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“I had a patient that came in today who has both chronic slightly active acne and older acne and chicken pox scars and she wanted to know the best course of action to improve the texture of her skin, as well as help to prevent the acne that's coming out occasionally hormonally is really her main problem with hormonal acne and really improve the color along with it. There is some dyschromias, discoloration in her skin and her face that go along with the acne redness and brown colors that happen after the redness post inflammatory hyper-pigmentation and it’s a tough question she came in with a lot of knowledge about fractional laser resurfacing or some type of laser resurfacing which is very effective and smoothing the skin texture out, improving the pits or pot marks, the surface irregularities and the sort of bunched up wrinkling that happens around the old acne scars but fractional laser resurfacing doesn't do a lot for pore size or the gland size where the bacteria live, and thus we talk a little bit about an alternative and talked about in general the strategies in acne management all of them begin with being on a good skin care program.
A good skin care program would be something that cleanses the skin obviously, that helps to keep the pores open from plugging with debris and dead skin cells which are constantly working their way to the surface, as well as gentle exfoliation of the skin which can be done simply at home with a bath puff and a light facial acid wash. You could go to a spa or salon like the Appearance Care Center and get a Beta or Alphahydroxacid peel, those thing are very effective in taking those dead skin cells away and typically we like to see patients on retinoid if they can tolerate them, at tretinoin molecule or a retinol type of product which are good in helping to thin the outer layers of the epidermis, the dead skin cell layers and thicken the dermal layers, just improve skin functioning in general.
Once we assumed that we're on that base of the pyramid that skin care program we'd go the next level of care and that next level of care includes, and this is what we're talking about earlier, treatments that can actually reduce the glands size and thus pore size and the only one that I think reliably offers that is the treatment that's called Photodynamic Therapy.
Photodynamic Therapy or PDT can be done in a number of different ways but the basic premise of it is that we're painting on a product called Levulan and Levulan is a sun or light sensitizing, photo-sensitizing agent and when a certain color of light in the sort of lighter blue or green spectrums are applied to the skin surface that activates that molecule and actually shrinks the glands down and kills the bacteria that have been pre-sensitized by the Levulan. So this is a good way of actually making the pore size smaller, killing off the overall bacteria count in the skin and thus can improve the skin texture and quality just by simply reducing pore size.
So in this patient that I talked to, we really had kind of dilemma and that we have or some choices to make in that we can treat the pore size and reduce some of the bacteria load and even the outbreaks of bacteria by doing Photo Dynamic Therapy and still we can treat the scarring from the older injuries or acne that she had previously and do that more with Fractional Laser, and in the end really both option seem a good choice for her and then we talked a little bit about the order that we do this.
"Would you rather do photodynamic therapy first or would you rather do fractional laser first?"
My suggestion typically is to do the fractional laser first, get the skin smoother and more even you can come back with IPL and/or photodynamic therapy later to get rid of some of the redness in the skin and thus speed recovery of the fractional recovery resurfacing. I've talked about fractional lasers in other videos and other papers that I’ve written but the basic premise of fractional laser is that as opposed to the full laser resurfacing done with the sander dermabrator or a chemical deep chemical peel or even full laser, the entire surface of the skin is injured, stimulating a wound healing response that improves the collagen that's aligned to stimulates collagen formation, remodels the existing collagen and creates new skin cells that smooth’s the skin in general.
With fractional laser, we're still stimulating that by injuring the skin in a very controlled way but instead of the entire surface being injured only a fraction, only small dots of injury are created and thus we're still stimulating the same process but the residual skin the areas that are undamaged service reservoirs for wound healing and it moves the healing time down from 7 to 10 days with full laser where the redness after that 7 to 10 days can last for months to 5 days until make-up and redness that only last for a few weeks, to maybe several weeks at most. Slight pinkness that can easily be covered with make up doing fractional resurfacing.
Recovery can be a few days to people with PDT and using a low way of link filter IPL treatment like what we do, patients are typically pretty puffy for the first couple of days and not in social commission, really there's puffiness, swelling, and some redness and that we see very commonly with photodynamic therapy that we often don’t see with IPL, so we tell people to plan on 3 days or so of downtime maybe over weekend with photodynamic therapy obviously longer with fractional laser.
So they are apples and oranges in a way comparing fractional laser, photodynamic therapy they work in completely different ways. Fractional laser is ablative means it actually injuring the skin cells themselves and stimulating remodeling photodynamic therapy on the other hand is using a photo-sensitizing agent to shrink the glands down and kills bacteria and we still have that intense pulse of light if you will that can get rid of the sun damage pigment that is called melanin as well as improve or reduce the vascular through the redness or flashing that we see in the skin.
So acne management is complicated I hope I have provided a little bit of enlightenment in terms of the beginning options and skin care and then the more advanced options. There are certainly medical options that can't be ignored like the use of antibiotics or certain other medications and they're very important too, but in terms of the energy interventional therapies, fractional laser for scarring is excellent choice, photodynamic therapy for pore size and for bacteria count reduction are excellent choices all inlaid on top of a good skin care program.
A very tricky subject, acne is a complex disease that has no magical wand that cures it all but one that you can surely get great improvement on if you're connected with the right advice and the right technologies.
This is Dr. Corey Maas on Looking Your Best. If you have any other question about acne send them in to DrMaas@MaasClinic.com, visit our website at MaasClinic.com or you can call for consultation at The Maas Clinic 415-567-7000. This is Dr. Corey Maas on Looking Your Best.”