Virtue Radio-Frequency (RF) Microneedling

We are proud at Purely Skin Aesthetics and Laser Center PLLC to be the first clinic in the area to offer VirtueRF Microneedling the latest, most versatile and clinically effective radio-frequency microneedling platform available today. RF Microneedling is one of the most sought-after cosmetic procedures in the aesthetic marketplace.  The array of alternatives to choose from is staggering and confusing in deciding which is the best microneedling option for you to achieve your cosmetic goals. The purpose of today’s Blog is to review radio-frequency microneedling, pros, cons, how it works, what it can help, the basic procedures needed to achieve desirable results, what add on procedures can enhance the treatment results, side effects, post-procedure treatment for healing, when to expect to see results and most importantly why choose Purely Skin to perform its magic with the VirtueRF Microneedling platform.

Microneedling had its origins with the invention of a roller wheel with metal needles, by a South African Plastic Surgeon, that could be used to improve skin. It soon evolved into traditional microneedling with hand-held powered treatment heads that created controlled skin-puncture wounding to the skin to stimulate new collagen type I and III and elastin production in healing the punctures. Microneedling offered different needles and power levels to treat different issues and peoples’ individual skin needs. It was found to improve sun-damaged skin, light wrinkle lines and acne scars, with multiple treatments. It soon became apparent to Aesthetic Doctors and health care treatment providers that more needed to be done to engender better, more effective results with each microneedling treatment and to expand the clinical range to skin issues the treatment could be effective for.

What was the next step in the logical evolution of microneedling treatment?  Radio Frequency microneedling.  As microneedling evolved, so did radio frequency treatments. While microneedling created controlled puncture wounds to stimulate increased collagen and elastin production superficially, radio-frequency treatments heated the deeper layers of the skin to shrink collagen and stimulate collagen types I and III and elastin, showing more effectiveness on skin laxity, but less on superficial collagen and elastin stimulation.  Combining the delivery of superficial controlled wounding energy and depth and deeper tissue heating to treat simultaneously could enhance treatment applications and results. Hence, RF Microneedling.  Head to head clinical trials have proven that RF Microneedling produces superior results to either microneedling or radio frequency treatments separately. RF microneedling administers controlled energy and needle depth to create the superficial collagen and elastin production and at the same time sends heat in the tissue treated more deeply to shrink the collagen and stimulate deeper collagen and elastic production as well for the most effective results for treatments.  

The benefits of radiofrequency with microneedling include:

 

Natural skin rejuvenation, by stimulating the body to produce its own  collagen and elastin (neo-collagenesis), and by stimulating new blood vessel formation (neo-angiogenesis).

Virtually painless

Little or no downtime

Scientifically proven to be effective and safe

Cleared by the FDA

 

And can be used to effectively treat

           Fine lines

           Wrinkles

           Skin laxity

Loose facial and neck skin as well as more recently knees, elbows, backs of hands, thighs, abdominal skin, buttocks and other areas

Dull skin tone, including brown spots, melasma, superficial small bloodvessels                               

           Enlarged pores

           Stretch marks and striae

           And new applications yet to come

 

What is treatment like?

 

After your consultation with Michelle or another Purely Skin Professional, you will know what to expect for treatment, results and the number of treatments you will need.

 

At the start of treatment, your areas to be treated will be cleansed and a specially prepared topical anesthetic to diminish the discomfort of treatment. After the anesthetic works, your provider will begin treatment.  While many people have no discomfort, some people get a feeling of warmth from the radio-frequency heat administered. After treatment you may be cleansed again and a VirtueRF After-Treatment dual mask applied to aid post-treatment comfort and enhance healing.  Any redness, swelling, bleeding and discomfort dissipate quickly. Most people can return to normal activities the next day or rarely in two days.  Needle marks fade within two weeks. Make-up can be used the day after treatment, although skin treatments like retinoids and vitamin c skin products should be avoided for a few days because the skin will be more sensitive temporarily.      

 

When will the benefits be apparent?

 

Improvement in skin tone may be seen as early as two weeks, but improvement in tone, texture, fine lines, wrinkling and laxity take two or more months to see a meaningful difference.  Usually three or four treatments are needed for maximum clinical results, with improvement increasing after each treatment.                                                  

 

Are there any persistent side effects?

 

There are usually no persistent side effects. A grid pattern of spots or persistent discoloration of needle marks has been reported. These side effects are almost always a reflection of operator mistakes in choosing treatment parameters. One of many reasons to choose a very experienced professional like Michelle, to avoid preventable side effects.  

 

What other treatments can be used with RF Microneedling?

 

Lasers can be used in conjunction with RF Microneedling for resurfacing, but most people would rather avoid the extra downtime. Increasingly the past year a lot of clinical work has been done with diluted biostimulatory fillers like calcium hydroxylapatite (Radiesse) and poly-l-lactic acid (Sculptra). Injecting them right after a VirtueRF Microneedling treatment can significantly stimulate more collagen and elastin to further enhance treatment.  Radiesse stimulates primarily collagen type I, the longer lasting collagen than type III stimulated by Sculptra, and also stimulates more elastin than Sculptra. It can be used on the face, neck, décolleté, arms, back of the hands, abdomen, buttocks, knees and other areas. 

 

Why choose VirtueRF Microneedling treatments?

 

There are several effective RF Microneedling platforms available and all can provide effective treatments. The point often missed is that the equipment is not the most important consideration in choosing treatment.  The provider is the most important to get the best results.  Michelle is a very experienced, compassionate  professional who can deliver the best-in-class RF Microneedling treatments with her knowledge, experience and abilities. So why VirtueRF Microneedling? Because the VirtueRF Platform is the World’s first microneedling platform.  It offers the most versatile number of treatment parameters for the treatment professional to best customize your treatments, with the addition of a pipeline of new, enhanced treatment handpieces pending FDA approval. It offers 36 gold-coated needles, handpieces, Robotic Precision Delivery, more pulse modes to customize energy delivery, three treatment speeds and red and blue LED light. And a special post-treatment MicroCurrent Dual Face Mask System. The two-mask system soothes skin and eliminates redness.  After VirtueRF treatment, a wet Enriching mask infused with antioxidants, vitamins, moisturizing and anti-inflammatory properties is applied to the skin.  To activate the Enriching Mask a second Empowering Mask is overlaid that uses patented Tissue XTM technology to deliver ingredients deeper into the skin with an ion induced current. In other words, the VirtueRF Microneedling platform allows Michelle to deliver the best-in-class range of treatments, efficacy, clinical results and patient experience with a treatment.

 

Sources and Studies from www.realself.com Published November 11, 2020 Updated November 9, 2020

 

Chandrashekar, Byalekereshivanna, et al. “Evaluation of Microneedling Fractional Radiofrequency Device for Treatment of Acne Scars.” Journal of Cutaneous and Aesthetic Surgery, vol. 7, no. 2, Apr. 2014.

Dayan, Erez, et al. “Adjustable Depth Fractional Radiofrequency Combined With Bipolar Radiofrequency: A Minimally Invasive Combination Treatment for Skin Laxity.” Aesthetic Surgery Journal, vol. 39, May 2019.

Iriarte, Christopher, et al. “Review of Applications of Microneedling in Dermatology.” Clinical, Cosmetic and Investigational Dermatology, vol. 10, Aug. 2017.

Easing Anxiety In An Uncertain World

As I was weeding out yet another room in my home to keep busy, I came across a hand-written simple note my daughter wrote to me a few years ago which said,

“Be strong because things will get better. It may be stormy now, but it never rains forever.”

This reminded me of one of my other favorite quotes, “Life isn’t about waiting for the storm to pass, it’s about learning to dance in the rain.”

It’s easy to get wrapped up in the doom and gloom of what is happening right now in our world which can bring on overwhelming stress. Chronic stress can impact overall health and longevity as well as the visible signs of aging.

Like most people, I need structure and to have a sense of purpose to my day. When I don’t, I find myself feeling a little lost, lonely and isolated. Cabin fever can be powerful and feeling isolated can lower your immunity, lead to poor sleep, poor cardiovascular health, difficulty focusing or even depression.

There are a variety of things we can do to manage and keep our stress in check while in quarantine. Try focusing on the positive things you are grateful for, such as family members, and take the time to appreciate your home and people around you.

To help find more structure, I started a to-do list; things that I couldn’t get done while I was working, including the half-finished projects around the house, weeding the closets, cleaning the garage, yard work and many, many other things. I’ve even compiled a new recipe book of meals we’ve never had.  Every day I find myself adding to the list but my goal everyday is to be able to check something off the list before I go to bed.

The goal is trying not to overwhelm yourself. Take time in the morning to enjoy that cup of coffee or maybe a cup of nighttime tea before bed. If you have kids home from school, take a break and play games with them. How about reading that book that you’ve been telling yourself you were going to get around to? Or maybe go for a walk with your significant other. Now is the time to download that yoga app you’ve been meaning to try out (myself included). Take a relaxing bath with essential oils and add a face mask. Relaxation actually boosts our energy levels, our mood and refreshes the mind and body.

A sense of humor is a great way to beat stress and worry and can really make you feel better about life. Did you know when you laugh you are working 15 facial muscles? Your pulse and respiration increase briefly, oxygenating your blood and your brain experiences an increase in pleasure-giving endorphins. Your body is calmer, your brain is clearer, and you may even find that your headache or stiff neck has disappeared. The best part of all is you can do a lot of this for yourself.

To quickly calm down when you feel a surge of stress or anger, try this breathing technique:

1)      Inhale for a count of four

2)      Hold for a count of 7

3)      Exhale for a count of eight

4)      Repeat 10 times.

The slightly longer exhale helps calm you quickly. You can repeat this process until you feel more relaxed.

One other thing, don’t worry about developing laugh lines on your face. Positive wrinkles like laugh lines are beautiful and give your face some character.

Be kind, be calm and stay healthy!

Thanks,

Michelle

P.S. – No facemask at home?

Try making something from ingredients already in your pantry.

Calming Cucumber mask

It’s a water-rich, anti-inflammatory cooling mask that contains high levels of caffeic acid to quell swelling and irritation.

½ cucumber (pureed)

2 TBSP. Plain yogurt

Mix the two ingredients together, apply on your freshly cleansed skin and kick back for 15-20 minutes before washing it off.

No cucumber or yogurt?

Try one of my other favorite masks!

Soothing Milk and Oatmeal face mask

The lactic acid in the milk helps exfoliate dead skin cells to reveal smoother, clearer skin while the oatmeal helps soothe and soften for brighter glowing skin.

1 TBSP whole rolled oats

2 TBSP milk

¼ tsp cinnamon (optional)

Mix the ingredients and apply to your face, sit back and relax for 15-20 minutes, then wash off with lukewarm water.

Acne Update & Hyperpigmentation

Acne Update

The 4% minocycline foam mentioned in a previous blog has been approved and will be available in January, 2020.  It is an effective agent for acne control and it is hoped that it will be used for maintenance after initial control of acne is obtained with a shorter course of oral antibiotics than was commonly used in the past, or, of possible, use in lieu of oral antibiotics.

The topical anti-androgen, anti-sebocyte agent glucosterone is also being tested for use in hormone-related hair loss.  It appears to be effective in early testing.

Hyperpigmentation 

Hyperpigmentation is a common concern for many people.  It often has more serious concerns for people who suffer from it than non-affected people realize, and can be an underlying cause of adversely affected self-images, anxiety and even depression, in addition to the cosmetic consequences.  While there are many causes of hyperpigmentation, the commonest causes are post-inflammatory hyperpigmentation from acne, eczema, psoriasis, sun, sun damage, superficial burns, cuts, injuries, trauma, lupus and other inflammatory causes, and hormonally-related hyperpigmentation causes like melasma and cholasma, caused or aggravated by pregnancy, birth control pills, HRT with progesterone and sunlight, visible light and infra-red light. 90% of melasma occurs in women. The most commonly affected areas are the face, back, chest and backs of the hands. A consult with your cosmetic aesthetician and or dermatologist can help determine the type of hyperpigmentation you have and the best treatment alternatives for you, including rare medical causes like drug reactions, Addison’s Disease and haemochromatosis, which are beyond the scope of this blog.

This time of year is the best time of year to get your hyperpigmentation treated because the sun is less likely to inhibit treatment success and people are usually less socially active.  The treatments for post-inflammatory hyperpigmentation include azelaic acid cream 15 or 20%, retinol, tretinoin, retinol-alpha-hydroxy creams (coming to market soon), aloe vera plant juice, a licorice derivative in creams and lotions, kojic acid, green tea derivatives, hydroquinone bleach, vitamin c products, lighter chemical peeling agents or combination agents like flucinolone, tretinoin and hydroquinone, and other agents. Confusing? Yes.  That is why a consult with your cosmetic aesthetician can be very helpful to start you on the road to successful treatment. 

It becomes especially important to consult with your cosmetic aesthetician or dermatologist when the usual topical and cosmetic product treatments are not enough, or if you suffer from the more difficult to treat melasma. Why? Because they can offer other very effective treatments that will work when topical treatments, sun avoidance and good routine skin care are not enough. Other options include microdermabrasion, micro-needling, micro-needling with radio-frequency, micro-needling medication delivery to skin, chemical peeling, intense pulsed light treatment, photo-dynamic therapy with amino-levulinic acid and laser or intense pulsed light activation and different types of laser treatments.  Your skin care specialist like Michelle Correia, the owner of Purely Skin Aesthetics and Laser Center and her medical director Dr. Ballantyne can be instrumental in your successful treatment.

Research-related news about hyperpigmentation

The current recommendation to use a 30 SPF sunscreen as part of treatment and prevention of hyperpigmentation may be inadequate.  A sunscreen with a SPF of 70-100 may be better.  Besides being a better blocking agent, a higher SPF sunscreen gives longer sun protection than a lower SPF in case like many people one is not religious about re-applying sunscreen ever 80 minutes or if one cannot in some situations.

Products like a non-hydroquinone, non-retinol, multi-agent skin corrector that blocks melanin (pigment) production in several different ways are being developed by Skinbetter Science and looks very promising in initial clinical studies on facial pigmentation and dyschromia (dis-coloration).  It also enhances routine medical topical agents results.

Platelet Rich Plasma, PRP, injections have been used with occasional success in facial melasma, although in recent studies, the benefits have not been statistically significant.

Unilever researchers have found that niacinamide is an effective, protective agent to reduce post-inflammatory hyperpigmentation and may be available in new products from Unilever in the future.

A study published September 30, 2019 in the Journal of the “ European Academy of Dermatology and Venereology” concluded that people with pigmentary disorders, including melasma, have a high prevalence of psychologic conditions, including anxiety and depression. “Pigmentary disorders give rise to psychologic disturbances, which in turn can hamper adequate medical treatment thus aggravating the pigmentary disorder itself.” (Dabas G, Vinay K, Kumar A and Kumaran M, J Eur Acad Dermatol and Venereol. 2019, Hilton L, www.dermatologytimes.com)

Aesthetic Health News

To look and feel our best aesthetically entails more than having various aesthetic procedures and judicious make-up.  It requires a positive state of mind, a good lifestyle, good nutrition, and suitable exercise that benefits us and fits our busy lifestyles. Simply, we need holistic, balanced lives to look and feel our best and be our healthiest.  To help our clients achieve their aesthetic goals and healthy lifestyle goals, we will occasionally include evidence-based health and lifestyle information in our blog to help our clients achieve what they want to achieve and help optimize their looks and health. 

Exercise has long been held to be an important part of achieving and maintaining good health physically and mentally.  Exercise includes aerobic activity and resistance activity to get the most benefits. Each is important for different reasons. Both forms of exercise have been touted to be better for metabolic health, but which one is?  The question was asked in a study reported in the JAMA Network Open.  Their conclusion was that people’s aerobic endurance -or the lack of it- can influence their metabolism potentially more than muscular strength or weakness.  The results and conclusions have significant implications for anyone deciding which type of exercise could be most beneficial for their health.

The study used data gleaned from the performance testing records of 580 young Finnish military recruits. They rode stationary bicycles and performed weight lifting exercises to measure their maximum aerobic capacity and muscular strength.  They also had extensive blood work and general health testing and completed questionnaires about their lifestyles. From analysis of the different data, researchers grouped the men and assessed their metabolomes (number and types of metabolites in your body) of the aerobically fittest men against the men who were out of aerobic shape, and separately, the strongest against weakest.  The conclusion?  The results suggest that aerobic capacity affects metabolism substantially more than muscular strength does, in beneficial ways. (Health Tap Saturday Digest)

Demographic trends and societal changes often affect health trends, in both beneficial and detrimental ways that are slow to be recognized.  Changes in the workplace, gender make-up of many professions and other trends have had a significant effect on the equality of the genders.  A research group in North Carolina did a study in 1985 where they recruited primarily college and university setting individuals from 20-34 years of age.  They analyzed grip strength and pinch strength (the force generated to squeeze two fingers together) for 237 men and women in the right hand.  Men averaged 117 pounds of force and women 79 pounds of force in grip strength. What is the implication of grip strength for our health?   It is accepted that a person’s grip strength generally correlates to body strength and health outcomes such as cardiac health.

The format of the study was repeated in 2016, with researchers recruiting a similar demographic of 20-34-year-old college and university-based men and women in North Carolina again and repeated the grip and pinch strength study.  The average grip strength of millennial men had fallen to 98 pounds, 19 pounds less than their parents’ generation. The 25-29 

Year-olds averaged only 92 pounds of grip strength.  The 30-34-year-old age group had lesser decrease in strength, averaging 106 pounds of grip strength. The pinch strength also decreased but not so dramatically for all the men’s groups.  

What about the women’s results?  The women averaged 79 pounds of grip strength, the same as they did 30 years earlier. Interestingly, the 30-34-year-old group of women averaged 98 pounds of grip strength, the same as the average older millennial male in the study, compared to a 31-pound disparity 30 years ago.  The average grip strength overall for women was lower because of weaker readings in the 25-29-year-old group.

Is this a result of mass effeminization of the millennial male or a crisis of masculinity? Simply, no. It is more of a reflection of the demographic changes in the workplace, with loss of manual labor jobs and expansion of the information economy for men.  It is less so for women, hence the similar grip strength result.  Less physical activity generally is associated with less strength and weight gain.  The decrease in grip strength for men also has long-term health implications and longevity, which is already being reflected in plateauing and decreasing longevity for males.

The newer study appeared in the Journal of Hand Therapy and in the Washington Post. The study reflects the results for college and university associated people and may not reflect similar results in the general population.

A new, first in class medicine for acne mentioned in the Purely Skin 4 Me Blog last month is coming soon. Clascoterone 1% cream is the first topical medicine that blocks male hormone receptors in the sebaceous (oil) glands, reducing the effect of dihydrotestosterone stimulation that is an important driver of acne.  It is also the first new class of topical acne treatment in forty years.  A New Drug Application was submitted by Cassiopea SpA based on two phase three studies that compared 1% cream applied twice daily or the cream’s vehicle and the results in improvement were statistically significant when measured at twelve weeks.  An open-label study was continued for an additional 9 months and showed no evidence of hormonal effect internally, despite an enlarged application area. Adverse events (minor) in skin were primarily some redness and dry scaly skin. It will be nice to have new, effective topical therapy available for acne, especially hormone-related adult acne.

What’s New & What’s Coming (Part 4)

Acne Part IV - What’s New and What’s Coming

At the present time there are twelve or more products and pharmaceutical agents in Phase 2 and 3 testing to potentially treat acne, including both topical and systemic treatments. They hold the promise of more effective and even safer acne treatments in the next few years.

Altreno was recently FDA approved (August, 2018) as the only retinoid treatment in a lotion base on the market and it has been approved for patients 9 years older.  It is in a formulation of known moisturizers, hyaluronic acid, collagen and glycerin. It allows important retinoid treatment with much less potential redness, swelling and irritation, compared to other topical retinoid therapies. (Johanek E. Deramtol Times, June 2019)

Trifarotene is another topical retinoid nearing FDA approval for moderate acne. It was the first retinoid cream tested in truncal acne as well as facial acne.  It demonstrated significant and similar effectiveness in treating both facial and back acne and re-emphasized the effectiveness of a topical retinoid in treating both blackhead and papulo-pustular acne on the back, an area usually neglected. (Tan J, et al. J Am Acad Dermatol. 2019 – Epub)

4% Topical Minocycline was developed as a way to get much of the known therapeutic benefit of systemic minocycline for acne, without many of the potential side effects of systemic treatment and it has finished Phase 3 testing for moderate to severe acne, demonstrating significant effectiveness.  (Gold, LS et al. J Amer Acad Dermatol. 2019;80:168-177)

Anti-androgen treatment with spironolactone and birth control pills has become increasingly common place to treat acne with a strong hormonal component (primarily in women), but which is also often avoided or discontinued because of side effects. There has long been a need for a topical anti-androgen, now there is one coming for acne treatment, Clascoterone 1%. Initially, it has shown significant benefit for both papulo-pustular and comedonal acne, by reducing and modifying oil gland production of sebum that contributes to formation of acne lesions, much like oral anti-androgens do.  The cream is used twice a day and has very little irritation or redness. (Herbert A. AAD 2019. Abstract 5034)

Sarecycline is a new tetracycline derivative that was recently approved by the FDA and is the first new antibiotic approved for acne in 4 decades.  It is dosed strictly by weight 1.5mg per kg., once daily.  It is effective for moderate to severe acne and a nice addition to the acne therapeutic armamentarium, especially for short term (3 months or less) control of the inflammation in acne. (Moore A. J Drugs Dermatoll. 2018;17:987-996)

A unique topical medication Novan SB204 is in phase three testing as monotherapy for acne. It increases localized topical delivery of nitrous oxide to provide anti-inflammatory activity by inhibiting the NLRP3 inflammasome, decreasing the release of cytokines and killing the bacteria that helps cause acne, propionobacterium acnes. (Johanek)

The future of acne treatment looks bright, with positive changes in understanding the disease and treatment.

Device-Based Treatment of Acne and Acne Scarring (Part 3)

Technological advances in treating acne do not only include medications.  They also include high tech equipment that can supplement medicine treatment to improve acne, especially acne scarring or provide even primary treatment, when medicine treatments are contraindicated for example when acne flares or continues in pregnancy...  Device-based treatment can also extend remission and improvement from medicine-based treatment, to further improve the quality of life for acne sufferers.

Numerous lasers can and have been used to treat the plaque of acne.  Pulsed-dye lasers were among the first lasers used to treat acne.  The treatment involved two to four treatments at 2-week intervals, with little down-time or discomfort and the ability to return to normal activities within hours and little after care.  It was and is most successful reducing acne papules and pustules for up to six weeks following treatments and then maintenance for up to six months.  It was also found to cause significant reduction in acne scarring, with an average volumetric reduction of 60% in depressed scars.  When used in conjunction with amino-levulinic acid derivatives, topically, with two treatments a month apart, even cystic acne responded, and remissions average a year.  This type of treatment can provide relief from acne for an entire pregnancy without medicine treatment.  Pulsed-dye lasers are under-utilized today.  Intense pulse light treatments have been used for twenty years for mild to moderate improvement in acne but are generally less effective than laser treatments.

More aggressive lasers are used primarily for acne scarring.  Traditional ablative CO2 and erbium lasers can reduce atrophic acne scars 50-80% and moderate to excellent improvement in acne but has an extended recovery and has a higher risk of post-inflammatory pigmentation than other options. Fractional ablative CO2 and erbium lasers can achieve moderate improvement in acne and atrophic scarring, have a shorter recovery time, but requires multiple treatments and have a similar risk of post-inflammatory pigmentation. (Thiboutot, D, et al. J AM Acad Dermatol, 2009;60:51-50, Kravvas G, et al. Scars Burn Hel. 2018;4:2059513118793420.)

Multiple fractional non-ablative lasers offer moderate improvement and a short treatment recovery but requires multiple treatments and has a risk of post-inflammatory pigmentation. (Kravvas G et al, Kaushik SB, J Clin Aesthet Dermatol. 2017;10:51-67.) Newer pico second lasers offer moderate outcomes in improvement, a short recovery time and no pigment changes from treatment, enabling more treatment options for use in skin of color.

Microneedling is an evolving technology that began twenty years ago with a needle-based roller to provide superficial damage to skin to generate new collagen and elastin and then became more specific with the development of various needle depths, density et cetera, administered with a powered pen.  By making portals of entry into the skin, controlled, site specific microneedling was found to increase penetration of skin collagen and elastin stimulators that enhanced the benefit of microneedling.  Microneedling was also found to enhance the clinical benefit of platelet-rich plasma therapy.  The latest and perhaps most effective iteration of microneedling is the development of Radio Frequency Microneedling that stimulates markedly increased collagen and elastin production when administered as the microneedling is performed. It has many applications, but for acne, it can achieve moderate improvements in acne and improvements in acne scarring that approaches benefits from more aggressive laser treatments. The treatments have a shorter recovery time, needs multiple treatments, but carry a lower risk of post-inflammatory pigmentation.  Needles are often insulated to limit specific effect on the skin and to mitigate healing time after treatment. Kravvas et al)

Hybrid lasers and combination of fractional devices are also used to treat acne and acne scarring with moderate to excellent improvement but require multiple treatments and result in mild epidermal and dermal wounding with increased recovery time. The common lasers in this category include fractional 1470nm and fractional erbium, and fractional 1540nm and fractional CO2 lasers. (Waibel S, et al. J Drugs Dermatol. 2018;17:1164-1168.)

Photodynamic therapy successfully treats acne by applying delta amino levulinic acid or a newer derivative that incubates on skin for an hour and then is exposed to laser light, blue light or red-light devices, causing it to react with skin to help reverse sun-damaged skin, but also reduce oil gland production and reduces bacteria involved in inflammation and causation of acne.  Recovery is about 5-7 days and usually two treatments about a month apart are needed. It can improve cystic ace, popular acne, blackheads, with remissions lasting a year in adolescents and two years in adults.

1320nm and 1450nm lasers are also used to treat acne occasionally.  Also, free electron lasers at 1720nm have been reported to improve acne.

An effective offbeat treatment for acne is the ultrasonic treatment that causes penetration of 150nm gold particles into sebaceous (oil) glands, then the residual particles are wiped off and the gold particles in the oil glands are heated by exposure to near infra-red lasers and damage the oil glands so they do not help cause acne. It is FDA approved for mild to moderate acne.

There are many choices for device-based therapeutic modalities to treat acne. Care providers need to consider many factors when deciding on device-based treatment regimen for patients to tailor treatment for optimal outcomes. (Tanghetti, E.)

Medical Treatment of Acne (Part 2)

The actual medical treatment of acne has undergone significant changes in the last few years for several reasons.   Prolonged antibiotic use was common in the past as sole or adjunctive treatment. Recent research has changed attitudes for using antibiotics long-term because their use has been associated with increasing resistance of bacteria to antibiotics, making treatment of bacterial infections more difficult.  Their prolonged use has been found to increase patient’s chances of developing IBS – inflammatory bowel disease years later, especially tetracyclines. Additionally, the medical importance of the microbiome of the skin and gut is increasingly being appreciated in our general and immune health and even our mental health, especially depression.  Antibiotic use changes the natural microbiome balance in the skin and gut, adversely affecting our immune and psychological health and ability to handle and prevent infections.  Even with a week of antibiotics, it takes the microbiomes three weeks to be restored and ironically if one takes the wrong pre or probiotics to restore the microbiome sooner, it can take as long as a year for the microbiome to recover. (People’s Pharmacy, WUNC) The longer-term use of antibiotics can be even more devastating.  Topical antibiotics have fewer adverse effects on the microbiome because of limited areas of use and little if any absorption through skin. 

The emphasis on early and aggressive medical treatment has also become more mainline with the realization of the adverse effects acne can have on the quality of a sufferer’s life and with the recent studies showing that scars and all the effects acne scar formation cause, can be significantly improved and often prevented with early aggressive treatment. It was also felt that topical treatment for truncal acne was not as important. Recent research has dispelled this as well, showing that truncal acne also adversely affects quality of life and that topical treatment can work well to treat truncal acne. (Tan J, et al. J AM Acad Dermatol. 2019 Epub) Acne has multiple factors at work to cause clinical disease, so it has also become obvious that acne will respond better to treatment if it is attacked therapeutically at multiple points, instead of just one point by single therapy. There is no place for single agent treatment of acne anymore, with exception of Accutane generics

So how is acne treated? First asking about how acne affects one’s life, how long it has lasted, how often and much it breaks out, the family history, any hormonal effects on the acne outbreaks and any other important history, including hat has been used or prescribed for prior treatment.  Then the type of acne is assessed clinically, whether it is mild, moderate or severe, the areas involved and scar potential. 

The mainstay of treatment of mild to moderate acne is a retinoid like adapalene or retinoic acid which is both therapeutic and preventative.  For adults with acne, they also help reverse sun damage and reduce wrinkle progression.  They also reduce scar development and can help reverse mild scarring.  They are effective for both blackhead and papules, pustules.  Usually they are used with benzoyl peroxides which help reduce the propionobacteria acnes that are involved in acne causation.  Often a combination agent of a retinoid and benzoyl peroxide is used for once a day usage and convenience. The strength of the gents can be individualized for each patient.  Azelaic acid cream can be substituted for one of the agents when there is also a problem with post-inflammatory hyperpigmentation. Retinoic acid also can help fade over pigmentation.  Topical antibiotics can be used occasionally such as clindamycin and dapsone. 

Similar or the same topical agents can be used for moderate to severe acne both on the face and truncal areas that are affected clinically.  As the acne worsens, antibiotics will often be used for 3 to 4 months to stabilize and improve the acne, seldom longer.  In women, spironolactone or birth control pills (4 kinds are approved for acne) in place of antibiotics or with the antibiotics and continued for maintenance after the antibiotics are discontinued.  In men, the presentation of severe acne with cysts makes Accutane generics the treatment of choice.  It is the treatment of last resort in women with severe acne that does not respond to antibiotics or hormonal therapy.

When pregnant women have acne that needs treatment, benzoyl peroxide agents can be used safely, but retinoic acid, azelaic acid, antibiotic topicals and dapsone are contraindicated as are hormonal treatments and the more effective antibiotics.  Pregnant women with acne can often be treated with light and laser treatments or with photodynamic therapy treatments before a planned conception, because the remission is often a year or longer and lasts through a pregnancy.

Mild, moderate or severe acne can also be treated with many different devices – lasers, photodynamic therapy with levulan and laser light, infra-red light following gold particle massage, LED lights and others to be discussed in the next blog installment. Acne surgical lesional removals and numerous chemical peels that physician offices and spas offer or home use products.

It should be noted that effective benzoyl peroxide medications are available over the counter and recently an effective retinoic acid-like medicine, Differin, has become available OTC. 

Acne treatment can be very effective, especially if started early and aggressively.  It is also most effective when the patient is included in the treatment decision making process by your professional providing your skin care.