Hit The Spots

Posted: Monday 17 January 2011 07:51pm

It’s a cruel irony. You leave your troubled teens and 20s only to be confronted by acne through your 30s, 40s and even beyond. As adult skin is drier and more fragile than that of teen sufferers, keeping it clean, hydrated and protected from the sun while fighting spots can be a delicate balancing act.

There are also many misconceptions about the condition, among the most bandied that it’s caused by junk foods and poor hygiene. Click here for the causes and types of adult acne. “Acne is a skin disease and should be treated as such,” says Dr Michael Freeman, dermatologist and laser specialist at The Skin Centre, on Queensland’s Gold Coast.

The first, and arguably most vital step in treating acne is an effetcive home care regime, which may include medication as well as topical products.

If the problem is more serious – as is so often the case – it’s time to investigate drug and clinical treatments. We look at your options for attacking adult acne, including a breakthrough new treatment, Isolaz, that is awaiting approval for use in Australia.

HOME CARE

Shun The Sun

Acne sufferers often find their symptoms worsen in summer, particularly in very hot, humid conditions. And many people mistakenly believe that getting a tan will improve matters.

“Since getting a tan can help hide the discolouration acne can cause, and sun exposure sometimes dries up excess oil, it may look like the sun is helping to clear up the skin,” says Dr Garry Cussell, of Sydney’s Facial Rejuvenation Clinic. “However, both of these benefits are temporary - and once they disappear, acne can flare up and even worsen because of the damage caused by ultraviolet light.”

It goes without saying that acne breakouts are only one side-effect of UV exposure. UV light also creates free radicals which are associated with cancer and ageing in the skin.

Don’t Strip Off

Not cleansing is bad, but over-cleansing is as dire, as you’ll only trigger more oil and exacerbate the problem. “Poor skin care can aggravate – even cause – adult acne,” says Dr Cussell. “People often try to treat acne by `de-oiling’ and `drying’ the skin with products that include harsh soaps, strong scrubs and mass-market medicated (drying) cosmetics.

“This approach to acne can cause intense drying of the skin and provides only short-term benefits.

“While drying out blemishes can make skin appear satisfactory for a few weeks, over-drying can cause oil glands to compensate by working harder, resulting in clogged pores and more breakouts 3 to 4 weeks later.

“In turn, this often causes the user to resort back to drying products, which are causing the problem.”

Look for cleansers specifically designed for acneic skin – products labelled non-comedogenic or oil free, and formulas containing salicylic or glycolic acids (which promote the shedding of skin cells that clog pores).

There are a wide variety available at all price points from department stores, chemists and supermarkets, as well as cosmedical clinics and salons. These cleansers are usually mild, soap-free liquids that are acid and/or pH balanced.

Some products to try: Neutrogena Oil-Free Acne Wash, RRP $13.99; Neutrogena Oil-Free Acne Stress Control Power-Cream Wash $14.99; Dr Lewinn’s Medic Oil Control Foaming Cleanser, $19.95; Avon Clearskin Purifying Astringent Cleanser, $9.99; Cosmedix Purity Clean, $99; Priori Forte Facial Cleanser, $100.

Use tepid water and gently and thoroughly massage the cleanser into the affected areas, and rinse just as thoroughly with tepid water.

More cleansers are recommended by All About Acne, an online resource for sufferers compiled by leading Australian medical and health professionals: www.acne.org.au

More highly moisturising cleansers should generally be avoided, such as those containing high levels of paraffin, mineral or highly fragrant “natural” oils. Avoid vitamin E cream or products with sorbolene.

“For people with mild acne, a cleanser with salicylic acid might be all you need for your everyday control of acne,” says All About Acne. “Remember to speak with a pharmacist or doctor before combining this with any other medicated products (eg, prescription acne products or those containing benzoyl peroxide).”

Acne sufferers in the US have reported significant improvements with their trouble spots after using the sonic cleansing system, Clarisonic, which has systems for both professional and personal use. It was released in Australia late last year. Click here to read more about Clarisonic.

Shed The Load

“Acneic skin produces five times more dead skin cells than other skin conditions, meaning proper exfoliation can have great benefits for acneic skin,” according to leading skin care brand Dermalogica. “Hydroxy acids (chemical exfoliants), in general, will be effective as they help the dead skin cells detach, preventing dead skin cells from clogging the follicle and contributing to acne.”

However, just as with over-zealous cleansing, physical exfoliation – ie. scrubs - may not be suitable for all acneic skins and cause more problems than it attempts to fix. Check with a dermatologist or qualified skin therapist for advice.

Exfoliating two to three times weekly will better enable skin to purge toxins, sebum and bacteria, but watch your product choices.

“Avoid harsh scrubs,” advises Dee Davies, of The Clear Skin Clinic, in Sydney’s Double Bay. “You’ll remove the protective layer of skin and trigger more blemishes. Choose a glycolic formula, enzyme-based product or one with small, smooth granules that won’t scrub the heads off blemishes or damage skin.”

Some products to try: Avon Clearskin Correct and Fade Peel, RRP $12.99; Neutrogena Oil-Free Acne Stress Control Power-Clear Scrub, $14.99; Cosmedix Pure Enzymes Exfoliating Mask, $133.10; MD Formulations Face and Body Scrub, $95 and Clinique Anti-Blemish Solutions Clarifying Lotion, $42.

Mask The Problem

“Use weekly masks to draw impurities and clarify skin,” advises Dee Davies. “They should also address excess oil without stripping skin of moisture. Your skin should never feel tight” Initially, a mask might seem to intensify blemishes, but this is congestion being drawn from the skin.

Some to try: Dermalogica Sebum Clearing Mask, RRP $63.50; Neutrogena Deep Clean Invigorating Cleanser mask, $13.99; Clinique Anti-Blemish Solutions Oil Control Cleansing Mask, $52; MD Formulations Vit A Plus Clearing Complex, $160 and Results RX Acne Mask, $275.

Keep It Moist

“Skipping the moisturiser will only intensify the problem,” warns Dee Davies. “Don’t do it! Instead, choose a balancing moisturiser that will hydrate without leaving skin oily or congested.”

Some products to try: Ultraceuticals Ultra Hydrating Gel, RRP $75; MD Formulations Moisture Defense Antioxidant Hydrating Gel, $115; Clinique Anti-Blemish Solutions Clearing Moisturizer, $39; Dr Le Winn’s Medic Oil Control Day Fluid, $29.95 and Cosmedix Phytoclear Clarifying Moisturizer, $157.30.

Remember to be patient and diligent with skin care. It takes up to four weeks to deliver noticeable results (in line with skin’s natural renewal cycles).

On The Spot

Although facial cleansers are useful in preventing outbreaks, spot treatments are effective when pimples have already formed.

These often come in the form of a gel or cream, and the active ingredients usually have stronger concentrations than those found in facial cleansers.

Ingredients such as benzoyl peroxide can help reduce oil and dead skin cells from pores while killing the bacteria that cause inflammation. Treatment products containing bacteria-busting tea tree, sulphur, zinc oxide, or salicylic acid can help calm and heal blemishes.

Some products to try: Dermalogica Medibac Concealing Spot Treatment, RRP $49.50; Jan Marini Bioglycolic Acne Gel, $69; Ultraceuticals Ultra Clear Treatment gel, $60; Neutrogena Rapid Clear 2-in-1 Fight and Fade Spot Gel, $16.99; Dr  Le Winn’s Medic Spot Clear Gel, $19.95; ASAP Clearskin Gel, $29 and Avon Clearskin Invisible Blemish Corrector, $9.99.

Don’t Touch!

Never squeeze blemishes. “If you have medium to dark skin, you risk triggering melanocytes,” explains Dee Davies, “and will be left with brown-pigmented scar. Pale skins risk bursting blood vessels, which results in red star-like clusters on the skin. All skin tones risk crater-like pockmarks.”

Makeup Mayhem

Improper use of makeup is a major contributor, starting with dirty make-up brushes. “Brushes should be cleaned daily,” says Dee Davies. “Never use sponges as they harbour bacteria.” Try: Make-Up Store Brush Cleaning Fluid, RRP $18, or clean brushes with an anti-bacterial handwash or gentle shampoo.

Foundations with high oil content can make acne worse. “Mineral make-up is best,” explains Davies. “It won’t clog your skin, and because it has high zinc content, it is very healing.” Some products to try: Jane Iredale Liquid Minerals, RRP $86; bareMinerals Loose Foundation SPF15, $79.

Hint: “Never reapply makeup over makeup,” advises Davies. “You’re simply pushing old makeup and bacteria into your skin. Keep cleansing wipes in your bag and remove old makeup before touching up.”

A-Plus

Vitamin A is renowned for relieving acne, thanks to its specific skin renewal actions. “Look for it as retinyl palmitate or retinyl acetate in skin care,” says Dee Davies. “It normalises skin, teaching it to behave in a balanced way.”

Some products to try: Aspect Retinol Brulee Serum, RRP$114.40; Ultraceuticals Ultra Clear Treatment gel, $60 and MD Formulations Vit A Plus Clearing Complex, $180.

When vitamin A-packed skincare isn’t enough, a dermatologist can prescribe either a topical retinoid (vitamin A derivative) that keeps pores open and prevents inflammation, or a product that combines benzoyl peroxide with an antibiotic.

“Retinoid creams and gels topically have proven to be very effective at suppressing mild to moderate acne while waiting for the natural ‘growing out’ of pimples,” says All About Acne. “At the beginning of treatment, to obtain faster acne improvement and control, they are often combined with an antibiotic.

“This combination reduces levels of acne-causing bacteria and directly reduces inflammation. It also helps prevent problems with irritation which can affect 10-20 per cent of people when they begin using topical retinoid treatments.

“Retinoid creams and gels are adapalene (Differin®), tretinoin (Stieva A®, Retin A®, Re Trieve®), isotretinoin (Isotrex®) and tazarotene (Zorac®). There is also a combination product (Epiduo® gel) that combines adapalene and benzoyl peroxide.”

Vitamin A can be prescribed as an oral treatment in the form of Roaccutane (see below).

DRUG TREATMENTS

In women, hormonal treatment in the form of the oral contraceptive pill – Dr Michael Freeman suggests as an example the anti-androgen pill Diane – can be combined with an antibiotic and/or a topical retinoid to help provide better longer term acne control in moderate sufferers.

As a last resort, for all people with very severe, widespread and deeply scarring acne, Roaccutane may be prescribed.

“The medical term for Roaccutane is isotretinoin and it is the only known cure for acne,” says Dr Michael Freeman. “It is essentially a substance that is similar to Vitamin A, but has a very different action.

“In short, Roaccutane works by reducing the oily substances in your skin, caused by oil producing glands. In turn, this reduces the amount of bacteria in the skin which is the cause of the inflammation and pus associated with acne. Roaccutane has also been shown to have an anti-inflammatory effect on the skin.”

The average course of treatment last 5-6 months and in more than 80 per cent of cases acne will be completely cleared if instructions are strictly followed. Roaccutane is prescribed only under strict medical supervision, one notable reason being that it causes birth defects.

“Under absolutely no circumstances should Roaccutane be used by pregnant women or by women who intend to become pregnant - during treatment and for one month after stopping Roaccutane therapy,” says Dr Freeman.

“All possibility of pregnancy must be ruled out one month before and after you start your Roaccutane treatment. This should include the strict birth control methods.”

The most common and expected side effects are cracked lips and dryness of the skin, says Dr Freeman. “The healing process of Roaccutane dries up the oily glands in your face,” he says. “Consequently this will make your face drier and more fragile than normal during your course of Roaccutane.

“When you experience dryness on any part of the body, there is no need to panic. This merely proves that your treatment is working.”

These side effects are usually temporary and will reverse once treatment has finished. There are other, less common side effects. Discuss these with your doctor before embarking on Roaccutane.

CLINIC AND SALON TREATMENTS

When adult acne has been properly diagnosed and a good home treatment program is in place (which may include medication), clinic and salon treatments can significantly assist in the skin’s fightback against acne.

Advances in clinical treatments also mean that acne scars and discolouration can be drastically reduced, often reversed, when in previous generations they could remain as lifelong legacies of the condition. Click here for more information about reducing and reversing acne scarring and discolouration.

Some treatment options to consider:

Medi-peels

Beauty salons and cosmedical clinics around the country offer varying forms of acid or enzyme peels, usually as a series of treatments, that can be beneficial in helping clear active acne and preventing further outbreaks. Click here for some options.

Photo Dynamic Therapy

PDT is a treatment involving the application of ALA (aminolevulinic acid) which is then activated by a blue- or red- coloured LED light source. “Once the skin is under good control, PDT is very effective for reducing the number of sebaceous glands in the skin [where the acne forms] with longterm benefits,” says Dr Joseph Ajaka, Medical Director of Cosmos Cosmetic Medicine Clinic, in Sydney’s Double Bay.

PDT mimics the natural process of the sun’s reaction on the skin. ALA is the body’s own “suicide bomb”, according to Dr Ajaka, and increases in the sebaceous glands in response to solar exposure, killing them (and the bacteria within).

It works threefold:

• Destruction of the sebaceous glands – blockage of these glands is primarily responsible for causing acne to form.

• The destruction of P. acnes, the bacteria that triggers acne.

• As a bonus patients notice improved skin texture and tone. It also reduces pigmentation, broken capillaries and fines lines.

However, this should not encourage acne sufferers to take a “shortcut” and just lie in the sun instead. “The sun pro-ages you, and leads to lines, wrinkles and other damage,” adds Dr Ajaka. “PDT is not harmful.”

Frequency of treatments depends on the severity of the condition.

Blue Light Therapy

A non-laser, non-UV light therapy that penetrates deep into the acne cysts to destroy the acne-causing bacteria, BLT is recommended for mild to moderate acne/inflammation and is particularly beneficial when used to treat acne in its early stages, according to Dr Garry Cussell. It is effective on all skin types and on any area of the body.

“The blue-violet beam of light targets the exact layers of sebaceous glands where most acne bacteria reside. It causes the oxidisation of certain chemicals (porphyrins) within the acne bacteria, breaking down their cell walls,” he says.

“It can be combined with ALA, which is applied to the skin before the light therapy to increase the photosensitivity of the bacteria.”

Patients lie under a lamp that emits a blue-violet beam of light for short sessions, wearing special goggles to shield the eyes. Initially two sessions are required per week for four weeks.

Afterwards there may be temporary pigment changes, slight swelling of the treated areas as well as some skin dryness. Skin becomes more sensitive to sunlight for about 48 hours.

After four weeks patients should see mild to significant improvement in their acne. Maintenance sessions may be needed.

Chemical Skin Peels

These resurface the skin to treat skin blemishes such as sun damage, wrinkles, uneven pigmentation, acne and acne scarring, says Dr Deborah Davis, of Sydney’s Heber Davis clinic.

“They exfoliate the outer layers of dead skin to reveal the more beautiful, fresher skin beneath which has improved tone, smoother texture, and more even colour. Chemical peels can be light, medium (TCA) or heavy, depending on your skin type and concern. Light chemical peels are usually performed repetitively over a course of treatments, whilst medium or heavy chemical peels are usually a one-off.”

Adds Dr Garry Cussell: “Chemical peels work on the damaged outer layers of skin with a mild acidic solution. The treatment is believed to remove dead skin cells, clear up blocked pores and boost growth of new skin cells. However, the ability of chemical peels alone to decrease acne has not been proven. They are often used in combination with a topical cream to increase their effectiveness.”

Ballpark cost of light to medium peels: $100-$500.

Microdermabrasion

A non-invasive skin resurfacing treatment, microdermabrasion rejuvenates the skin on the face, neck or arms with virtually no downtime, according to Dr Deborah Davis. “It deeply exfoliates the skin’s ageing, damaged, outermost layers to reduce imperfections and sun damage, blemishes, fine lines and uneven pigmentation.

“While aged, dull surface skin sheds naturally in the young, as we age this process slows, allowing a layer of dull, thickened skin to accumulate and to obscure the healthy radiant skin below.

“Microdermabrasion can reduce mild acne scarring and blotchy pigmentation, and can improve the appearance of poorly textured skin, fine lines, and large or clogged pores. The procedure is considered effective for both dark- and light-skinned patients.”

Ballpark cost: $150 per treatment, or course of 5 treatments $550.

The Light Fantastic

OMNILUX™ was developed in the UK after 12 years’ medical research, based on using a narrow band of light delivered through Light Emitting Diodes (LEDs). When the body is exposed to light, these receptors absorb the light waves and kick-start a cellular response.

Different wavelengths of light will stimulate different cellular responses within the cell, according to True Solutions, Australian distributors of OMNILUX and premium brands of cosmeceutical skincare. OMNILUX blue™, which delivers Blue Light therapy, has proven to be an ally in the fight against acne. It stimulates anti-bacterial and anti-inflammatory activity in the deeper layers of the skin, working to stabilise sebum production and treat acne.

When OMNILUX revive™ and OMNILUX blue™ are used in combination therapy the benefits for the skin are combined, in that you can treat the acne with the Blue Light and the redness, inflammation and acne scarring with the Red Light.

There are a number of home, handheld light devices which can also assist your acne home care regimen, although obviously these are not as powerful as those systems used in clinics. Click here to read more about DIY light devices.

Fractionated Lasers

Under brand names like Fraxel and Cutera, this laser technology is the skin rejuvenation and correction breakthrough of the last decade and works to reverse the scarring and other skin damage caused by acne.

Instead of treating the whole skin surface they treat a polkadot pattern of small treatment zones - a “fraction” of the skin surface. But in that fraction it treats more deeply in the skin in very narrow columns.

By treating only a fraction of the top surface of the skin, it leaves the rest, and especially the epidermis on top, uninjured so it can heal very quickly and very well over these narrow treatment zones. By doing this it is possible to achieve the benefits of a deeper treatment but with minimal downtime and fast recovery of only a few days.

“Fraxel [re:store 1550nm]will destroy oil glands, get rid of acne and bumps and help smooth skin texture that has been affected by acne,” says cosmetic laser physician Dr Jack Ting, of the Laser Cosmetic Day Procedure Centre in Coogee, Sydney.

“Treatments such as this need to be done by a highly experienced operator, such as a trained doctor or nurse, combined with a high quality laser platform,” says David Segal, author of  Skin, The Essential Australian Guide.

“Do your homework and do not settle for anything sub-standard, as inappropriate or poor treatments can make the situation worse.”

ON THE HORIZON

Awaiting approval for use in Australia is the Isolaz, a photo pneumatic (light and suction) therapy from Solta Medical, the purveyors of Fraxel laser and Thermage skin tightening technologies.

Dr Vic Narurkar, a prominent cosmetic dermatologist from San Francisco, addressed a medical conference in Sydney late last year on the system.

“I was the first physician in the world to use the Isolaz and conducted the pivotal 510K FDA studies for its initial clearance [in the US] in 2004,” he said.

“The discovery for its use for acne came when we were doing trials for hair reduction. During the time where the patients had to stop the treatments, they suffered flare-ups of their acne.  This led us to doing FDA [US Food and Drug Administration] trials for acne and it is the first device cleared for all types of acne – comedonal, papular and pustular.

“The Isolaz is very effective for moderate acne and it offers the advantage of being painless and with minimal recovery time. The number of treatments range from 3 to 5 sessions spaced 2 to 4 weeks apart. For more severe acne we perform the treatments sooner.

“In layman’s terms, the mechanism which is called photo pneumatic therapy stands for light (photo) and suction (pneumatic).  The suction or light vacuum ejects the congested sebum from the pores and allows for pore cleansing.

“Then a low energy blue/green light is delivered which is destructive of the propionobacterium acne.  After that, profusion is done with an acne medication which further enhances the effect.  Patients love the pore cleansing effects as well as the reduction of acne.

“We use the Isolaz for patients who have failed conventional acne treatments, patients who have failed systemic treatments, patients who do not want to take oral medications, patients who are trying to get pregnant or are breast-feeding, as well as patients with moderate acne who have never been treated with any acne regimen.

“It works best in conjunction with a topical regimen, as acne is a fluid condition.  Also the Isolaz helps with some of the aesthetic appearance-related issues of acne such as post inflammatory hyperpigmentation and redness of shallow acne scars.”

by Jenni Gilbert

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