General Dermatology Acne Therapy

Acne is a genetic, hormonal, and inflammatory disease characterized by overproduction of oil by the sebaceous glands, plugging of the sebaceous glands to form micro- and macro- comedones (blackheads) and, finally, action of skin bacteria on oil trapped underneath the skin, to produce red inflammatory cystic lesions.

Traditional therapies for acne include:

• Keralytic agent which thin the top layer of skin and unplug the oil glands. Topical retinoids fall into this category
• Topical antiseptics and antibiotics which diminish the numbers of bacteria in the skin
• Oral antibiotics which similarly diminish the bacteria, and reduce inflammation
• More severe cases of acne can be treated with isotretinoin (formerly known as Accutane), which is a systemic retinoid.

All of these treatments have benefits for different types of acne, and are still the mainstay and starting point for most cases. Drs. Elliott and Edhegard work with patients to choose the most effective and tolerable regimen based on each person’s skin type, prior treatments, and types of acne.

There has been some interest and some research in photodynamic therapy (PDT) of acne. The first step of PDT is in-office application of a topical medication to the affected skin. After a period of time (usually 1-3 hours), the drug is then washed off and the skin is exposed to particular wavelengths of light. The applied medication is photo-activated, resulting in the release of singlet oxygen molecules, which contribute to the killing P.acnes, the bacterial culprit in acne. The light also seems to cause involution of the sebaceous glands. The treatment is repeated weekly for several consecutive weeks.

What other conditions can be treated with PDT?

Photodynamic therapy has been effective in the treatment of actinic keratosis (pre-cancerous spots), sundamaged skin, acne, warts, and many other diseases.

Is PDT uncomfortable?

During PDT the skin is washed several times and the activated substance is applied. Either of these may cause stinging. Most people experience mild burning or itching for about one hour after the procedure, although this can last a day or two. Mild to moderate redness may also be experienced for 24 to 48 hours. After PDT, a small amount of activated substance remains in the skin for 24 to 48 hours. Sunlight and even indoor light may affect this and cause redness and itching. Use of sunscreen and a hat may diminish the undesired. Swelling (especially around the eyes) and peeling of treated skin may occur.