Figure.Multiple open comedones in two patients with papular and cystic acne vulgaris. Note the acne scarring. (Photo, Courtsey of Dr. A. Shalita).

Our Dermatologists at Texas Institute of Dermatology are well known for successfull treatment of Acne. We at the Institute offer FDA-approved prescribed medications combined with our unique  Acne Micro-AFT laser method.

What causes Acne?

Shedding dead cells and oil production of skin can be disrupted by the sex hormones, that change throughout your life. The acne is a result of excess oil and dead skin cells that plug the pore of a hair follicle. Behind the plugged pore, bacteria (called P. Acne) grow and multiply, triggering inflammation and swelling. Scars can develop, if you touch the acne blemish.

Acne vulgaris and acne rosacea are common disorders of the pilosebaceous units, which consist of sebaceous glands and their associated hair follicles. The most common anatomic sites of involvement are those that have the largest and greatest density of sebaceous glands: the face, neck, upper chest and back and upper arms.

Fig. A patient with closed comedons.

Acne vulgaris is a common disorder that peaks in incidence around the time of puberty. The pathogenesis of acne vulgaris is multifactorial. Abnormal keratinization in the upper canal of the hair follicle causes formation of hyperkeratotic, adherent plugs that are derived from desquamated epithelial cells, resulting in comedones (appearing clinically as whiteheads and blackheads), the noninflammatory lesions of acne vulgaris. Androgens stimulate the secretion of lipid-rich sebum from the sebaceous glands; sebum, in turn, provides a growth substrate for the commensal Propionibacterium acnes, an anaerobic diphtheroid. Proliferation of P. acnes is particularly facilitated by the anaerobic environment of the follicles that are plugged by comedones. This result in the production of proinflammatory mediators that are largely responsible for the appearance of the inflammatory lesions of acne vulgaris: papules, pustules, and nodules.

Treatments for acne vulgaris target one or more of its pathogenetic factors. Topical agents alone may be used for mild cases of acne, whereas systemic agents are generally reserved for patients with moderate to severe involvement. Comedolytic agents act primarily against comedones and include tretinoin and adapalene, both of which are available only as topical preparations. By diminishing the growth of P. acnes, antibiotics and antibacterials, available in various topical and systemic preparations.

Tips:

• Use a soap-free cleanser several times a day to gently remove oil, dirt, and dead skin cells.
• There are all kinds of great reasons to eat a healthy diet, including getting rid of your acne.
• It takes three weeks for a pimple to break out, which means that spot treatments are not helpful in treating the root causes of your breakout and will not prevent future breakouts.
• Many sunscreens \ make acne worse by clogging pores. Look for oil-free sunscreen labeled non-comedogenic—which means it’s proven to not block pores.

Rosacea

Rosacea is an inflammatory disorder of uncertain etiology that most commonly affects adults of northern European ancestry, between 30 and 50 years of age. The earliest manifestation of this disease can be recurrent episodes of flushing and blushing, often triggered by stimuli such as ingestion of hot beverages, spicy foods, and ethanol or exposure to ultraviolet radiation.
Clinical findings in the fully developed eruption include papules, pustules, erythema, and telangiectasias. The central face, including the nose, forehead, chin and cheeks, is involved predominantly.
Chronic inflammation may lead to permanent enlargement (phyma) of the affected areas due to sebaceous gland and soft tissue hypertrophy; rhinophyma(“W. C. Fields nose”) refers to enlargement of the nose. Involvement of the eye may lead to conjunctivitis and/or blepharitis. Rosacea may clinically resemble acne vulgaris; however, in contrast to acne, comedones are absent.
Treatments of mild rosacea include topical metronidazole gel, lotion or cream, or a combination of sodium sulfacetamide and sulfur. In moderate to severe cases, oral antibiotics, of which the tetracyclines are the most widely used, may be added. Isotretinoin may be used in severe, recalcitrant cases.

We, at Texas Institute of Dermatology, offer  several lasers such as a new AFT laser technology that significantly reduces the redness and inflammation, and  laser spectra peel that targets pilosebaceous units (the root cause of acne).

 For laser spectra peel, we first apply a thin layer of carbon particles, then allow 15 minutes for the their absorption through skin pores. The laser hits the carbon partciles and provide an effective thermal effect to the deep parts of skin where the pilosebaceous units reside.

Acne scarring can be treated with our state-of-the art fractional C02 laser.