Goals of Acne Treatment
Acne is a disruption in the skin caused by different factors, including bacteria, hormones and genetics. The pilosebaceous unit is comprised of the hair-growing follicle and the sebaceous gland which releases sebum to the skin surface through the pore. There is a normal population of bacteria called Propionibacterium Acnes (P.Acnes) in the skin, but when pores become clogged the build-up of sebum and the enhanced proliferation of P.Acnes under anaerobic conditions causes blackhead or whitehead comedones to form within the pore. White blood cells infiltrate the area and ensuing inflammation can lead to acneiform lesions called papules, nodules or cysts. The goals of treatment for active eruptive acne are: to reduce the bacteria count of the acne-causing P.Acnes, and to control the activity of the sebaceous gland to reduce excess sebum production. The clinical improvements in the appearance of acne are evidenced by reducing the size of individual acne lesions, reducing the frequency of acne eruptions, and promoting faster healing times.
Preventing future blockages or clogging of pores can be facilitated through a variety of topical therapies including micro-dermabrasion, light chemical peels, and an acne skin care regimen.
Acne treatment uses a broad spectrum of light and radio-frequency energies to target the sebaceous unit in the skin. The spectrum of light used is 400-980 nm. The short wavelengths in the blue light spectrum target the P.Acnes bacteria in tubes of the sebaceous glands. The photodynamic reaction between the blue light and the photoporphyrins, which are an integral part of the bacterial membrane (light- sensitive molecules), results in oxidation and free radical damage to the bacterial cell membrane. P.Acnes are destroyed in this free radical environment, reducing bacterial count and stopping the inflammatory process within the sebaceous gland. The red and infra-red portions of the optical spectrum, as well as the radio-frequency energy, have a thermal drying effect deeper in the sebaceous glands to produce and secrete less sebum. The addition of radiofrequency in acne treatment also offers the unique advantage of improving the texture of acneiform skin (which is often left blotchy and rough after acne eruptions).
Acne treatment procedure is a low risk treatment with no down-time, and which can offer gradual and safe improvements for patients with active papular-papulopustular acne.
Moderate inflammatory acne vulgaris.
Patients who have Grade I-III acne are suitable for the treatment. Some patients with Grade IV acne (pustulocystic) have also seen improvements with acne therapy.
• Grade I: Pure comedonal
• Grade II: Mild papular acne
• Grade II-III: Papulopustular and cystic
• Grade III-IV: Persistent pustulocystic
The treatment sessions during the initial four weeks are aimed at gradually attacking the P.Acnes population in the sebaceous gland. The clinical improvements, as a result of lowered bacterial count and consequential sebaceous gland normalization, may not be evident until approximately half way through the series. Patients may notice improvement in acne lesions after two weeks or four treatments, however there are always patients that respond faster or more slowly than average.
While the acne treatment with Elos can treat existing acne and also help to maintain results, genetic and environmental factors may cause new acne break-outs. Further treatments may be performed as a maintenance program for slight papular acne (once or twice a month) or another bolus of treatments to get severe outbreaks under control (twice weekly for four weeks).
A skin care regimen for acneic skin should be promoted, including but not limited to: oil-free sunscreen, gentle washer/toner, oil and keratin regulation agents such as glycolic acid, AHA, retinoids, and other products that help prevent a plug formation of epidermal keratin.
Residual erythema and/or pigmentary changes in the skin are common sequelae after acne lesions heal. Such dyschromia can be addressed with Skin Rejuvenation treatments to improve the vascular and melanin-based irregularity. The Skin Rejuvenation applicator provides some improvement to rough acneic skin. Acne scarring can be reduced with Skin Tightening treatments, which help to build new collagen in areas of depressed scarring and dermal fissures.
Pre-Post Treatment Care
• The patient should avoid skin irritation or intentional skin tanning.
• The patient should discontinue any irritant topical agents for 2-3 days prior to treatment.
• The patient should arrive for treatment with clean skin. There should be no lotion, make-up, perfume, powder or bath/shower oil present on the skin in the area to be treated.
• The hair in the area to be treated should be clearly seen by the operator. Therefore, it should be shaved ~2 days prior to treatment.
• Blistered or ulcerated skin can be treated with a prescribed antibiotic ointment or burn treatment cream.
• During the first two days following treatment, care should be taken to prevent trauma to the treated site.
• If scabs appear after blistering, they should be kept soft with a lubricating cream.
• The patient should use high factor sunscreen (30 SPF) and protect the treated area from sunlight. Tanning after treatment may cause hyperpigmentation.
• Return to normal acne skin regimen usually 1-2 days after treatment if there are potentially harsh or irritant topical agents in the program. Otherwise, gentle washer and non-irritant topical agents may be used without interruption.
It is recommended to treat the patient twice a week over a period of 5-6 weeks.
Provide prophylactic treatment twice a month, then monthly, and then increase intervals according to clearance.
• Pacemaker or internal defibrillator.
• Superficial metal or other implants in the treatment area.
• Current or history of skin cancer, as well as any other type of cancer, or premalignant moles.
• Severe concurrent conditions, such as cardiac disorders.
• Pregnancy and nursing.
• Impaired immune system due to immunosuppressive diseases such as AIDS and HIV, or use of immunosuppressive medications.
• Diseases which may be stimulated by light at the wavelengths used, such as history of Systemic Lupus Erythematosus, Porphyria, and Epilepsy.
• Patients with a history of diseases stimulated by heat, such as recurrent Herpes Simplex in the treatment area, may be treated only following a prophylactic regime.
• Poorly controlled endocrine disorders, such as diabetes or Poly Cystic Ovary.
• Any active condition in the treatment area, such as sores, psoriasis eczema, and rash.
• History of skin disorders, keloids, abnormal wound healing, as well as very dry and fragile skin.
• History of bleeding coagulopathies, or use of anticoagulants.
• Use of medication and herbs known to induce photosensitivity to light exposure at the wavelengths used, such as Isotretinoin (Accutane) within the last 6 months, tetracyclines, or St. John's Wort within the last 2 weeks.
• Facial laser resurfacing and deep chemical peeling within the last 3 months, if face is treated.
• Any surgical procedure in the treatment area within the last 3 months or before complete healing.
• Tattoo or permanent makeup in the treatment area.
• Excessively tanned skin from sun, tanning beds or tanning creams within last the 2 weeks.
• Electrolysis, waxing, and plucking within 6 weeks prior to treatment.