Introduction:
The disease of acne is characterized by a great variety of clinical leions. Aljthough one type of lesion may be predominant (typically the comedo), close oservation usually reveals the presence of several types of lesions (comedones, pustules, papules, and/or nodules). The lesions can be either noninflammatory or, more typically, iflammatory. (US 2004/0156873A1 to Gupta and assigned to Bioderm Research).
Definitions:
A comedone is a plugged hair follicle (skin pore) caused by a buildup of sebum (skin oil), dead cells (keratin) and sometimes bacteria.
Treatment: Most acne treatments are directed at preventing inflammatory lesionsk particulalry the larger nodul-cystic lesions that end to be destructive and lead to permanent scarring. In general, visible comdeones are the only minor cosmetic nuisances and do not lead to inflammatory lesions. Most acne treatment is directed to four areas: (1) Keratinous plugs in sebasceous ducts; (2) large sebaceous glands producing exess sebum; (3) increased numbers of resident follicular bacteria; and (4) inflammatory response to chemical mediators passing through the follicular wall. (US 2004/0156873A1 to Gupta and assigned to Bioderm Research).
–Antiobiotics: A number of topical and systemic agents are used to lower the number of bacterial that colonize the follicular duct. These include benzoyl peroxide (BP, BP 5% erythromycin 3% (Benzamycin). Systemic antiotics inclduetetracycline and its analogs, which are used in low doses for years or until the end of the acne prone years. A comedone is a plugged hair follicle (skin pore) caused by a buildup o
–Retinoids: The treatment of acne centers on operning the pore, kiilling P. acnes, reducing sebum produciton and regualting inflammatory resposnes. Retinoids are the agents to reduce sebum production and open the por. As a topical agent, Differin (adapalene) or Retin-A (tretinoin) is used for mild and moderate acne. A comedone is a plugged hair follicle (skin pore) caused by a buildup o
—-Tretinoin: Topical products used to remove comedones are known as comedolytics, the most effective being tretinoin, marketed as a prescription porduct (RetinA). Tretinoin or all-trans retinoic acid is the naturally corruing metabolite of Vitamin A. Tretinoin increases epidermal cell turnover, thus causing comedolysis and most importantly prevetns the promation of new keratenous plugs. Applications of retinoin are normally once a day at bedtime. Improvement is usually not seen for 6-8 weeks. Adapalene 0.1% (Differin) is a topical retinoid like tretinoin. Avaialbe by presecription only, the gel is usually applied once nightlhy. (US 2004/0156873A1 to Gupta and assigned to Bioderm Research).
Acne vulgaris:
afficts more than 50 million pople in the US. P. acnes, a gram-positive bacterium, is strongly associated with acne vulgaris. The inflammatory stage of acne vulgaris is the greatest concern to patients, as the lesions produced may lead to scarring.
1. Treatment: Systemic therapies for acne target P. acnes using antibiotics or target the follicle with retinoids such as isotretinoin.
a. Systemic antibotic treatments have limitations in that they may kill skin bacterial non-specifically impacting the homeostasis of resident dermal microflora. Oral antibiotics also contain the risk of harming intestinal microflora.
b. Istretinoin, 13-cis-retinoic acid, is a vitamin A-derived retinoid that has been widely prescribed for systemic treatment of severe acne. Although it was first approved in the US in 1982 for treating severe acne, it suse has become tighly regulated.
c. Sialidase inhibitors: Adherence of P. acnes to human sebocytes has been shown to be augmented after removal of sialic acids form the cell surface and that acne progression and recurrence can be effectively prevented by antibodies against sialidase of P. acnes.
Acne Scares:
CO2-Skin Resurfacing:
Sublative™ fractionated bi-polar radio frequency technology places the heat energy effectively into the upper dermis where it can produce a significant increase in both collagen and elastin with minimal epidermal disruption.syneron-and Candela