Tuesday, April 05, 2011

Any Alternatives to Accutane and Antibiotics for Acne?

Acne is a common and complex skin condition that affects individuals of all ages. Its prevalence is estimated at 79%-95% for adolescents, 40%-54% for adults older than 25 years, and 12% of women and 3% of men in middle age. Severe acne with inflamed lesions can lead to scarring. Papules, pustules, and nodular cystic lesions have been linked to psychological damage. A 2010 study linked the use of oral isotretinoin (Accutane) for up to 6 months with an increased risk for attempted suicide in adolescents with severe modular cystic acne. However, the risk did not persist at 3 or 15 years of follow-up in this study. A reproducible system of grading acne is essential to assessing the efficacy of treatments. The Leeds grading system uses a pictorial guide to assess severity from grade 1 (minimal) to 12 (most severe). The physical examination should be performed using a bright light such as the Brighton 1001 circular fluorescent lamp with a circular Sylvanian warm white tube placed not more than 30 cm from the patient. Failure to follow this protocol could cause the lesions to be undergraded. Grades 1-3 indicate noninflamed acne. Prevention of progression to scarring and inflammation would help in minimizing adverse social and psychological effects.

The bacterium Propionibacterium acnes represents the most proximate cause of acne, with sebum and oil production as causes of exacerbation. Daily cleansing with a nonabrasive cleanser that avoids excessive skin drying is essential to acne management. Harsh cleansers can lead to overcompensation by oil glands and greater skin surface oil. The mainstay of acne treatment remains topical benzoyl peroxide, topical antibiotics, and topical Accutane. More severe disease may require oral treatment with antibiotics or Accutane.

Dietary manipulation may influence the balance of steroid hormones, follicular keratinocyte proliferation, and inflammation. Some studies suggest that a high glycemic and insulinemic diet may exacerbate acne. Glycemic index has been used to study acne progression, particularly in the presence of metabolic syndrome and hyperinsulinemia. A randomized, controlled trial of 43 male acne patients aged 15-25 years treated over 12 weeks reported greater improvements in insulin sensitivity and body mass index in parallel with greater reductions in acne lesion count with a low-glycemic-load diet. The low-glycemic-load diet was achieved by boosting the intake of proteins such as lean meat, poultry, and fish, and by emphasizing foods with a lower glycemic index such as fruit and whole grains.

In another approach, drinking fermented cow's milk enriched with the milk protein lactoferrin was shown to improve acne. A total of 36 adults, aged 18-30 years, were randomized to receive either fermented milk alone or fermented milk supplemented with 200 mg of lactoferrin daily for 12 weeks. People in the supplemented milk group showed an improvement in total inflammatory lesion count, total lesion count, and acne severity of 38.6%, 23.1%, and 20.3%, respectively. In addition, people who were randomized to the enriched milk group had a significant reduction in triacylglycerols, a skin surface lipid, compared with the placebo group. Skin hydration and pH were unaffected by either treatment. Sebum content was reduced by 31.1% in the lactoferrin group, a finding replicated using fermented milk containing the probiotic Lactobacillus casei.

However, milk consumption alone also may be linked to a greater likelihood of severe acne, as shown in a study of 4237 adolescent boys. Those with the highest intake of both skim milk and whole milk were most likely to have severe acne. The proposed mechanism for this risk is increased androgenicity conferred by milk products. The role of milk in the pathogenesis and exacerbation of acne continues to be debated. More information can be found at this link.

A topical gel made with 5% tea tree oil appears to be as effective as 5% benzoyl peroxide lotion for treating acne, with fewer side effects. Alpha hydroxyl glycolic acid, use as a facial peel or lotion, has been reported to be moderately effective in persons who can tolerate facial peeling. Zinc levels have been reported to be suboptimal in some patients with acne, and both topical and oral zinc have been proposed as potential treatments. Studies that combined topical zinc with erythromycin reported improvement in comedones, pustules, papules, nodules, and macules.

While completely based upon client testimonials, milk of magnesia applied topically twice daily seems to have improve the acne of a number of our clients.

The treatment of acne scars with ablative lasers vaporize the epidermis and part of the papillary dermis. The resultant healing that occurs 'smoothes out' the scar tissue. The CO2 laser has been found to be more effective than the Er:YAG laser, but is also associated with a higher incidence of side effects. Ablative lasers should only be used for grade 3 acne scars, while nonablative lasers are indicated in grade 2 acne scars. Nonablative lasers are known to be less effective than ablative lasers, but they are also associated with less downtime and side effects. A relatively new laser technology, known as FP, uses zones of microthermolysis to injure the epidermis and dermis in a uniform manner, so that healing occurs in a controlled fashion.

Acleara Acne Clearing System is the first continuously-cooled system FDA-cleared to treat mild to moderate inflammatory acne, comedonal acne, and pustular acne. Acleara is powered by an advanced vacuum and filtered broadband light technology. A vacuum deep cleans pores by extracting build up of sebaceous material. Along with the targeted heating of sebaceous glands, the endogenous light activates porphryns to destroy P. acnes and reduces sebum production through photodynamic action.
No anesthetics, numbing or cooling gels are required.

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