Acne Treatment - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Acne Treatment or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Acne Treatment
Acne treatment is among the most common treatments performed at our practice. Fortunately, there are various ways to treat acne effectively. Using experience, knowledge, medication, and technology, we treat acne aggressively to deliver the best results possible.
Procedure Efficacy
Photodynamic therapy and medication (e.g. Accutane) are most effective for the treatment of severe acne. Medications, facials, and laser treatment with PDL (Pulsed Dye Laser) are the most effective treatments for moderate acne. Mild acne is best treated by a combination of facials, chemical peels, and microdermabrasion.
| mild acne | moderate acne | severe / cystic acne | |
|---|---|---|---|
| AviClear Laser Treatment | +++ | +++ | +++ |
| Photodynamic Therapy | - | +++ | +++ |
| Medication | +++ | +++ | +++ |
| Facials/ Backcials | +++ | +++ | ++ |
| Chemical Peels | +++ | ++ | + |
| Micro-dermabrasion | ++ | - | - |
| Pulsed Dye Laser | - | +++ | ++ |
| Smoothbeam Laser | - | ++ | ++ |
AviClear Permanent Laser Acne Treatment
Revolutionary New FDA Approved Treatment For All Acne Types
87% of patients saw at least 50% reduction of acne in 6 months!
No Medications, No Downtime, Minimal Side-effects, Incredible Results
Treatment Plan
Effective treatment often requires the combination of different modalities to treat all components that cause acne. For best and fast results, medical treatment or photodynamic therapy should be supported by various procedures.
Medical extraction facials, salicylic acid peels, and microdermabrasion open up the microcomedones, the starter lesions of all acne. Glycolic acid products and peels also diminish pigmentation from past breakouts.
Time to Results
| mild acne | moderate acne | severe / cystic acne | |
|---|---|---|---|
| time | 1-2 months | 2-4 months | 4-6 months |
Let's start...
First, watch to learn what type of acne you have
Mild Acne? Learn how to treat it
Treatment of Moderate Acne
Treatment of Severe Acne
Topical medical treatments target several components of acne and are usually used to prevent acne breakouts.
When acne is very severe and scar formation is impending, photodynamic therapy or systemic treatments are indicated.
Treatment Comparison
| AviClear Laser Treatment | Photo-dynamic Therapy | Medi-cations | Acne Facial | Acne Facial Extraction (*) | Chemical Peels | Micro-derma-brasion | Pulsed Dye Laser | Smooth-beam laser | |
|---|---|---|---|---|---|---|---|---|---|
| Results | +++ | +++ | +++ | ++ | ++ | ++ | + | ++ | ++ |
| Risks | - | ++ | +++ | + | + | + | - | ++ | ++ |
| # of treatments | 3 | 4-6 | NA | 2-6 | 2-6 | 3-6 | 3-6 | 3-4 | 3-4 |
| Price per treatment | To Be Announced | $650 | varies | $98 | varies | $100,$500/6 | $120, $600/6 | $250 | $250 |
| Insurance Coverage (**) | no | no | yes | no | yes | no | no | no | no |
(*) A prior medical consultation and an explicit recommendation by the medical provider (not by an aesthetician) is required. Please check the specific rate, your deductible, coinsurance, and co-pay on this procedure with your insurance using ICD9 code 706.1 and CPT 10040.
(**) Copay and deductable might result in out-of-pocket cost
- Treatment by core causes
- Tazarotene
- Tretinoin,
- Adapalene,
- Isotretinoin
- Salicylic acid incl. peel
- Glycolic acid incl. peel
- Benzoyl peroxide
- Sulfur
- Facials with extractions
- Microderm-abrasion
- Avoid tanning
- Use sunscreen regularly
- Spironolactone
- Oral contraceptive
- Cyproterone acetate (not available in US)
- Isotretinoin
- Photodynamic therapy
- Smoothbeam laser
- Alfalfa
- Flaxseed
- Oats, Celery Parsley
- Rhubarb Fennel Evening primrose oil
- Exercise
- Yoga
- Meditation
- Biofeedback
- Topical and some oral antibiotics
- Sulfur
- Benzoyl peroxide
- Photodynamic therapy
- Blue light
- Isolaz
- Visible light (not tanning beds)
- VitaminB3 + zinc + copper + azeleic acid complex
- Anti-inflammtory antibiotics
- Isotretinoin
- Tazarotene
- Sodium sulfacetamide
- Sulfur
- Dapsone (topical)
- Pulsed dye laser
- Photodynamic therapy
- Avocados Nuts,
- Flaxseed Avoid refined carbo-hydrates
- Avoid trans-fat
Medicine Laser/light device Nutrition Other supportive treatment Overgrowing skin clogging oil ducts Hormone regulation+ response Bacterial colonization Antibacterial cleanser Inflammation - Patient Handout
- Genetic factors that promote clogging of the oil ducts
- Hormones that stimulate oil glands
- Bacteria that are feeding on the oils in enlarged glands
- Inflammatory reaction of the body to enlarged oil glands and presence of bacteria
Introduction
Appearance is important at any age yet undoubtedly it seems most important in your teenage years and in young adulthood. You are at the prime of your life in a time to form relationships and build your career. A flawless look is most desired during an interview or on your date. It seems unnatural that nature poses the extra burden of acne during this time, as if it wants to test your self confidence.
While some deal with acne very naturally, most people with blemishes, pimples, zits, painful cysts, dark marks and even scars from past breakouts have a significantly lowered self-esteem. They feel insecure, may not want to go out, develop depression, Many engage in activities that distract them from their ailment which can be positive but unfortunately also negative.
What causes acne?
Acne is caused by a combination of well known factorsDespite the common factors that cause acne, everyone’s expression of acne is unique. Acne needs different treatment on oily skin compared to dry skin. Many people have so called “combination” skin. Therefore treatment must be customized to each person. Care must be taken to avoid over drying of the skin as many prescription acne medicines tend to be formulated in drying rather than emollient bases. Medical treatment should be supported effectively by general skin care such as the use of very gently exfoliating cleansers (not scrubs), sunscreen that do not clog pores and moisturizers when necessary.
How is acne treated?
Targeting acne from only one angle may work when acne is extremely mild or just beginning. Customized treatment usually targets multiple causative factors. Retinoids promote proper turn-over of the skin, thereby unclogging the oil duct; acne facials unclog the oil duct and facilitate proper drainage of the oil gland and remove the bacteria infested content. Oral antibiotics and the pulsed dye laser reduce the inflammatory response. The Smoothbeam laser destroys oil glands. Topical and oral antibiotics reduce acne-promoting bacteria. Spironolactone and oral contraceptives help regulate hormonal levels or reduce the available androgens in women. Topical antiandrogens that can be used in men are still under investigation. Please see table below for more detailed information.
How can we help acne from the inside out?
The severity of acne can depend on our emotional well-being. Emotional distress can worsen many conditions. Hence, if you have acne stress can break you out more. This is not an imagined response; in fact stress increases your androgen levels and androgens turn up oil production. Effective relaxation techniques may be learned. Sometimes a simple exercise program is all it takes. Yoga, meditation or biofeedback techniques can be extremely beneficial.
What role does your diet play?
Reestablishing your balance should be a major effort on the road to healthy skin and will include paying attention to a well balanced diet. Under certain circumstances it can mean going back to basics such as eating raw foods or avoiding dairy, refined carbohydrates, cooked fat and meats. Hormone production is tweaked by alkaloid caffeine found in coffee or black tea and its cousin theobromine in chocolate. Hence avoiding these compounds may be necessary in more difficult to tackle acne or if you notice increased breakouts after ingesting these substances.
A number of fruit and vegetables are said to reduce acne such as mangos, rhubarb, dark berries, papayas, olives, watercress, fennel, garlic, celery, parsley, wild greens, salad leaves, avocado, olives, flaxseeds, alfalfa, Brazil nuts, pumpkin seeds , oats.
I recently visited Dr. Ringpfeil and she suggested that I go on Accutane. I have a few questions before I consider this course of treatment.
1. Can I get my eyebrows waxed while on Accutane?
2. Will my currents meds have an adverse reaction with Accutane (I can provide this information)
3. Can I drink alcohol on Accutane?
4. Can I go to the beach in the summer wearing sunscreen on Accutane or will it be easier to do the course of treatment during the winter months? I have another appointment with Dr. Ringpfeil on …… and would like to speak with her before this appointment.
Thank you
1. Not recommended while on Accutane.
2. There are very few medications that are contraindicated while on Accutane. Before suggesting or prescribing Accutane your current medication is reviewed for any contraindication.
3. No, absolutely not.
4. Sun tanning is dangerous and UVA rays were declared a carcinogen in August 2009. However, Accutane treatment in the summer is no more difficult than in the winter and throuout the year, efficient sunscreen should be applied to exposed skin.
For African American skin what do you suggest for blemishes and uneven skin tone? What type of treatment with somebody with moderate to severe acne would you suggest?
Whether African American, Asian or any other ethnicity, treatment of blemishes or acne is very individual and depends on many factors, not just the color of your skin. An in-person evaluation is crucial for treatment recommendation.
Hi,
I am 27 and suffered from acne since I was 15 with periods of excaperations and improvements with meds, but it has always seemed to be an underlying issue for me. Right now I would say that I have moderate acne, but every breakout I get seems to scar or leave a telltale red discoloration that lasts months! I have researched Photodynamic therapy and it seems like it could be a solution to my battle, except for the cost. My first questions is the cost, and if you offer packages? Does it remove the old acne marks? Does it really work as well as accutane?
Photodynamic therapy is used for severe acne when isotretinoin/Accutane is not an option, either for personal reasons or because of rare side effects.
On average 4-6 treatments, 4-6 weeks apart are needed to achieve clearing of the acne. According to the data we have available at this time, photodynamic therapy can achieve almost the same results as isotretinoin/Accutane in regards to clearing the acne. Both treatments work well on removing fresh scars or discoloration however photodynamic therapy works better at remodeling old scars. We charge $450 per treatment.
Franziska Ringpfeil, MD
Hello. Do you have any treatment for enlarge pores? Also I have this very very light brown small patch developing on my nose. (its almost unnoticeable) Is there any safe perrmanent way to get rid of this? I know enlarge pores are genetics… but having oily skin and a man doen’t help at all. Help.
Unfortunately, there is no treatment yet that eradicates large pores. Pores can tighten to a small degree with regular and lifelong use of a prescription topical retinoid in conjunction with glycolic acid that can e applied daily or as a peel. CO2 laser resurfacing also helps to reduce pore size to small degree. While it requires typically only one treatment it is a technique with considerable downtime (please see website) and therefore must be carefully weighed against the small benefit.
Franziska Ringpfeil, MD
Are there more natural approaches to treating acne? I would prefer to stay away from pills and creams that are harsh on my skin.
You may consider a well balanced diet rich in antioxidants, such as flax seed oil, green salad and avocado, to name just a few. The extract of the sugar cane (glycolic acid in daily topical lotions or applied during in-office peels) helps exfoliate the skin naturally and drives moisture into the skin. Acne facials serve as a means to mechanically extract acne lesions and are not harsh on skin.
There are a number of botanicals marketed for the treatment of a number of skin conditions and many have never undergone any rigorous testing, including safety testing. You may appreciate that nature does not hold only harmless substances in store for us – just think about poison ivy, or other poisonous plants. Current prescription medications have undergone rigorous testing for efficacy and safety. And not all acne medications are harsh on skin. An evaluation of your type of skin and your acne should yield a treatment plan that is tailored to your treatment preferences.
Franziska Ringpfeil, MD
I want to get my acne cleared, but I have no insurance as of now. Do you except clients with no credit, and who just make payments?
This is not problematic. We only charge for the services you receive on the day of the actual service; no upfront payment or credit for future services is collected. Please call the office for current consultation charge. We will discuss the treatment plan once you have been evaluated and will customize it to your needs.
I am 31 and about 6 years ago, I had a mild cystic acne breakout. I was put on Doryx for a short period, along with the topicals tazorac and duac. The combo cleared me up. I’ve remained on the topicals since then. I have a few cysts on my chin that flair up every now and again but not often. I visited a spa in the city in october for a facial and the esthetician encouraged me to go off of the prescriptions, convincing me that I would thank her in 6 months. It’s january and my skin is in pretty bad shape–not as bad as it could be of course–but I have a good collection of black heads on the sides of my face and a number of cysts. I just started using a medium level of retinol A a week ago as the esthetician suggested, as I really do (or did months ago) want to give this a 6 month trial. Anyway, my question: Can cystic acne be cleared from a retinol A alone? I have a pretty healthy diet and drink a good amount of water. I do experience stress a lot but that’s somewhat hard to control. Would you suggest I give the retinol A a go for another 2/3 months or am I running the risk of having a greater breakout/more scars? If so do you recommend I return to the products I was using before or it is unsafe to use said topicals for a long time? Thanks for your time.
Retinol is the break down product of topical retinoids, such as Tazorac. Retinoids are converted to retinol in the nucleus of skin cells where they work to control acne. Retinol does not treat cystic acne when delivered to the skin as it does not penetrate into the nucleus of cells as retinol. In other words, the retinol recommended by your esthetician will not fight your acne. Without evaluation of your skin I cannot comment on your specific treatment needs. You should certainly discuss this with your dermatologist during a consultation.
I am 10 and four 2 years i have been getting bad acne what would be a good solution?
There are many treatments available to you. Please set up an appointment for evaluation so that a treatment regimen can be tailored to your specific needs.
HI, I am 17 years old and I’ve been dealing with this problem for about 5 years .My acne goes up and down. I think its stress im not sure. BUt I am going on prom soon and I need to have something to treat this IMMEDIATELY and have a clear face.
Acne can be extremely bothersome. It tends to be present at a time in life when you would like it the least. In some, it is triggered by stress, in others by hormonal influences and there are also unknown triggers. It will burn out eventually. It is unpredictable whether one will have acne just a couple or several years. However, acne is treatable. The goal of treatment is to minimize the visible signs of acne until your body is ready to no longer make it. While some “quick fixes” are available to make you look good for an upcoming event, longer term treatment is the most successful and rewarding. It allows you not to stress about the big event as your skin will be in good shape already. If desired, long term treatment can be started at the same time as the “quick fixes” are prescribed.
Could you please tell me what the difference is between Pulsed Dye Laser, Smooth Beam Laser, and Photodynamic Therapy? I’m 38 years old and have had moderate to severe acne since I reached my 30s. I have tried antibiotics, topicals, etc. The last dermatologist I went to recommended Accutane, which I am strongly opposed to. I am looking into laser therapy now, but I wasn’t sure what the differences were. I have hyper-pigmentation from scarring, but no deep pock marks. I also have active cystic acne. Could you tell me what you would recommend? Thank you.
All three treatments that you are inquiring about treat acne.
PDL (pulsed dye laser) is used to treat inflammatory acne. Typically 2-4 treatments are administered about 4 weeks apart and will induce remission of inflammatory acne for about 6 months. It has no known long term effect on acne. It is often chosen when fast results are needed or when there is a contra-indication or hesitation to treat with chemicals. It is very safe as it has no long term side effects on the skin. Initially, you may expect redness, swelling and even a slight acne flare for several days. It is best used at least 10-14 days before an important event.
The Smoothbeam is a diode laser with only one ability: it destroys oil glands. It can be used in inflammatory acne as well as comedonal acne.
Between 3-4 treatments are needed every 4 weeks for desired results. It has similar short term effects as well as downtime as the PDL but does not typically flare acne. Like the PDL, it is safe to use without any long-term effects.
Photodynamic therapy (PDT) is capable of inducing remission in acne. The exact percentage in whom acne does not come back after the treatment course is unknown. Some investigators feel that the chance of remission may even be higher than with isotretinoin (Accutane) treatment yet we really do not have solid data on this. PDT employs the application of a photosensitizing substance to the area affected by acne. It stays on the skin for 1-3 hours and then is activated by a light source. Additional light activation after the treatment must be avoided for 42 hours. Therefore, strict sun precautions must be followed, which includes avoidance of fluorescent light.
Some will use sun protective clothing like a hat in addition to sunscreen that must be reapplied every 2 hours. The skin can be red and inflamed for up to one week although most will only have redness for a couple of days.
Typically 4-6 treatments are required. They can be spaced every 2-4 weeks.
In a blog I can only explain the differences between procedures but I am unable to recommend treatment for an obvious reasons: I have not evaluated your skin. Many other factors such as life style and finances have to be weighed as none of these treatments are insurance covered. Please make your appointment.