Acne is an inflammatory disease and it can be controlled.
Skin -The skin has 3 main layers, the deepest is the dermis, then
the epidermis with the stratum cornium being the outermost layer.
The deeper layer of the skin-the dermis-is made up of collagen and
elastin, which support the surface of the skin and provide a home
for blood vessels, nerves, and other cells. Pores originate from
the dermis as a tube. From this tube branch (oil) glands that
produce an oily substance dermatologists call sebum. The sebum
flows to the top of the tube (follicle/pore) eventually to be
secreted onto the skin’s surface.
On the surface of the skin, the top layer of the epidermis is
called the stratum corneum-(it is made up of dead, protein-rich
cells known as keratin, which act as a protective barrier for our
underlying cells). The dead cells of the stratum corneum, which
contain a large amount of he protein keratin, are supposed to fall
off the skin in a natural process called exfoliation, or
desquamation. The stratus corneum also lines the inside of the
tube(pore). If the inside of the pore does not exfoliate properly,
the keratin mixes with sebum, making it viscous and sticky,
clogging the pore.
The primary cause of acne is inflammation which then causes
clogged pores.
Hormones-Acne usually makes its first appearance during puberty.
When we enter puberty, our body begins to produce testosterone.
Testosterone breaks down into a substance called
Dihydrotestosterone (DHT) that stimulates the sebaceous gland to
produce more sebum (oily substance). This sebum begins the process
of retention hyperkratosis, or insufficient exfoliation within the
follicle (pore) lining clogging pores.
Clogged pores-“Retention Hyperkeratosis”- Within a short time a
bacterium, P acne, begins to multiply rapidly creating further
inflammation and more clogged pores. Pimples start as tiny white
bumps below the surface of the skin (sliding your fingers over
your skin, you can often feel these small, hard bumps). If it
remains deep, then it can become a cyst.
Need Anti-oxidents to fight free radicals because the skin does
not have enough of its own anti-oxidant plus we need to stop the
inflammation even before it starts. Anti-oxidants do this.
AHA such a glycolic acid-helps increase shedding of the skin
cells. Glycolic acid also acts as a powerful anti-bacterial &
anti-inflammatory agent.
Light 10-420 nanometers-Blue Light
Stress is another proven precipitator of acne from release of
cortisol. Elivated cortisol causes an increase in blood sugar,
which causes our cells to enter extreme pro-inflammatory mode.
1) Be on an Anti-Inflammatory Diet
2) Nutritional Supplements
3) Anti-inflammatory topical-3 weeks DMAE, ALA, Vitamin C-ester
A Chronic skin disorder and also an inflammatory
condition-Dilated capillaries on the skin’s surface, persistent
redness mostly on the forehead, nose, cheek bones, and chin.
What Causes Rosacea?
Doctors do not know the exact cause of rosacea but believe that
some people may inherit a tendency to develop the disorder. People
who blush frequently may be more likely to develop rosacea. Some
researchers believe that rosacea is a disorder where blood vessels
dilate too easily, resulting in flushing and redness.
Factors that cause rosacea to flare up in one person may have no
effect on another person. Although the following factors have not
been well-researched, some people claim that one or more of them
have aggravated their rosacea: heat (including hot baths),
strenuous exercise, sunlight, wind, very cold temperatures, hot or
spicy foods and drinks, alcohol consumption, menopause, emotional
stress, and long-term use of topical steroids on the face.
Patients affected by pustules may assume they are caused by
bacteria, but researchers have not established a link between
rosacea and bacteria or other organisms on the skin, in the hair
follicles, or elsewhere in the body.
Can Rosacea Be Cured?
Although there is no cure for rosacea, it can be treated and
controlled. A dermatologist (a medical doctor who specializes in
diseases of the skin) usually treats rosacea. The goals of
treatment are to control the condition and improve the appearance
of the patient's skin. It may take several weeks or months of
treatment before a person notices an improvement of the skin.
Clinical features
Rosacea used to be called ‘acne rosacea’ but it is quite different
from acne. There are red spots (papules) and sometimes pustules in
both conditions, but in rosacea they are dome-shaped rather than
pointed and there are no blackheads, whiteheads, deep cysts, or
lumps. Rosacea may also result in reddened skin, scaling and
swelling of affected areas.
Characteristics of rosacea
include:
Red papules and sometimes pustules on the nose,
forehead, cheeks and chin. Rarely it involves the trunk and upper
limbs.
Frequent blushing or flushing
A red face due to persistent redness and/or
telangiectasia (‘broken capillaries’)
Dry and flaky facial skin
Aggravation by sun exposure and hot and spicy food
or drink (anything that reddens the face)
Sensitive skin: burning and stinging, especially
with make-up, sunscreens and other facial creams
Red, sore or gritty eyelids including papules and
styes (blepharitis and/or conjunctivitis)
Enlarged unshapely nose with prominent pores
(sebaceous hyperplasia) and fibrous thickening (rhinophyma)
Firm swelling of other facial areas including the
eyelids (blepharophyma)
Treatment
Where possible, reduce factors causing facial
flushing.
Avoid oil-based facial creams. Use water-based
make-up.
Never apply a topical steroid to the rosacea.
Protect yourself from the sun. Use light oil-free
facial sunscreens.
Keep your face cool: minimize your exposure to hot
or spicy foods, alcohol, hot showers and baths and warm rooms.
Oral Antibiotics
Tetracycline antibiotics including doxycycline and minocycline
reduce inflammation. They reduce the redness, papules, pustules
and eye symptoms of rosacea. The antibiotics are usually
prescribed for 6 to 12 weeks, the duration and dose depending on
the severity of the rosacea. Further courses are often needed from
time to time as the antibiotics don't cure the disorder.
Sometimes other oral antibiotics such as cotrimoxasole or
metronidazole are prescribed for resistant cases.
Topical
Treatment
Metronidazole cream or gel can be used
intermittently or long term on its own for mild cases and in
combination with oral antibiotics for more severe cases.
Azelaic acid cream or lotion is also effective, applied twice
daily to affected areas.
Isotretinoin
When antibiotics are ineffective or
poorly tolerated, oral isotretinoin may be very effective.
Although isotretinoin is often curative for acne, it may be needed
in low dose long term for rosacea, sometimes for years. It has
important side effects and is not suitable for everyone.
Medications to reduce
flushing
Certain medications such as clonidine (an alpha2-receptor agonist)
may reduce the vascular dilatation (widening of blood vessels)
that results in flushing. Side effects are usually mild but may
include low blood pressure, gastrointestinal symptoms, dry eyes,
blurred vision and low heart rate.
Anti-inflammatory agents
Oral non-steroidal anti-inflammatory agents such as diclofenac may
reduce the discomfort and redness of affected skin. Although these
are uncommon, serious potential adverse effects include peptic
ulceration, renal toxicity and hypersensitivity reactions.
Calcineurin inhibitors such as tacrolimus ointment and
pimecrolimus cream are reported to help some patients with
rosacea.
Vascular laser
Persistent telangiectasia can be successfully improved with
vascular laser or intense pulsed light treatment. Where these are
unavailable, cautery, diathermy or sclerotherapy (strong saline
injections) may be helpful.
Be on an Anti-Inflammatory
Diet
www.mendosa.com/gi/htm-(should consume foods less
than 50)
8-10 glasses of water
No coffee
Nutritional Supplements
Anti-inflammatory topical-3 weeks DMAE, ALA, Vitamin C-ester
Photodynamic Therapy (PDT) is a special treatment performed with a
topical photosensitizing agent called Levulan (5-aminolevulinic
acid or ALA) activated with the correct wavelength of light. This
is also known as “ALA/PDT treatment”. These treatments remove sun
damaged pre-cancerous zones and spots called actinic keratosis.
Sun damage, fine lines, and blotchy pigmentation are also improved
because of the positive effect of Levulan and the light treatment.
ALA/PDT treatment also has the unique ability to minimize pores
and reduce oil glands, effectively treating stubborn acne vulgaris,
acne rosacea, and improve the appearance of some acne scars.
How much improvement can I
expect?
Patients with severe sun damaged skin manifested by actinic
keratosis, texture, and tone changes including mottled
pigmentation and skin laxity may see excellent results. You may
also see improvement of large pores and pitted acne scars. Active
acne can improve dramatically.
How many treatments will it
take to see the "Best Results?
To achieve maximum improvement of pre-cancerous (actinic
keratosis) sun damage, skin tone and texture, a series of three
treatments 2-4 weeks apart is the most effective. Some patients
with only actinic keratosis are happy with just one treatment.
More treatments can be done at periodic intervals in the future to
maintain the rejuvenated appearance of the skin.
What are the disadvantages?
Following PDT, the treated areas can appear red with some peeling
for 2-7 days. Some patients have an exuberant response to PDT, and
experience marked redness of their skin. Temporary swelling of the
lips and around your eyes can occur for a few days. Darker
pigmented patches called liver spots can become temporarily darker
and then peel off leaving normal skin. (This usually occurs over
seven to ten days.) Repeat treatments may be necessary as PDT
medicine is not an exact science.
What are the advantages?
1) Easier for patients than repeated topical liquid
nitrogen, Efudex (5FU), or Aldara because the side effects are
minimal, rapid healing, and only 1-3 treatments required.
2) The ALA/PDT treatment at our clinic is painless
verses liquid nitrogen, 5-FU, and Aldara.
3) Reduced scarring and improved cosmetic outcome
compared with cautery, surgery and Efudex. Liquid nitrogen can
leave white spots on your skin.
4) Levulan improves the whole facial area treated
creating all one color, texture, and tone rather than just spot
treating with liquid nitrogen, cautery and surgery. In summary,
PDT matches the “Ideal treatment” for photodamaged skin:
well tolerated (essentially painless)
easily performed by a specialty clinic environment
non-invasive (no needles or surgery required)
excellent cosmetic outcome (particularly in
cosmetic sensitive areas of the face)
Why Microdermabrasion?
A typical short contact photodynamic therapy treatment begins with
a light microdermabrasion. This technique is used to remove any
dead skin cells on the surface of the face, which allows for
better penetration of the aminolevulinic acid. The
microdermabrasion is followed by a topical application of
aminolevulinic acid, which is left in place for approximately 30
to 60 minutes. The medication is then removed using an alcohol
swab, soap and water. Finally, the patient is treated with a laser
or light source.
Photodynamic Therapy is an essentially painless procedure for the
patient. While initial results may be seen as early as the first
session, some patients require a series of three to five sessions
to see significant results. However, it really depends on the
patient and the severity of the skin condition being treated.
Acne
