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Acne is a common problem especially for teenagers. It can greatly affect their confidence and development. Active acne is best treated with Daily Skin Care and Photodynamic Therapy (PDT). 30% patients are cured of their acne following one treatment of PDT, 60% are cured after 2 treatments of PDT and 90% are cured after three treatments of PDT.
The combination of a vitamin A cream, antibiotics and benzyl perioxide wash has a 50% success rate compared to the 80-90% success rate of PDT. Roaccutane has a slightly higher success rate than PDT but many patients do not want to trail this option because of the multiple side effects.
PDT is a effective and safe treatment for active acne lesions
Patient with acne 1 month after Photodynamic Therapy.
Acne scarring can be treated with Ablative/Fractionated Lasers.
Photodynamic therapy (PDT)
You have probably noticed that when you go to the beach in summer your acne improves. The sun is responsible for this improvement by activating a substance called ALA in your oil gland. This leads to the destruction of the blocked oil gland and the bacteria that causes acne. Photodynamic therapy is a treatment that amplifies this natural process by artificially increasing the amount of ALA in your skin.. Photodynamic therapy involves the application of a cream called Aminolevulinic Acid (ALA) which is activated by a light source. Aminolevulinic Acid (ALA) is a "natural" product found throughout the body. The activation of ALA by light leads to:
- The destruction of sebaceous glands.
- The blockage of these glands is responsible for causing acne.
- The destruction of Propionibacterium acnes (P. acnes), the bacteria that triggers acne.
- Improved texture, tone and complexion of the skin. It reduces pigmentation,
broken capillaries and fine lines.
This makes this therapy particularly useful for acne, Rosacea, pigmentation (freckles), large pores and photorejuvination of the skin. It can be used for all skin types over the whole body. The use of Retin A gel and fruit acids prior to the PDT helps with the effectiveness of the treatment. After the procedure, it is important for the patient to avoid the sun where possible, wear sunscreen and a hat. Exposure to the sun will result in a burning sensation on the face (photosensitivity). The face becomes red a few hours after the treatment. The photosensitivity and the redness will last anywhere from two days to two weeks depending on the intensity of the treatment selected by the patient. The greater the intensity, the better the result, but the longer the redness and photosensitivity.
Understanding Acne
Acne results from the obstruction and inflammation of the sebaceous glands, and it affects 80% of the population. Acne typically begins in adolescence with hormonal changes.
Acne is caused by overactive sebaceous glands in the skin. The sebaceous glands, triggered by the hormone androgen, produce sebum (oil) in the skin. Although androgen is a male hormone, it is present in both men and women. Production of this hormone is highest during puberty, but it is always present in the body. When androgen levels increase, the sebaceous glands release sebum. Ordinarily this oily substance spills onto the skin. Clogged pores cause sebum to be trapped beneath the skin causing whiteheads and blackheads. Sebum can then mix with the trapped cells and cause Propionibacterium acnes (P. acnes) bacteria normally found on the skin to grow in the clogged follicles. P. acnes can cause inflammation and pus and can result in papules or pustules. When the follicles expand as much as they can, bumps called nodules are formed under the skin.
There are different levels of acne ranging from milder blackheads and whiteheads to moderate, pustular/papular and severe cystic acne. In many cases, several or all of these levels of acne can be present on an individual simultaneously.
Causes of Acne
Clogged pores or follicles - Acne is caused by clogged pores or follicles (small openings in the skin) that contain a hair and sebaceous (oil) gland. It can show up anywhere on the body but it is usually found on the face, back, shoulders, and chest. Follicles become clogged by dead skin cells and oil (called sebum) made in the pore
Hormones and extra sebum – Humans have hundreds of hair follicles, or pores, on the surface of our skin through which hair grows. Deep inside each follicle is a hair shaft attached to small glands called sebaceous glands. These glands make an oily substance called sebum to moisten our hair and skin. Sometimes when too much sebum is made, it can mix with dead skin cells (that we are constantly shedding) to create a sticky plug. Trapped bacteria grow very fast in these plugged follicles and make chemicals that can cause swelling, redness, and pain. Eventually the plugged follicle can burst and spill everything – oil, dead skin cells, and bacteria – onto the skin surrounding other follicles.
When you become a teenager and go through puberty, your body makes more hormones (especially androgen hormones). This can make sebaceous glands enlarge and too much oil or sebum can be made. Sebum is supposed to carry dead skin cells up to the surface of the skin, but when there is too much of it, it clogs the pores leading to whiteheads, blackheads, pimples, and cystic acne.
Types of Acne
Acne Vulgaris is the most common form of acne which includes several types of pimples. These acne lesions include blackheads, whiteheads, papules, pustules, nodules and cysts.
Mild to moderate acne vulgaris consists of the following types of acne spots:
- Whiteheads appear as small skin bumps . They are blocked swollen pores that are filled with dead skin cells and sebum(oil)
- Blackheads happen when a clogged pore is open and a chemical reaction causes the surface to darken. The blackhead is caused from a build up of melanin-a skin pigment and its reaction with oxygen in the air.
- Papules and pustules both occur when a clogged pore becomes infected by bacteria (p.acne). Papules appear as a small red, raised lump. Pimples/pustule appear as fragile small white pus filled domes, which is the body’s way of reacting to a bacterial infection. Pimples, also called "zits," can be tender to the touch
Severe acne vulgaris is characterized by nodules and cysts:
- Cysts and nodules occur when clogged up pores break under the skin causing bigger and often very painful bumps. If left untreated, these cysts can cause scarring.
- Nodules are large, hard bumps under the skin's surface.
- An acne cyst can appear similar to a nodule, but is pus-filled, and has been described as having a diameter of 5mm or more across.
Acne Rosacea can look similar to the aforementioned acne vulgaris, and the two types of acne are sometimes confused for one another. It appears as a red rash which is normally confined to the cheeks, nose, forehead and chin. The redness is often accompanied by bumps, pimples, and skin blemishes.
Prior to Photodynamic Acne Treatment, the best available treatment option for resistant and cystic acne was Roaccutane. However, there are many side effects linked to the use of with Roaccutane including birth defects, liver abnormalities, depression, and virtually all patients experience dryness and night vision changes.
PDT Acne Treatment provides a viable alternative to all types of acne treatment without having negative systemic effects.
FREQUENTLY ASKED QUESTIONS
What is PDT used for?
PDT is useful for the treatment of acne, Rosacea and pigmentation (freckles). It is also used for photorejuvination of sun damaged skin to improve the texture, tone and complexion while reducing the pigmentation, pores and fine lines of skin.
Who is a suitable candidate for PDT?
PDT is suitable for all patients with active acne lesions who have not had a response to antibiotic treatments and do not want to commence Roaccutane (due to the numerous side efffects). The combination of a vitamin A cream, antibiotics and benzyl perioxide wash has a 50% success rate compared to the 80-90% success rate of PDT. Roaccutane has a slightly higher success rate than PDT but many patients do not want to trail this option because of the multiple side effects.
PDT is a effective and safe treatment for active acne lesions
Patients with dark skin types are able to be treated with PDT. The risk of hyperpigmentation is small if they are treated appropriately. If hyperpigmentation does occur, it resolves with appropriate treatment in 3-4 months.
What is ALA Photodynamic Treatment (PDT)?
You have probably noticed that when you go to the beach in summer your acne improves. The sun is responsible for this improvement by activating a substance called ALA in your oil gland. This leads to the destruction of the blocked oil gland and the bacteria that causes acne. Photodynamic therapy is a treatment that amifies this natural process by artifically increasing the amount of ALA in your skin.
Photodynamic Treatment (PDT) is a process by which a photosensitising cream called Aminolevulinic Acid (ALA) is applied to your skin and then activated by a light source. The Photosensitising cream is a special solution that is activated by a red or blue light, which "turns it on". ALA is a "natural" product found throughout the body. It is needed for haemoglobin synthesis. (It wouldn't be possible to make the red blood cells to carry oxygen without ALA in your body).
How does it work?
The activation of ALA by light leads to:
-
The destruction of sebaceous glands. The blockage of these glands is responsible for
causing acne.
-
The destruction of Propionibacterium acnes (P. acnes), the bacteria that triggers acne.
-
Improved texture, tone and complexion of the skin.
-
A reduction in pigmentation, pores and fine lines.
-
A progressive reduction in redness with every treatment. The redness and flushing caused by Rosacea and broken capillaries can be reduced by 80 to 90 percent.
What does the procedure involve?
The skin is cleaned with acetone. The ALA cream is applied for 15 minutes to one hour depending on the desired effect and the amount of downtime available to the patient. After the cream is removed the patient is required to lie under a light source for 20 minutes during which a mild tingling sensation may be experienced.
What can I expect after the treatment?
After the procedure you should wear sunscreen and avoid the sun by staying indoors for the first 24-48 hours. Exposure to the sun will result in a burning sensation on the face known as photosensitivity.
Your face will become red a few hours after the treatment. The photosensitivity, redness and peeling will last anywhere from 2 days to 2 weeks depending on the intensity of the treatment selected. The greater the intensity of the treatment the better the result but the longer the redness, peeling and photosensitivity.
How many treatments will I need?
At Cosmos Cosmetic Medicine we advise 2-4 mild to moderate PDT treatments at 2 to 4 week intervals to obtain optimal results for acne and photorejuvination. Thirty percent of acne patients improve after one treatment, another thirty percent of acne patients will improve after two treatments and ninety percent of acne patients improve after three treatments.
How soon will I see results?
Active acne can improve dramatically within 2 weeks and will continue to improve 8 to 10 weeks after the treatment.
After each session, you will experience improvement in your skin tone and texture. There will be a decrease in the overall redness and flushing. Sunspots will fade; pore sizes will shrink. Fine lines and wrinkles will gradually decrease in size as the new collagen forms beneath the skin. These improvements will continue to increase with each treatment.
How long will the results last?
This treatment has been shown to have the potential for long term improvements in acne due to the destruction of the oil glands. Significant clinical improvement and a decrease in oil production and oil gland size have been shown after PDT
The results will last for up to two years
Are there any problems with PDT?
There is no risk of scarring with PDT. Some patients have a lively response to PDT and experience marked redness of their skin which will resolve. Temporary swelling may occur with the lips and around the eyes for a few days. Darker pigmented patches, called liver spots, can become temporarily darker and then peel off leaving normal skin. (This usually occurs after seven to ten days).
Patients with dark skin types are able to be treated with PDT. The risk of hyperpigmentation is small if they are treated appropriately. If hyperpigmentation does occur, it resolves with appropriate treatment in 3-4 months.
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