Am I a good candidate for laser acne therapy if I have darker skin type?

As we may or may not know that acne is quite a common concern in people with darker skin. In fact, lasers have been avoided for acne treatment for those with darker skin because of the risk of potentially disfiguring complications such as acne scarring, keloids, and skin discoloration.

However, the advances in technology today have made laser treatments for acne safer for those with darker skin types. For instance, there are some acne treatments, i.e. using both lasers and intense pulsed light devices that are being tested and have shown encouraging results for acne on the face and on the chest and back for those with darker skin. It is important to note that as with other skin types, maintenance acne treatments such as by using retinoids, topical acne antibiotics, and benzoyl peroxide, are usually needed to minimize the recurrence of acne.

It was reported that lasers and intense pulsed light devices that are being used to treat acne for this purpose, i.e. in people with darker skin included:

• ClearLight (blue: 405 to 420-nm);
• Aura laser (532-nm KTP laser, green light); and
• Aurora (an intense pulsed light/radiofrequency kind of combination device)

Can I do laser treatments while I am on oral or topical acne treatments?

We may not aware that laser and intense pulsed light treatment are often best to combine with other, i.e. mostly topical acne treatments for maximum acne treatment results. (Topical means a product that is used on our skin, such as a lotion, cream or gel)

When the laser procedures are completed, we should continue with the usual maintenance acne therapy, i.e. topical acne treatment to prevent the recurrence of the acne. However, we should stop to use retinoids (i.e. products that are generally in the vitamin A family) for 4 to 5 days before a laser or intense pulsed light treatment and then restart again 3 to 4 days after the treatment.

For other acne medications such as topical antibiotics or benzoyl peroxide (i.e. an antiseptic that is commonly used topically to treat acne, and is widely used as it does not induce bacterial resistance), and depending on our skin sensitivity, we may stop for 1 to 2 days around the procedure. From the acne clear and acne care perspective, it is advisable to review all of our acne medications with our doctor prior to any laser or intense pulsed light procedure in order to determine our level of sensitivity.

How many acne treatments do I need from those procedures done in the doctor’s office? How long does it take to see the results?

Studies have shown that the number of acne treatment sessions required to achieve satisfactory results will depend on the system used and the severity of our acne at the start of the treatment. We also need to follow-up with the maintenance acne treatments in order to minimize future acne flare-ups.

The results from the laser or intense pulsed light treatments can occur from 1 day to 1 month after starting the treatment.

What laser and light treatments are available to treat my acne?

Laser stands for "light amplification by stimulated emission of radiation." Laser energy can be provided by various sources, i.e. from a gas to a liquid to a solid.

These energy sources allow for specific wavelengths of light to be intensified and directed through a column to our sebaceous gland (i.e. oil-producing grand located in the deeper layers of our skin, and are attached to the hair follicles. The oil produced can travel up the follicle to end up on the surface of our skin) or melanin high up or deeper in or within our skin. Also, it can target water in the skin or various components of blood vessels within our skin. In short, it works to heat and damage the skin in a very specific ways without damaging the surrounding skin tissue, hence in the process of healing our skin will look clear and healthy, i.e. without acne or broken blood vessels or brown spots or even wrinkles. Studies have shown that the longer the wavelength, the deeper the light will penetrate. Additionally, there are specific elements in our skin that prefer certain wavelengths of light.

On the other hand, intense pulsed light devices are similar to lasers with the exception that they use a wider range of wavelengths as opposed to only one single beam of light. From the acne clear and acne care point of views, this is very useful as it helps us to target our source within a range of light.

What was noted is that, CO2 lasers were used to heat water within our skin in the past, however, this method is not perfect as it would cause destruction of the upper layers of our skin and sometimes may go even deeper. Usually, a 2 to 3 months’ healing time is quite common, after which there could still be redness for months, and then areas of our skin could appear darker or lighter than the adjacent skin. This treatment is not recommended for the treatment of active acne, or for those within 6 months of taking oral isotretinoin, nevertheless, it is still being used to treat certain types of acne scarring.

The advances in technology have made newer acne devices more effective and specific to target the source of our acne, and within a broader context without damaging the surrounding skin, i.e. the sebaceous gland, the P. acnes bacterium (i.e. short for Propionibacterium acnes, a bacterium that grows and flourishes under certain condition and is the main culprit for inflammatory acne), or the blood vessels that supply the swelling and redness. Additionally, those acne treatments can be done over time without limiting the activities of the person being treated. In short, the newer acne devices are more accessible and more useful in the treatment of many skin conditions, and caused less painful experience than the earlier devices.

It was learnt that the FDA has approved several lasers and light systems for the treatment of acne. Basically, they are designed to treat inflammatory acne associated with the active growth of P. acnes, and are not effective if we have only blackheads (i.e. also called open comedo, is a type of acne that does not contain active bacteria. Is the result of the follicle that have turned black after exposure to oxygen) or whiteheads (i.e. white bumps in our skin that are closed to the the surface. Is a type of acne lesion, also called closed comedo).

Listed below are the laser and other related procedures for reference:

Laser

• OmniLux - blue light
• OmniLux Revive - red light
• Smoothbeam - is a diode laser that used to treat both acne and depressed scars caused by acne. This laser emits energy at 1450-nm. Statistics showed 6 months remission of acne lesions after treatment.
• Aura (KTP - green light)
• CoolTouch - is a 1320-nm laser system that is used for back acne and acne scars. CoolTouch works by targeting the sebaceous glands without damaging our skin's surface.
• Nlite-V - a 585-nm pulsed dye laser that is used for moderate inflammatory acne on the face. Nlite-V emits a wavelength of yellow light that heats our small blood vessels, as well as encouraging the healing and stimulating the collagen (i.e. protein that is responsible for the elasticity of the skin and plays an important role in the development of scars) production.
• CO2 - will heat up larger areas of our skin and can have a significant amount of healing or down time associated with them. It is used to treat certain types of acne scars that are not very deep, and also commonly used to treat signs of sun damage and wrinkles.
• Erbium - as in CO2.

Intense pulsed light

• ClearLight - is the first device to get clearance from the FDA for the treatment of acne. It is used to treat moderate to severe inflammatory acne (i.e. a class of acne where the main lesions are papules and pustules but not comedones). ClearLight works by targeting the bacterium P. acnes by using high intensity light to excite specific elements of P. acnes and to destroy them without harming the surrounding tissue.

Light-emitting diodes

• OmniLux Blue - a new type of system that uses light-emitting diodes in the visible spectrum at 415-nm and is used to treat mild to moderate inflammatory acne, and that treatment are generally well tolerated.

Radiofrequency (is produced by an electrical current instead of a light source and can penetrate more deeply through our skin. It is safer because it is not scattered by tissue or absorbed by melanin.)

• Aurora

Experimental

• Pulsed dye therapy

What we could say about the trend ahead is that advances in technology will sure help in better understanding our acne clear and acne care needs, and to expand their uses in very specific ways for us to better manage to have an acne free complexion.

What is electrocautery?

Electrocautery is the use of an electric current that is converted into heat and passed through a fine tip in the treatment of acne.

It works by directly applying the heat to the acne lesion that exfoliates the skin and kills the bacteria. It also sometimes used to open our whiteheads (i.e. a type of acne lesion, are white bumps in our skin that are closed to the skin surface. Also called closed comedo) for the contents to be extracted in order to clear the lesion (i.e. a mark in the skin). Nevertheless, there exists a risk of scarring from this treatment that explained why it is not being considered as a main treatment for acne and is not often used.

Is cryotherapy right for me? Is it good to treat acne?

Basically, cryotherapy involves the use of liquid nitrogen or carbon dioxide slush to treat our acne. These procedures are useful, but the drawback is that they require special storage containers and are becoming less popular and uncommon as newer acne treatments procedures are being available. Despite this, people do love the way their skin looks after the treatments, though there is a risk of scarring.

Cryotherapy works by exfoliating the localized areas of our skin where the pimples are concentrated. It is noted that liquid nitrogen is very cold, i.e. 195° F, which means that it needs to be stored in a special container as it can evaporate at room temperature. In general, both the liquid nitrogen and CO2 slush are applied by the doctor to specific pimples. The after treatment result is that the site can easily turn red and become a little swollen, which lasts anywhere from half an hour to a day. What followed is that we will find our pimple dries up and exfoliates off with washing over the next few days or so. Sometimes a very light layer of the cryogen can be applied to our entire face for a general peel. What was noted is that our skin will usually turns red, follows by peeling over the next week. However, the peeling process is not an obvious peeling of our skin, but the skin does look smoother and feel softer to the touch.

What is microdermabrasion? Do they really work for my acne?

Microdermabrasion works by using fine crystals blasted at the skin and then vacuumed back away from the skin. These two components help to temporarily clean out the pores, and make our skin feel smoother. Through this, the upper layers of our skin are exfoliated off, this helps to provide other acne treatments to penetrate more evenly.

In general, a series of five to seven microdermabrasion treatments are done in order to get optimal acne treatment results. This shall follow by maintenance treatments every 6 to 8 weeks. It is noted that no comprehensive studies exist showing the benefits of microdermabrasion, nevertheless, people who undergoes for microdermabrasion do suggest that it does help to improve their acne condition.

What is dermabrasion? Is it ideal for acne scars?

It is a process whereby the upper and middle layers of our skin are removed in order to improve our acne scarring condition. However, dermabrasion is ideal for people with the following skin types who have superficial acne scars:

Unexposed Skin Color	Tanning History
Ivory white, pale white White White Beige or lightly tanned	- Burns easily, never tans - Burns easily, tans minimally - Burns moderately, tans evenly - Burns minimally, tans easily

We have to take into account the healing time involved, and that local anesthetic is a must because dermabrasion is indeed a very painful experience.

If we have very deep, pitted acne scars then dermabrasion is not an ideal solution as the scars would end up deep and wide and would most likely be more obvious than before. In this case, the best acne skin care treatment for this type of acne scars is either we try to fill them with some temporary fillers, such as collagen (i.e. the main protein in connective tissue that is responsible for the elasticity of our skin and plays an important role in the development of scars) or Restylane, or with one of the more permanent fillers available on the market like Artecoll. Alternatively is to use a method called punch grafting, a technique that use a cookie-cutter type of blade to punch out the scar, and then followed by adding skin taken from another site to fill in the hole, and thereafter with dermabrasion to smooth the edges.

Are chemical peels safe?

From the acne clear and acne care perspective, it is safe if done properly and can be done along with a topical or oral acne regimen to achieve better acne treatment results.

In fact, chemical peels have become an increasingly popular option for us to treat acne and to minimize scarring from acne. There are several different solutions available for chemical peels, and each has its advantages and disadvantages.

Common peeling agents shall include α-hydroxy acids (or glycolic acid), salicylic acid, and trichloroacetic acid. Among them, salicylic acid which is fat soluble does have anti-inflammatory effects and may penetrate into those sebum-heavy follicles more easily than the water-soluble α-hydroxy acids. On top of that, there is usually more active peeling after a salicylic acid treatment than with glycolic acid. Hence, many consider salicylic acid as a very useful peeling agent in the treatment of acne.

As for trichloroacetic acid which can be used in strengths from 5% to approximately 20%, is generally a more active peeling agent for achieving a superficial peel. Because the strength of the peel does varies depending on how it is applied, and with the possibility of some risk of scarring associated with deeper penetration of trichloroacetic acid, as such this treatment should be done by a qualified dermatologist.

Light chemical peels is generally useful to help correct our surface scarring and hyperpigmentation (i.e. darkening of skin resulting from higher amounts of melanin in a particular spot). Although the light chemical peels do not penetrate beyond the upper layers of our skin, its light or superficial chemical peel may cause our skin to stay red for a few hours before returning to normal. It is considered unusual to have blisters or areas of bleeding after a superficial chemical peel and we should have no obvious peeling of the skin after the treatment.

What procedures can be used to treat acne?

There are a number of procedures that can be performed in a doctor's office to treat acne, i.e. chemical peels, microdermabrasion (i.e. a technique that helps repair facial skin), dermabrasion (i.e. a method of surgical scraping of the skin’s top layers), laser and laser-like procedures, electro­cautery, cryotherapy (i.e. whereby surface skin lesions are frozen) with either liquid nitrogen or CO2 slush and surgery to remove acne scars.

What is the right acne treatment? This will depend on our skin type, how much acne scarring we have, how active our acne is and how much we can spend on these acne treatments. Usually, those acne treatments will need to be done several times to get the desired results with its main­tenance treatments in order to have lasting improvement over time. It is safe if done properly and can be done along with a topical or oral regimen to maximize our acne treatment results.

It is noted that chemical peels have gained the popularity to treat acne and to minimize scarring from acne. What follows is a list of the most commonly used chemical peels:

• glycolic (α-hydroxy acid, fruit acid),
• Jessner's solution,
• salicylic acid (β-hydroxy acid) and
• trichloroacetic acid.