Dermatological Treatments
Acne
Information on Acne
Acne is a chronic problem that usually occurs during adolescence, while its severity varies. However, it may occur at any age, even after the age of 40, where we have adult acne. It appears mainly on the face, upper chest and back. It causes heavy psychological burden, both in young people and adults, and tends to recur. Acne is due to sebaceous gland overheating, leading to increased sebum production, and to the propionic bacteria of the acne causing local inflammation.

Which Are the Basic Acne Types?
The truth is that acne is difficult to heal completely, but this also depends on the type of acne. The basic types of acne are:
 
  • Infant acne: Infant acne is a common condition that occurs a few days or within the first few weeks after birth and may be related to up to 20% of infants. It mainly affects boys and is characterized by transient papules and pustules on the face, which are usually resolved spontaneously within a few days or weeks. The causes of neonatal and infant acne are not clear. There may or may not be a family history. Neonatal disease is thought to be related either to the stimulation of sebaceous glands by maternal androgens or to the transient production of androgens by adrenal glands and gonads.
  • Acne vulgaris: It is the acne that affects almost 90% of adolescents, showing maximum activity between 15 and 18 years, and then declines. It mainly appears on the face, back, and chest and, if not accompanied by any other illness, is considered a completely normal situation that is often ignored.
  • Post-adolescent acne: It concerns women aged 30 to 40 who have never had acne problems during their puberty, but at this age have pimples mainly on their chin and jaw. This type of acne shows a flare a few days before menstruation, while it is associated with hormonal disorders, such as polycystic ovary syndrome.
  • Comedonal acne: It is characterized by the presence of comedones, which may either be "open" (black keratin spots consisting of sebum, keratin, hair segment and sebaceous gland remnants), or "closed" (small white keratin spots). It is the mildest form of acne, without inflammation on the skin
  • Papule acne: It occurs with the appearance of papules or pustules usually accompanied by pus. It is a moderate form, and there is a slight inflammation on the skin, suggesting an increase in infection.
  • Pustule acne: It is characterized by more papules and pustules inside under the skin that have pain. Inflammation is greater, and affects more parts than the face, such as the back and other parts of the body. If not treated in good time, it is in danger of becoming cystic.
  • Cystic acne: It occurs with the appearance of cysts, which are pimples larger in size than nodules and are mainly found on the face (forehead and around the mouth), back and chest. It is the most severe and painful form of acne. If not treated properly, it leaves scars. Inflammation is mainly due to a microbe, the propionibacterium of acne.
  • Rosacea: It grows mainly in adults from 30 to 50 years of age, and women often associated with menopause, but the most severe cases are experienced by men. This inflammatory dermatopathy does not depend on the type of skin, and can initially appear just as temporary redness in some parts of the face such as the cheeks, nose, forehead or chin. When it gets worse, the nose swells as there is excess tissue. The capillaries of the face are sensitive, and often break.

Adult Acne
Adult acne has been an increasingly common phenomenon in recent decades. Among adults, acne occurs more frequently in women. But there is also a significant number of men suffering from acne during adulthood. Although in most cases adult acne is mild to moderate, there is high probability of causing significant negative psychological, social and emotional effects. It has also been shown to be associated with greater problems on the quality of life of the patient. Besides hormonal and hereditary, other important factors that burden the adult body and can lead to adult acne feature the use of oily cosmetics, smoking, anxiety, poor nutrition as well as the use of some drugs such as antidepressants.

Acne: How Is It Affected by Your Diet?
"We are what we eat!", and in the case of acne it seems to be very much the case. In addition to hereditary and hormonal factors, it has been observed in many studies that changing dietary habits to the worst contributes to the increase of acne.
According to research, everything is based on blood insulin levels, which, if disturbed, favor the presence of acne. This is why it is recommended for people with acne to avoid foods that raise glycemic index of blood, insulin, such as carbohydrates and sugar. Finally, dairy businesses have also begun being the ones to blame for increasing acne. 

How to Treat Acne?
The most widely used treatment against acne is topical treatment using: 
  • Topical retinoids such as tretinoin. They reduce the number of pimples and inhibit the development of new lesions. In addition, they have significant antiinflammatory activity, inhibiting leukocyte activity, releasing proinflammatory cytokines and other mediators involved in immunomodulation. Retinoids are particularly irritating and therefore it is recommended to use them during the night. Irritability can be reduced through the initial use of retinoids every other night or through the simultaneous use of a moisturising product. They are also particularly useful for dark skin patients, as they may reduce the degree of post-inflammatory hyperpigmentation.
  • Benzene peroxide. Treatment is usually applied once or twice a day. Benzene peroxide can cause skin irritation and scaling. Irritability will also be reduced by reducing the frequency of application once a day or every other day. Allergic contact dermatitis rarely develops, which is evident due to pruritus and not due to a tingling or burning sensation.
  • Topical antibacterials, such as clindamycin and erythromycin. Generally, they are well tolerated and effective in mild to moderate inflammatory acne. However, the use of these topical antibiotics alone is not recommended due to the increasing resistance to antibiotics. Concomitant use of a topical retinoid will speed up the response and allow a faster discontinuation of the antibiotic.
  • Sulfur, salicylic acid and resorcinol. Sulfacetamide-sulfur combination products have a moderate degree of efficacy in both acne and rosacea. The use of these formulations should be avoided in patients with known hypersensitivity to sulphonamides.
  • Azelaic acid. It is a dicarboxylic acid that does not involve many undesirable reactions and has some efficacy for both inflammatory and comedonal acne.
For moderate to severe acne it is often recommended to use oral antibiotics as contraceptives. The most common ones are:
  • Tetracycline: It is the safest and most affordable option and offers a positive response to many patients. It is usually given at an initial dose between 250 and 500 mg 1 to 4 times a day, with gradual dose reduction depending on the clinical response.
  • Doxycycline: The usual dose is 50 - 100 mg once or twice daily, depending on the severity of the problem. This type of tetracycline is not rarely the occurrence of photosensitivity reactions, which may be quite dramatic. The advantage of this option is that the anti-inflammatory effect is used without antibiotic resistance due to the low dose.
  • Minocycline: Minocycline is the most effective oral antibiotic to treat acne vulgaris, ideal for those who are resistant to tetracyclines. Absorption is less affected by milk and food than tetracycline absorption. Various side effects such as vertigo and pigmentation in areas with inflammation may occur.
  • Hormonal therapy or contraceptive pills: This treatment refers to women with normal laboratory test results that usually respond well to hormone therapy for acne, if they can receive oral medication. The specific agents (spironolactone, dexamethasone, prednisone) function preventing both adrenal androgens and ovarian androgens. Contraceptives increase the chance of thrombosis, and smoking is forbidden during treatment. It should be noted that contraceptive treatment aims at acne itself rather than the scars of acne.
Best Acne Treatments
At Dermatology & Cosmetics Lab we use special, sophisticated treatments for acne that come to replace or complement traditional treatments with creams and pills.
  • Fractional Laser: Acne pimples and scars accept the powerful effect of Fractional Laser that helps fibroblasts activate collagen production by fighting inflammation, scarring and discolouration of acne.
  • Chemical peeling: Chemical peeling that creates a controlled "burn" to remove the outer layer of the epidermis and help in its regeneration,
  • Deep Cleansing Treatment: It is the most popular and popular anti-acne treatment that removes the mouthfeel and significantly reduces sebum and pimples.
  • Autologous PRP therapy: PRP alone or in combination with Fractional Laser reduces acne pimples and heals tissues thanks to its antimicrobial action.
  • Photodynamic therapy: Photodynamic therapy involves the activation of a chromophore (a substance that absorbs light) to produce monomeric oxygen. This oxygen molecule is toxic and kills the cells. The light used in photodynamic therapy irradiates the substances that produce the bacterium of the acne at a specific wavelength, causing the bacterium to produce internally the above toxic oxygen molecule. This causes the "suicide" of the bacterium. The bacteria are eliminated, the inflammation decreases, and due to the increase in collagen and elastin that the light causes, the skin remains elastic, shiny and smooth.
How Is Topical Acne Treated? 

The most widespread acne treatment is topical treatment with:
  • Local retinoids such as tretinoin. They reduce the number of pimples and inhibit the development of new lesions. In addition, they have significant anti-inflammatory activity, inhibiting leukocyte activity, releasing pro-inflammatory cytokines and other mediators involved in immunomodulation.
  • Retinoids are particularly irritating and therefore it is recommended to use them during the night. Irritability can be reduced through the initial use of retinoids every other night or through the simultaneous use of a moisturizing product. They are also particularly useful in dark skin patients, as they may reduce the degree of post-inflammatory hyper-pigmentation.
  • Benzene peroxide. Treatment is usually applied once or twice a day. Benzene peroxide can cause skin irritation and scaling. Irritability will also be reduced by reducing the frequency of application once a day or every other day. Allergic contact dermatitis rarely develops, which is evident due to pruritus and not due to stuttering or burning sensation.
  • Topical antibacterials. such as clindamycin and erythromycin. Generally, they are well tolerated and effective in mild to moderate inflammatory acne. However, the use of these topical antibiotics alone is not recommended due to the increasing resistance to antibiotics. . Concomitant use of a topical retinoid will accelerate the response and allow a faster discontinuation of the antibiotic.
  • Sulfur, salicylic acid and resorcinol. Sulfacetamide-sulfur combination products have a moderate degree of efficacy in both acne and rosacea. The use of these formulations should be avoided in patients with known hypersensitivity to sulphonamides.
  • Azelaic acid. It is a dicarboxylic acid that does not involve many undesirable reactions and has some efficacy for both inflammatory and comedonal acne.

What Is Systemic Acne Treatment? 
In cases where acne is not treated effectively with topical treatment, it may require systemic treatment to deal with it. For moderate to severe acne, it is often recommended to use oral antibiotics as contraceptives. The most common ones are:
  • Tetracycline: It is the safest and most affordable option that offers a positive response to many patients. It is usually administered at an initial dose between 250 and 500 mg 1 to 4 times a day, with gradual dose reduction depending on the clinical response.
  • Doxycycline: The usual dose is 50 - 100 mg once or twice daily, depending on the severity of the disease. This type of tetracycline is not rarely the occurrence of photo-sensitivity reactions, which may be quite dramatic. The advantage of this option is that the anti-inflammatory effect is used without antibiotic resistance due to the low dose.
  • Minocycline: Minocycline is the most effective oral antibiotic for treating common acne, ideal for those who are resistant to tetracyclines. Absorption is less affected by milk and food than tetracycline absorption. Various side effects such as vertigo and pigmentation in areas with inflammation may occur.
  • Hormonal therapy or contraceptive pills: This treatment refers to women with normal laboratory test results that usually respond well to hormone therapy for acne, if they can receive oral medication. The specific agents (spironolactone, dexamethasone, prednisone) block both adrenal and ovarian androgens. Contraceptives increase the chance of thrombosis, and smoking is forbidden during treatment. It should be noted that contraceptive treatment refers to acne itself rather than the scars of acne.
What Is Photodynamic Acne Treatment?
Photodynamic acne treatment involves the activation of a chromophore (a substance that absorbs light) to produce monomeric oxygen. This oxygen molecule is toxic and kills cells. The light used in photodynamic treatment irradiates the substances that produce the acne bacterium at a specific wavelength, causing it to produce internally the above toxic oxygen molecule. This causes the "suicide" of the bacterium. Bacteria are eliminated, inflammation decreases, and due to the increase in collagen and elastin that the light causes, the skin remains elastic, shiny and smooth.

The light used by photodynamic therapy is clear, free of UV radiation at a specific wavelength that targets the bacterium of P. acnes. There are two types of light used in photodynamic treatment, blue light, which is bactericidal, and red light that stimulates fibroblasts to increase collagen and elastin production, reduces oiliness and scars. Depending on the type of acne, it is recommended to switch between the two types of light per session.
The main benefits of this treatment are absolute safety and quick and satisfactory results as photodynamic treatment encounters the multi-factorial problem of acne at various levels. Another important advantage is that after the treatment, the skin remains hydrated and elastic, contrary to conventional methods that usually dry the skin.
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