and may reduce oil production. Resorcinol, salicylic acid, and sulfur help break down blackheads and whiteheads. Salicylic acid also helps cut down the shedding of cells lining the follicles of the oil glands.
5. Topical antibiotic solutions and lotions can also be applied.
6.Tea tree oil is a natural antibiotic and antibacterial agent and has a drying effect on the skin. It keeps the P. Acnes bacteria at bay along with decreasing facial oiliness, which makes this oil a worthwhile investment.
7. Sulfur helps to heal existing blemishes by unblocking pores.
8.Alpha or Beta Hydroxy Acids (AHA or BHA) works by keeping the skin exfoliated. Glycolic acid, the most well-known of the bunch is a useful adjuvant therapy for mild acne. Mandelic acid, a lesser known one, but one that combines the keratolytic properties of glycolic acid with natural antibacterial properties that help reduce the presence of P. acnes, may be considered a more effective alpha hydroxy acid in treating acne lesions. It is also much less irritating than glycolic acid, a factor that may be very important to those with sensitive skin who are unable to use other agents such as Retin-A, benzoyl peroxide, sulfur, or salicylic acid. It is effective in treating mild cases of acne on its own, and can be used successfully with other therapies on moderate acne.
These treatments are usually effective for mild to moderate acne problems only. The effectiveness usually takes several weeks or approximately three to six months to be noticed. For more severe and serious acne conditions, do not hesitate to consult your dermatologist.
These days dermatologists and aesthetic physicians prefer to use laser treatments to control severe acne and resurface acne scars. Experienced physician will prescribe a regimen, which may include some medication but mostly a series of laser treatments, which will be very effective on your acne.
If regular cleansing routines and a laser-assisted treatment plan are not followed or disrupted, some people with severe teenage acne may end up having acne scars, which may never flatten out if left untreated.
The most common laser treatment for acne scarring is laser skin resurfacing, which can be done by a variety of laser modalities.
Everyone wants clear and acne-free skin. Unfortunately, a lot of people have various skin disorders, and many flock to drugstores to buy the latest miracle cure for that naturally beautiful skin.
1. The cosmetic industry makes billions of dollars from the public quest for great skin. Do not be fooled by the advertising hype.
2. There are many factors that contribute to the clogging of pores: like dehydrated skin, improper cleansing, excessive oil production, excessive build-up of dead skin cells, hormones, excessive sweating, dirty work or play environments, genetics, makeup, fingers on the face, allergic reactions, a diet high in sugar content and many others.
3. Most skin impurities are due to clogged pores, so the best way to have that beautiful skin is to unclog your pores.
Beauty starts with your skin. If regular routines are not enough, the best and the safest way to take your acne treatments to a different level is to go to an aesthetic physician for laser treatments.
Acne is a skin problem that affects almost all teenagers. The condition results from the action of hormones on the skin’s oil glands (sebaceous glands). The sebaceous glands make an oily substance called sebum that empties onto the skin surface through the hair follicle opening (pore). The mixture of oil and cells allows bacteria that normally live on the skin to grow in the follicle openings. When this happens, pores become clogged and pimples develop.
Comedones: Non-inflammatory papules that can be open (blackheads) or closed (whiteheads).
Papules: Lesions that are inflamed and can be tender to the touch. These usually appear as small, pink bumps on the skin.
Pustules (pimples): Lesions that are inflamed and filled with pus. They may be red at the base.
Nodules: Solid lesions that are large, painful, and lodged deep within the skin.
Cysts: Pus-filled lesions deep under the skin. These may cause scarring and pain.
In most cases, pimples occur on the face, neck, back, chest, and shoulders. Acne does not present a serious health risk, but severe acne can result in permanent scarring. In addition, acne can have significant physical and psychological consequences, such as causing a poor self-image, social inhibition, and anxiety.
It is not clear why some people are more prone to acne than others. The exact cause of acne is not known, but one important factor is an increase in male sex hormones called androgens. Androgens increase in both boys and girls during puberty. Androgens cause the sebaceous glands (oil glands) to get larger and produce more sebum. Androgens also can increase because of hormonal changes related to pregnancy or starting or stopping birth control pills.
Another factor in the cause of acne is genetics. Researchers believe that the tendency to develop acne can be inherited from parents. In addition, some drugs (for example, anti-epilepsy medication, prednisone, androgens and lithium) are known to cause acne. Cosmetics that have a greasy consistency may change the cells of the follicles, causing them to stick together and resulting in a plugged pore. Water-based products are less likely to cause acne.
Other factors that were previously thought to make acne worse do not seem to have an effect on the development of acne. These factors include chocolate, greasy foods, and dirty skin.
Dermatologists often treat acne, particularly in severe cases. Family or general practitioners, pediatricians or internists may treat milder forms of acne.
Treatments may include:
OTC topical drug treatments: Over-the-counter (OTC) medications include salicylic acid, benzoyl peroxide, and sulfur. These treatments are available in many forms including gel, lotion, cream, soap, or pads. When these products are used regularly, they are moderately effective in the treatment of acne. It may take 4-8 weeks for an improvement to occur in the skin.
Prescription topical drug treatments: The prescription topical drug treatments that are used to treat acne include benzoyl peroxide, antibiotics, tretinoin, adapalene, and azelaic acid.
Prescription and OTC benzoyl peroxide work the same way. Doctors often prescribe benzoyl peroxide so that they can make sure that their patients get the most desirable formulation (for example, cream, lotion or gel).
Prescription oral drug treatments: For patients with moderate to severe acne, doctors often prescribe oral antibiotics (taken by mouth) in addition to topical medication. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and decreasing inflammation. They are usually taken daily for a period of four to six months and then tapered and discontinued as acne improves.
The most potent oral drug, isotretinoin (Accutane), is usually taken once or twice a day for 16 to 20 weeks. It is believed to markedly reduce the size of the oil glands so that much less oil is produced. As a result, the growth of acne-causing bacteria is decreased. However, isotretinoin can cause birth defects in the developing fetuses of women who are pregnant while taking the drug. Women of childbearing age must not be pregnant and must not become pregnant while taking isotretinoin.
Talk to your dermatologist or aesthetic physician about using Nd:YAG 1064 nm laser for the treatment of active acne. 2-4 sessions will help in a vast majority of cases. And stay away from Accutane.
A valuable input has been provided by a group of physicians from Korea, which published the results of their study in May issue of the Journal of the American Academy of Dermatology.
The group did a very interesting split-face clinical study of 18 Korean patients with facial acne scars. They treated on cheek with a 585-nm pulsed dye laser (PDL) and the other with a 1064-nm Nd:YAG laser to compare the efficacies of these two lasers in the treatment of acne scars.
Each patient received 4 sessions of PDL or Nd:YAG laser at 2-week intervals in a randomized split-face manner.
“Both lasers induced notable and comparable improvement in the appearance of acne scars, particularly superficial scars, with significant reductions in the scores associated with the clinical evaluation scale for acne scarring (ECCA). Histologic evaluations revealed significant increases in collagen production and deposition following both lasers. Patient satisfaction scores concurred with these improvements. Ice-pick scars and boxcar scars tended to respond better to PDL and Nd:YAG lasers, respectively”.
Atrophic acne scars of representative patients showed notable improvement at 8 weeks after completion of laser treatment. A and B is PDL-treated side versus; C and D – Nd:YAG laser–treated side. Left column A and C) is the baseline (before treatment). Right column (B and D) – 8 weeks after completing 4 laser treatment sessions. Ice-pick and deep scars (C and D) as well as superficial scars (A and B) showed noteworthy improvement after laser treatments.
The study group concluded that both lasers are effective modalities for the treatment of acne scars. Results appear to be very comparable in efficacy.
This is a notable study, which conclusively shows that both lasers work well on Asian skin type, and the skin type is a very important factor in choosing one laser over the other. Nd:YAG laser should clearly be the laser of choice for a darker skin type. The 1064 nm wavelength is a much safer modality for the skin of color and tanned skin.
The study did not address the pain level for patients. Again, 1064nm with a short pulse width would be preferable as the patients with darker skin would experience less pain during the treatment.
An experienced aesthetic medical professional should determine the choice of laser for a specific skin color, skin condition and the scar type to achieve optimal results for the individual patient.