Modern Acne Treatment - Advanced Skin Care to Control Outbreaks and Scars


All of us who have ever had an acne sore or Comedone have found it very distressing. It is even more distressing for people who have many breakouts which keep coming back. People who go on to develop acne scars are troubled by them for many years as scars left by breakouts are very difficult to conceal.

The good news is that modern medical methods of acne control are very good and can reduce outbreaks and lessen the chance of acne scarring.

However, you will need to follow the skin care program fastidiously. You will also need to consult an expert dermatologist or plastic surgeon that is up to date and knows how to treat acne. You will need prescription medications. You will also need to have monthly exfoliation treatments by a medical aesthetician who is experienced in acne control treatments.

You also need to start early, at the first sign of an outbreak. Delaying treatment only gives the lesions the chance to worsen and possibly cause scarring.

What Causes Acne

Lesions or Comedones are caused by the obstruction and infection of the oil glands in our skin. Our skin contains oil glands called Sebaceous Glands which secrete normal oil called Sebum which helps moisturize and protect our skin.

If Sebum production is too high, for example during adolescence, or skin debris like dead skin obstructs the pore, the Sebaceous Gland can become distended and obstructed so that oil builds up and distends the gland.

An obstructed, distended Sebaceous Gland provides an ideal place for bacteria to grow and create an infection. Once the Sebaceous Gland becomes infected, the skin overlying the gland becomes red, swollen, and painful, an acne lesion. A whitehead can form on the integument, which is essentially a small abscess, called an acne pustule.

Lesions tend to occur most commonly in areas where oil glands or Sebaceous Glands are most plentiful, the area around the nose, forehead and chin, called the T zone, and the back.

What Causes Acne Scars

Visible scars are caused by destruction of the Dermis, the deep layer of the integument. When the Dermis is damaged and tissue is lost, a visible depression or scar appears.

Because the Sebaceous Glands extend deep into the Dermis, the infection in the Sebaceous Gland or Comedone causes infection and destruction of the surrounding Dermis. After healing a deep depression or scar forms because the supporting Dermis tissue has been lost.

How to Control Acne Outbreaks

The basic requirements for control of lesions involve:

  •  Reduce oil production of the Sebaceous Glands
  •  Remove skin debris to prevent obstruction of the Sebaceous Glands
  • Treat and prevent infection of the Sebaceous Glands

Topical Benzoyl Peroxide is an anti-bacterial agent and an integument drying agent. It is marketed as Brevoxyl Cream or Brevoxyl wash. It is the most commonly used product to control a Comedone breakout and is very effective. Benzoyl Peroxide reduces oil and helps prevent infection.

Vitamin A (retinoic Acid) derivatives reduce integument oil production by inhibiting the Sebaceous Gland cells. Products that are commonly used are Differin (adapalene), Retin A, Tazorac, and Accutane (isotretinoin). These prescription drugs are very effective but do have side effects like skin irritation dryness and other potential problems, thus they must be used under the direction of a physician.

Topical Clindamycin is the most effective antibacterial agent for controlling infection in my experience. It comes as a gel or cream or small wipes called Clindets, which I use most frequently.

Microdermabrasion is the most effective minimally invasive, no down time deep exfoliation method. Microdermabrasion treatments are essential to remove debris, open pores and prevent obstruction of the Sebaceous Glands and the development of a Comedone breakout.

Oral Antibiotics like Minocyclene and other Tetracycline derivatives are widely prescribed for lesion control. They can be effective, but my own prejudice is that it is very hard, if not impossible, for an oral antibiotic to reach a skin abscess like a Comedone. The skin abscess forms a thick wall of inflammation that is almost impossible for the oral antibiotic in the bloodstream to penetrate.

That is why I place so much emphasis on topical care to reduce oil production, deep exfoliation to remove debris and allow the oil out of the gland, and topical Clindamycin applied directly to the infected oil gland or lesions.

IPL, Diode Laser and Blue Light Treatments can kill the bacteria Propionibacterium acnes which cause the infection or lesions. Some of these therapies can reduce oil or Sebum production. These therapies are effective when used properly.

Acne Control Program

The control program depends on the severity of the lesions.

Mild Occasional Outbreaks

  • Monthly professional medical grade microdermabrasion treatments
  • Topical Benzoyl Peroxide-(Obagi Clenziderm MD penetrates the best)
  • Clindamycin- Clindets for acute lesions

Moderate to Severe Outbreaks

  • Monthly to bi-weekly microdermabrasion
  • Obagi ClenzidermMD Benzoyl Peroxide
  • Topical Clindamycin-Clindets
  • Retin A Derivative-in increasing order of strength-Differin, Retin A, Tazorac, Accutane
  • Consider IPL, Blue Light or Diode Laser Therapy

Severe Cystic Outbreaks

  •  Microdermabrasion
  •  Obagi Clenzidrm
  • Topical Clindamycin Clindets
  •  Accutane
  •  IPL, Diode Laser or Blue Light treatments

How to Remove Acne Scars

Traditionally dermabrasion or surgical excision was used to remove scars. However, with the advent of laser resurfacing in the mid 90"s, laser resurfacing with the CO2 laser became the most common method. However, CO2 laser resurfacing required prolonged recovery, often caused the integument to lose color. In addition, the CO2 laser resurfacing only smoothed the surface of the skin and did little to improve deep lesion scars caused by destruction of the Dermis by the Comedone infection process.

Deep ice pick scars still require a special surgical procedure called floating grafts followed by CO2 laser resurfacing for effective removal. During this procedure, under local anesthesia, a small circular punch or trephine is used to cut around, but not remove the ice pick scar. The punched area floats up above the surface of the surrounding integument. After 2 weeks, the protruding graft has taken, which means it has new blood supply and will survive. At this point, the CO2 laser is used to plane down the protruding grafts flush with the surrounding integument. The new graft closes the ice pick scar. This is the only method I have seen that effectively corrects ice pick breakout scars.

New fractional non-ablative laser skin resurfacing lasers are able to significantly improve deep lesion scars by building new collagen to replace the collagen lost in the Dermis by the Comedone infection.

These new fractional non-ablative resurfacing lasers do not break the skin thus no healing time is required. You will need at least 4 treatments scheduled 4-6 weeks apart. The laser energy is fractionated, that is broken up into many small beams that pass through the integument without injuring it, and heats the deep dermis to build new collagen to actually plump up the breakout scar.

The fractional non-ablative resurfacing laser is a revolutionary advance in scar removal treatment.

Where Do You Find a Good Treatment Program?

First, re-read this article and be armed with the facts about proper therapy. Many physicians just prescribe Minocyclene and do not understand the importance of a comprehensive approach to control this problem.

I recommend that you consult two board certified dermatologists or plastic surgeons that have an interest in this field. Check their websites, do they offer all of the services mentioned above. It is important to find a doctor who offers microdermabrasion treatments and laser therapy in their office. That means they are up to date on current technology.

I also believe that it is essential that the physician have an excellent experienced medical aesthetician in their office. Most of your contact and the most important person in your program will be the medical aesthetician, and she needs to know what she is doing.

You are very unlikely to find the expertise you need in a walk in Medical Spa without a board certified doctor present to examine you and recommend a course of therapy. Physician supervised in the Medical Spa world usually means the doctor is actually at an office some distance from the Medical Spa and provides his/her supervision in the form of a phone call when something goes wrong.

Do your homework.

Article by
Boston Plastic Surgeon