Acne is caused mainly by three important factors: bacteria, hormones, and sebum or oil. In its most simple form acne consists of blocked hair follicles, called comedones. Comedones come in two varieties: open and closed. Closed comedones (whiteheads or zits) form when a follicle is blocked beneath the surface of the skin. Debris such as oil and dead skin cells build up under the plug. As the pore swells, these substances leak into the adjacent skin and the body produces an inflammatory response. This appears as pus filled bumps. Open comedones (blackheads) are follicles blocked by dead skin cells and oil. In contrast with closed comedones, the surface of the follicle is open to the air. Dead skin cells and other debris react with the air and gradually change color. This oxidation produces chemicals that turn dark in much the same way that an apple changes color when exposed to the air. Dr. Goldenberg offers a wide range of therapies to combat acne and to improve acne scarring. Treatment options include topical creams, oral antibiotics or accutane, TCA 25% peel, blue light, and acne surgery. One of the most bothersome symptoms of acne is persistent redness, known as persistent erythema. Dr. Goldenberg specializes in using the V-Beam laser to help patients with redness due to acne.
Photodynamic blue light therapy (PDT) is a non-invasive method used to treat acne and other skin conditions. The blue light may be used alone or with a special light-sensitive medication called AminoLevulinic Acid (ALA). ALA is applied to the skin affected by acne and allowed to remain there. Then the blue light is directly to the skin and the cells that have absorbed the medication respond. The application of ALA followed by the exposure of specific blue light causes selective destruction of targeted cells. Many patients can achieve excellent results with a course of treatments using ALA and pulsed light. PDT therapy for acne is usually not covered by insurance and is considered a cosmetic treatment.
Severe acne is characterized by deep cysts, inflammation, extensive skin damage and scarring. It requires a more aggressive treatment regimen. Acne surgery consists of comedone extraction of non-inflamed lesions and extraction of milia or tiny white cysts. Some large cysts or granulomas may require drainage and extraction. Comedone removal for acne is usually not covered by insurance and is considered a cosmetic treatment.
When an acne cyst becomes severely inflamed, the chance of scarring increases. To treat severely inflamed cysts and prevent scarring, Dr. Goldenberg may inject the lesions with a diluted corticosteroid to reduce inflammation and promote healing. An interlesional corticosteroid injection breaks up the cyst over a period of 3 to 5 days.
Accutane® or Isotretinoin, a vitamin A derivative, has been a cure for severe cystic acne. Accutane® works by decreasing oil in the skin, adhesion of skin cells and bacteria in the follicle. It is the only drug that effectively addresses these different steps in the production of acne. If you are considering using Accutane®, you must consider the associated risks, and discuss them with Dr. Goldenberg before beginning a course of therapy. It is imperative to avoid pregnancy while taking Accutane®, which can cause severe birth defects. Two forms of birth control are recommended for any sexually active woman taking Accutane®. It is also important that women not breast feed during this time. While taking isotretinoin, patients are regularly monitored for side effects through follow-up visits. For most people, these side effects are tolerable and not a reason to discontinue therapy before remission is achieved.