| The Skin Center 26081 Merit Circle Suite #109
Laguna Hills, CA 92653 (949- 582-7699 (949) 582-SKIN Fax (949) 582-7691
Diplomat, American Board of Dermatology
Fellow, American Society of Mohs Surgery Fellow, American Academy of Dermatology Former Professor University of California, Irvine
What is Acne? Acne is the term used to descibe clogged pores or comedones (blackheads, whiteheads), pimples and deeper lumps such as cysts or nodules that usually occur on the face, neck, back, shoulders and upper arms. There are so many types of acne. The most common is called acne vulgaris. Almost everyone goes through a period of acne at one time or another. Just beneath the surface of the skin lie hundreds of timney glands called sebaceous glands. Their function is to collect and excrete the oily substance called sebum, to keep the skin healthy. However, the tiny pathway for the sebum to escape often becomes clogged, and a bacterium called p. acne grows inside. In a short time, the area swells up, and forms a pimple on the skin. At certain times of life, this process becomes very active, troublesome and hard to control. Model Photo of Acne: before and afer Blue Light (DUSA)
Acne Treatment Options
Blu-U Acne Treatments  BLU-U® Blue Light Treatment by Dusa Pharmaceuticals, Inc.
Photodynamic Therapy
Acne Treatment
There's no reason to suffer with acne. If you have acne, it can be embarrassing and lead to low self esteem. Without treatment severe cases of acne can be disfiguring, leaving permanent scars. New techniques are available to treat acne and minimize outbreaks. Call our office for an appointment and lets clear up this problem!
Acne is an equal opportunity condition, afflicting teenagers, young adults, and occasionally even more mature adults. BLU-U® Blue Light Acne Treatment uses light - without drugs or antibiotics - to treat hard to control acne, including acne vulgaris. The special blue light kills the p. acnes bacterium that grows inside clogged pores that swell up and form pimples on the skin.
BLU-U® light treatments involve sitting with your face close to the light for a short time (typically 8 to 16 mins 40 secs) about once or twice per week for a period of about five weeks or so. The procedure is safe, not painful, and not hot. Over the course of the treatments, most patient experience noticeable control or clearing up of their acne for a very long period.
Acne Facial Treatment Our popular acne treatments include a deep pore cleansing that may include a glycloic peel, manual extractions, acne healing mask, complimentary microdermabrasion and a cool refreshing slush. It is designed to help with acne, acne pigmentation, rough skin, blemishes and rosacea. Facial Steps - Glycolic and or salicylic peels
- extractions using 30g needle or lancet and comedone extractor
- slush ( light cryotherpay on swab
- Microdermabrasion
- steam, high frequency
Acne Products
The Skin Center offers a complete selection of specialty skin care products as well as an array of facial services and cosmetic treatments with our specialty product lines. *Glycolic Gly/Sal Acne Wash Our #1 selling acne product! Medicated cleanser with glycolic and salicylic acids to treat acne. A gentle wash with immediate results. Benzoyl Peroxide Wash 5% or 10% Therapeutic wash with benzoyl peroxide for the treatment of acne prone skin. Excellent for thoes fighting acne on the face and body. Glycolic Acne Pads Toning pads with 5% glycolic acid and 2% salicylic acid for exceptional toning and exfoliation. Great for teens in sports.
ACNE
Acne PDF Version of this Document | Audio Version of this Document  | Time: 08:14 | Size: 7.7 MB Publication Date: March 2005
Revised August 2006 What Is Acne?
Fast Facts: An Easy-to-Read Series of Publications for the PublicAcne is a disease that affects the skin's oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows. Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat but, it can cause scars. How Does Acne Develop?
Who Gets Acne?
What Causes Acne?
How Is Acne Treated?
How Should People With Acne Care for Their Skin?
What Things Can Make Acne Worse?
What Are Some Myths About the Causes of Acne?
What Research Is Being Done on Acne? How Does Acne Develop? Early treatment is the best way to prevent scars. Your doctor may suggest over-the-counter (OTC) or prescription drugs. Some acne medicines are put right on the skin. Other medicines are pills that you swallow. The doctor may tell you to use more than one medicine.
Personalize your Acne Treatment We will base your personal acne program on your specific needs at your visit. Call The Skin Center at (949) 582-SKIN to schedule an appointment. 1. Wash AM and PM: Wash your face twice daily with: Alternate Benzoyl peroxide wash and Glysal wash or Salac Or DHL Sal Shampoo-Use one wash in AM (shower) and in the PM (by sink). Avaliable at The Skin Center. Acne soap (DHS sal shampoo, Salac, Neutrogena oil-free acne wash, Panoxyl Bar 5%, Benzac wash, Brevoxyl wash, TRIAZ, Brevoxl). Ovace face wash, Plexion Cleanser, Rosanil, Clenia. Mild Soap/ Cleanser (Dove, Purpose, Basis, Cetaphil, Oil of Olay) Obagi Cleanser ( Step 1) and then apply Obagi Toner ( Step2)
2. AM: Apply the following each morning: Cleocin (clindamycin) lotion, clindet pledget (wipe), clindagel Benzoyl peroxide- sold exclusively at The Skin Center (Benzac,Brevoxyl, Triaz), Triaz Pad Klaron Lotion, Metrogel, Metrolotiom Benzaclin, Duac gel spot treatment
3. PM: Please apply the following each evening: (if too irritating, use every other night) Use these all over face- don’t spot treat, but DO avoid crevices like corners of mouth &nose,eyes (All OF THESE MAY BE IRRITATING) Differin gel/cream pledgets to all over face Tazorac every night / only every other night to face, back, chest, arms Benzaclin, Duac gel spot treatment, Finacea gel
4. Take the following pill: (follow the proper directions for all medications) Minocin/ Minocycline/ Dynacin/ Doxycyline/ Adoxa
5. AM or PM: If your skin gets dry, you can use non-comedogenic moisturizers The Skin Center Oil free moisturizer sunscreen or glycolix elite facial moisturizer Cetaphil or Eucerin lotion for face with sunscreen Desowen lotion- once or twice a day ONLY for red itchy rash, dry areas- (don’t use regularly)
6. AM: Use Sunscreens Daily Moisturizing sunscreens like TSC Oil free SPF30 moisturizer sunscreen, TSC sunscreen spray , Physician’s Complex SPF 30 sunscreen with zinc
Gel(non oil) suncreens- Ombrelle, Presun clear gel, solbar liquid, Ti-Screen  Best coverage for greater than 15-30 minute sun exposure Obagi Zinc SPF 30, TSC SPF 30 17% zinc
7. If you wear cosmetics make sure they are oil-free and try to avoid powders. 8. If you have any allergic reaction, stop the medication and call our office. STOP ALL MEDICATIONS IMMEDIATELY IF DECIDE TO BECOME PREGNANT OR THINK YOU MAY BE PREGNANT. 9. Return for a follow up appointment when suggested by your physician 10.Recommend The Skin Center Skin Recovery System (SRS) acne program at follow up including steam, slush, extractions, microdermabrasion and mild glycolic peel, blue light, ALA/ blue light
Call to Schedule an appointment at (949) 582-SKIN Dr. Gary Cole and Dr. Nili Alai are Board-Certified Dermatologists.
For more information, please call (949) 582-7699
Your personalized acne program MAY include: Facials/ Acne Treatments Glycolic Gentle Peels series every 2-4 weeks to begin Medium TCA/Jessner Peel (Blue peel) (1 hour appt )7 days downtime: Face, Neck or Chest Blue light or laser precision peel (15-30 min appt) Acne Extractions Photofacial/ Photo rejuvenation for brown spots, freckles, age spots, red areas, broken vessels, wrinkles- This may include several treatments. (No Downtime with Laser or IPL)
An Overview Acne & Related Inflammatory disorders
Board certified , American Board of Dermatology
Clinical Professor, Department of Dermatology University of California, Irvine ACNE & Inflammatory Disorders Folliculitis Acneiform Dermatitis
Who is Affected?Everyone at some time in their lifeFrom babies to seniors high prevalence Often under treated or self treated Atypical presentations of common disease May lead to permanent scarringControllable
Why Treat Acne? self esteem, confidence, job, social status Untreated may lead to permanent scarring Emphasis in teenagers -classic occurrence
Dispelling Acne MythsAcne is not caused by poor hygiene or dietVigorous washing will not remove comedones and may worsen inflammationTopical therapies should be applied to all potential acne areas, not just to lesions, because they work by preventing the formation of new lesions (they do little to shrink existing lesions)
ACNE TRIAD: What makes acne?Follicular plugging (pores closed) Sebum production ( oil production)
• Acne is disease caused by 4 interrelated processes affecting the pilosebaceous unit – altered follicular hyperkeratinization– sebaceous gland hyperactivity– Propionibacterium acnes (P acnes) proliferation– Inflammation/immune hypersensitivity to
P acnes TRIPLE THERAPY IS KEY! 1. Retinoid (unplugs) 2. Benzoyl peroxide (antibacterial, unplugs,etc) 3. Antibiotics (decrease bacteria)- oral or topical Combine one product out of each category .
Current Treatment Options
Topical  Retinoids Benzoyl Peroxide Antibiotics Azelaic Acid Salicylic Acid Comination treatments Benzoyl Peroxide + Antibiotics Oral Antibiotics Isotretinoin Corticosteroids RETINOIDS Tretinoin (Retin A, Renova, Avita) Tazaratone (Tazorac, Avage)
-Do not use in pregnant, breastfeeding, or trying to become pregnant. -May be irritating, use small amount, avoid around the eyes, apply every other night Severe Acne • Techniques to minimize irritation – gradual introduction of medication; initiate use with low concentration formulations– no scrubbing– adequate moisturization– brief application followed by gentle washingANTIBIOTICS: topical  Clindamycin ( Clindets wipes, or clindagel) Metronidazole ( Metrogel)
ANTIBIOTICS: Oral Antibiotic Resistance• Clindamycin and erythromycin have become less effective topical acne therapies in the past 20 years• Loss of efficacy is due to the acquisition of resistance by P acnes • The addition of BPO dramatically reduces resistance to erythromycin and clindamycinOther Oral Prescriptions Spironolactone ( anti-androgen)
Practical ACNE Review: Top 10 List 1. Benzoyl Peroxide 2. Topical Retinoids 3. Topical Antibiotics 4. Salicyclic acid 5. Glycolic acid 6. Combination topical products (Antibiotics & BP) 7. Oral antibiotics 8. Oral Retinoids 9. Oral Contraceptives 10. Oral Antiandrogens ( Spironolactone) Differential Diagnosis: eczema folliculitus drug reaction rosacea delusions of parasitosis neurotic excoriations furuncluosis hidradenitis suppurativa
Acne if Pregnant or Breastfeeding SAFE: Erythromycin gel oral amoxicillin/ampicillin
NOT SAFE: Retinoids (Retin-A, Differin, Tazorac) Oral Tetracylines
Lasers Different targets based on laser source Some target bacteria, some redness, others collagen usually multiple treatments needed No guarantees Generally cosmetic/ non- insurance
What is Rosacea? Primarily Red Located on Cheeks and Nose more in Caucasians (Scottish, Irish) Inflammatory
How to Treat RosaceaSulfa Wash as directed Metrogel Oral Antibiotics Lasers or Photofacial
Postacne ScarringTreatment options ÚDermal fillers ( collagen) ÚLaser therapy ÚSurgery ( punch removals) ÚFacial peels  Therapy for Postacne ScarringPostacne ScarringThe “ACNE SAMPLER”
In office adjunctive treatment : Ú Glycolic and or salicylic peelsÚ extractions using 30g needle or lancet and comedome extractorÚ slush ( light cryotherpay on swab) SummaryAcne affects many ages from infancy to geriatric“Triple therapy” very effective:
-topical retinoid -topical antibiotic &/or benzoyl peroxide -oral antibioticAccutane for severe, cystic, or refractory acne Acne is a common condition Acne may persist into adulthood in some patients (mostly women)Patients with acne commonly experience both physical and psychologic impairment
Photodynamic Therapy  Ú Uses a photosensitizer compound Ú Apply to skin and leave on for a time Ú Expose skin to controlled amount light Ú Levulan ( part of porphyrin system) Ú Has downtime 2-7 days- red/sunburn Ú Works by oxygen free radical formation 26081 Merit Circle Suite #109
Laguna Hills, CA 92653 (949- 582-7699 (949) 582-SKIN Fax (949) 582-7691 Call to Schedule an appointment at (949) 582-SKIN Dr. Gary Cole and Dr. Nili Alai are Board-Certified Dermatologists.
For more information, please call (949) 582-7699 or visit the practice website at www.lagunaskincenter.com.
Information in this publication and site is not intended to serve as medical advice. Individuals may use the information as a guide to discuss their treatments with their own physicians. This site does not promote nor endorse the unauthorized practice of medicine by non-physicians or state licensed health care providers.
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of these artciles have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert.
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