ACNE / PIMPLES:Have an acne prone skin? Let not the acne steal away your look. These acnes not only hamper your looks, but also damage the skin. Effective treatments are available, but acne can be persistent.
Get rid of your acne and feel confident in your own skin.
A wide range of treatment options for acne, ranging from topical creams to oral Isotretinoin, which has given excellent results in competent hands. Early initiation of treatment also helps prevent the scarring which is permanent, unless treated.
Apart from medicines and creams, we also believe in adjuvant therapies like salicylic peel, black peel, Co2 cryotherapy, LED light as well as plasma therapy.
Sequele of acne like pigmentation or acne scars often requires a combination of multiple procedures such as Dermabrasion, Chemical peels, Lasers, Punch Excision, Micro-needling to give the best possible results for any given patient.
What are acne?Acne commonly known as 'pimples' is a chronic inflammatory disorder of the sebaceous unit present in the skin. In mild to moderate cases, there may be black heads (comedones), white heads (papules) or pustules. In severe cases, there are nodules, cysts and abscess which lead to scarring if not treated on time. When pimples appear, they tend to do so on the patient's face, back, chest, shoulders and neck. Acne develops when follicles get blocked and infected.
Dermatologists say that approximately three-quarters of 11 to 30-year-olds will get acne at some time. Acne can affect people of all races and all ages. It most commonly affects adolescents and young adults. There are people in their fifties who still get acne. Females may get a pre-menstrual flare due to the increase in level of a hormone called Progesterone.
How do pimples form?The skin has minute glands called sebaceous glands which open into the hair follicle. These glands secrete an oily substance called sebum, which empties into the skin surface through the hair follicle. During puberty, the male sex hormones which are normally present both in males and females are on the rise and they activate the sebaceous glands to increase in size, which in turn leads to increase in the secretion of sebum. Secondly, the cells are shed more rapidly and they stick together, plugging the opening of the hair follicle, resulting in 'white heads'. The pigment melanin in the white heads when exposed to air, forms black heads. Thirdly, bacteria especially the 'Propionibacterium acne' in number and add to the formation of acne. When the follicle gets clogged, its wall ruptures. The sebum, bacteria and dead cells escape into the surrounding tissue and lead to formation of more severe form of acne in form of pustules, nodules, abscesses and cysts.
What are the factors affecting the formation of acne?Aggravating factors:
- Hormonal imbalance
- Premenstrual flare of acne occurs in 70% of female acne patients.
- Polycystic ovarian disease
- genetic predisposition.
- Hot and humid climate
- Use of cosmetics such as creams, oil based moisturizers, oil based foundations etc.
- Application of heavy oil or gel on the scalp leads to pimples on the back and forehead.
- People who work in chemical or oil industries and come in contact with hydrocarbons, heavy oils, cutting oil, wax, grease and coal tar derivatives can develop acne.
- Drugs such as oral contraceptives, steroids, isoniazid, lithium, phenytoin, iodides etc. can cause pimples.
- Squeezing or picking at a pre-existing lesion will lead to secondary infection and increased pigmentation.
What are the 'Do's and Dont's in treatment of acne?
- Wash your face with an anti-bacterial face wash at least 2-3 times a day.
- Increase the intake of citrus fruits such as oranges, grapes, lime and lemon and other food stuff which are high in vitamin C and zinc.
- Drink plenty of water.
- Don't try to burst the pimples. You may push the infection further down, causing more blocking, worse swelling and redness. Popping pimples makes scarring more likely.
- Avoid the use of oily cosmetics, cleansing milk and gels.
- Don't go to sleep with makeup on. Only use makeup that does not have oil and does not clog up the pores.
- Too much sun can cause your skin to produce more sebum.
- Keep your hair clean and away from your face.
- Do not apply excessive hair oil if you have acne over the forehead.
- Avoid stress factors.
- Be patient and give medicines some time to act. You may have to take antibiotics for 8 - 10 weeks.
Physical modalities in treatment of Acne
Chemical PeelsChemical peels for acne work by removing the surface layers of the skin to expose the fresh and unaffected layers below. Done in a series of four to six sessions, these peels can improve mild to moderately severe cases of acne, and can be given over the face or other body area where acne is a problem. Chemical peels don't really peel the skin, despite what the name implies. They rapidly exfoliate the skin, allowing dead skin cells to shed more effectively. By keeping dead skin cells and excess oil from clogging the hair follicle, pore blockages (comedones) and can drastically reduce breakouts of papules and pustules.
Chemical peels fall into a broad category of Alpha Hydroxy acids (AHAs) or Beta Hydroxy Acids (BHAs). Glycolic acid is the most commonly used AHA and Salicylic Acid is the most commonly used BHA in the treatment of acne.
MicrodermabrasionMicrodermabrasion is done to reduce the oiliness in acne prone skins. It also helps reduce superficial acne scarring.
IntralesionalCorticosteroids A steroid injection is delivered into larger pimples i.e. nodules and cysts to reduce inflammation.
ACNE SCARS:Scars due to acne are broadly classified as elevated or raised and depressed scars. In medical terms, that would be hypertrophic and atrophic scars, respectively. Atrophic scars are far more common than hypertrophic scars, but the latter are much more difficult to treat. Atrophic acne scars can be further divided into rolling, boxcar and icepick scars.
Treatment options for acne scars include the following.
Subscision - where a needle is used to lift the floor of the scar, and release the scar from its attachment to the surrounding skin. This is the best option for rolling scars, and works even better when combined with suction.
Dermaroller - where multiple needles mounted on a hand held device, are used to create tiny wounds in the skin, which when they heal, lift up the acne scars with them.
TCA CROSS - this is a popular and easy technique, where a high concentration of TCA is applied to the base of the scar to lift it. This is a great option for very deep scars like ice pick scars, and also is very useful in smoothening the scar edge, which can be a problem with boxcar scars.
Chemical peels - are very useful in managing superficial scars, and often require to be combined with another procedure for deeper scar correction. They can also be used in combination with procedures like subcision and after dermaroller, to improve the final outcome.
Fractional resurfacing - this involves the use of LASER/ radiofrequency energy to create tiny wounds in the skin, which lift the scars as they heal.
Scar excision - sometimes, a scar can be easily removed, while still maintaining the cosmetic outcome.
Punch floatation - in deep scars, the floor of the scar is raised using this technique.
Filler therapy - this technique involves the use of hyaluronic acid fillers/ fat/ silicon to lift the scar base.
Often, it is not possible to use one single technique to treat all the scars, that a person has. A combination is often required. Further, scar correction is not an overnight process. Procedures may require downtime, which is different from the time required to see the results of one session, before going for another. Often, it is not possible to predict how many sessions will be required, or how much time will be enough to give results, simply because a lot is dependent on the skin's ability to recover as well! And this ability differs from one person to another. So, it is very important that patients have realistic expectations in terms of results, time and expenditure, considering the drawn out process of scar correction.
However, scar revision is an evolving science - one that has grown rapidly in the last few years, and this makes it possible to deliver good results using the above techniques.