ZAP YOUR ZITS |
For teens, acne is sort of a rite of passage but for women—especially those who start breaking out for the first time as adults—it can be extremely embarrassing. So whether you are prone to the occasional pimple or are experiencing a more serious skin problem, Saadiya Ahmad investigates effective ways to get clearer skin today. |
TYPES |
Acne can vary from mild to moderate and is a chronic condition which while can be controlled, is not curable. “There are different types of acne; the most common is acne vulgaris which can vary from person to person, ranging from the skin having a few whiteheads and blackheads to more severe cases with papules, pustules, nodules and cysts,” he explains, “Mild acne vulgaris is characterised by closed commodones while more severe forms are cysts which are filled with pus and nodules forming large hard bumps under the skin. Acne rosacea is another type of acne; “Sufferers of this have excessively dilated blood vessels and the skin appears “very angry,” he states, “This is possibly one of the most difficult conditions to control and it affects millions of people – often women over 30.” This is a chronic condition, suggests Dr Singel, which although controllable and the symptoms eased, is almost impossible to cure completely. Acne conglobata is the most severe form of acne and mainly found in men, he says and characterised by numerous large lesions which may be interconnected. Acne fulminans is another whose symptoms include severe nodules and cysts which often lead to disfiguring scars. “Normally confined to young men, symptoms can also include aching joints and fever,” he says. Gram negative folliculitis is another type of acne which is very rare; “This is a bacterial infection characterised by pustules and cysts.” A severe form of facial acne affecting only females, usually between ages 20 and 40, says Dr Singel is Pyoderma faciale which is characterised by nodules, sores and pustules. “These are very painful and can lead to scarring,” he says. |
ACNE EXCORIEE |
Acne excoriee is another somewhat disturbing form of acne affecting yet not limited to women, points out Dr Singel. “While many individuals get pimples throughout their lifetime and are able to control them, when a pimple appears on the face of someone who may have low self esteem or mood related issues, they can be inclined to ‘pick’ at the blemish,” he says, which means that an infection can occur due to bacteria on the hands. This can cause more pimples and therefore the condition becomes part of a vicious cycle, he says; “A sign which distinguishes acne excoriee from acne vulgaris is the presence of pigmented lesions on the face left behind by picking the skin,” he says, and because this is often a psychological condition, treatment must first be sought by a doctor who is capable of understanding the root of the issue. |
ISOLAZ DEEP PORE THERAPY |
Using IPL combined with vacuum suction, Isolaz deep pore laser therapy explains Natasha Bennett, can help any individual suffering from acne or post inflammatory pigmentation. “The treatment begins after the skin is cleansed and next a cooled tip is placed onto the skin; the vacuum draws the target up out of the skin while the ‘pulse’ of light that’s passed into the skin kills bacteria and stimulates collagen production,” she says. Next a technique known as ‘profusion’ is used to penetrate a topical antibiotic serum into the skin to further enhance the results. While the treatment is virtually pain free, there may be occasional discomfort when the skin is being treated with the light. “As is the case with all laser and light-based therapies, systemic drugs such as certain antibiotics and in all cases Roaccutane, are contra indicated,” she notes. TIME Approximately 90 minutes |
PIXEL RF |
The Pixel RF, explains Bennett, is incredibly effective in treating over active sebaceous activity, active acne and scarring and pitting as a result of acne. “Ideal candidates are individuals suffering from excessive sebum production, active acne (not acne rosacea) and those who have acne pitting and scarring will benefit the most,” she says, “This is the ultimate treatment for scar tissue, pigmentation and the control of excess oil and acne and is the ‘gold standard’ in fractional resurfacing.” Treatment involves the use of a local anaesthetic to ensure the patient is more comfortable. “The skin is treated all over with the RF hand piece to create ‘trauma’ on the skin,” she says and this will encourage the collagen support network to accelerate, therefore, softening scars while the radio frequency is effective in killing bacteria in the skin. TIME approximately 60 minutes; depending on the severity and the type of acne and it will require repeat sessions. RESULTS Downtime is approximately one week, however make-up can be worn. The skin can be red and inflamed for a few days post treatment. Skin can peel and scab slightly for up to a week post treatment. On the fifth day the patient returns for a hydrating session where dead cells are exfoliated. Twenty one days post treatment, scars can be softened, colour more uniform and active acne may be controlled. |
GRADING |
Despite more than 25 grading systems for acne, Dr Anna Petrus, points out that there is still a lack of a single, standardized system consistently used in practice and research. “I prefer to grade acne simply as mild which is comedonal, moderate which is inflammatory and severe which is cystic / nodular,” she explains. |
ONSET |
Adult onset acne can be associated with other medical conditions that are sometimes characterized by excess androgens such as polycystic ovarian syndrome however most acne patients have no evidence of significant hormonal abnormalities, says Dr Mallory. “Interestingly in general, females with acne do not have irregular menses, hirsutism or female pattern androgenic alopecia and therefore it’s not usually necessary to investigate for associated disorders such as polycystic ovarian syndrome unless these other features are present and/or the acne appears refractory to therapy.” Recent studies also suggest a link between smoking and adult onset acne in females, especially above 39 years of age. |
DIET |
There’s an ongoing debate, admits Dr Mallory, concerning the relation between acne and diet. “During the last American Academy of Dermatology (AAD) meeting which I recently attended, some evidence had been presented confirming that acne can be aggravated by milk (particularly skimmed) and a high glycaemic index diet,” she notes, “Therefore, it may be reasonable to consult a dietician to optimize the anti-acne treatment outcome.” |
ROACCUTANE (BOX-OUT) |
Roaccutane or oral isotretinoin works extremely well in cases of severe acne which is not responding to appropriate antibiotics and topical therapy, says Dr Mallory; “Roaccutane is the only therapy which affects all four main aetiological factors implicated in acne; it reduces sebum excretion by 90 percent within six weeks of starting treatment and also reduces comedones by 90 percent after about three months of treatment,” she explains and it also has an effect on the bacteria and reduces inflammation. The downside is that it can cause serious side effects if used inappropriately and it’s imperative to strictly follow the instructions of the prescribing physician. “Commonly it can cause dryness of the skin and mucous membranes and may also affect the healing process, so no lasers or peels should be performed while taking Roaccutane and within six months of discontinuing it,” explains Dr Mallory. With regards to the link between depression and Roaccutane, Dr Mallory clarifies: “It was stated in the last AAD meeting that most studies confirmed no substantial evidence of depression induced by Roaccutane. However, some new data suggests its relation to inflammatory bowel disease.” |
FRACTIONAL CO2 LASER |
This treatment is the most effective way of dealing with acne scarring as well as wrinkles and freckles. “This non-invasive treatment delivers a laser beam divided into thousands of microscopic treatment zones that target a fraction of the skin at a time, hence only causing fractional damage,” she says which allows the skin to heal much faster and is safer than if the whole area was treated. “The patient should arrive one hour early to have an anaesthetic cream applied to minimize any discomfort,” she says, “Post treatment, it’s paramount to avoid sun exposure as well as use sun protection of at least SPF 30.” Generally speaking three to five sessions at one to two monthly intervals should be expected. TIME Approximately 30 minutes for the face RESULTS Post treatment, the skin appears red and swollen. There is a bronzing effect and mild peeling after a few days which lasts up to one week. RISKS It’s relatively safe, however there may be post-inflammatory hyperpigmentation in darker skinned individuals, therefore a bleaching cream may be recommended before and after to minimize the risk. |
FRAXEL LASER |
According to Dr Mallory, fraxel uses a similar concept to fractional CO2, but is less aggressive. “In this, microscopic laser columns penetrate deep into the dermis to create tiny wounds which trigger the body’s natural response system to heal those wounds,” she says and this process expedites the body’s remodelling of collagen and elastic which results in tighter, fresher and more youthful looking skin. “Fraxel improves acne scars and works effectively on fine lines, freckles and enlarged pores while improving skin tone,” emphasizes Dr Mallory and four to five sessions at monthly intervals are usually recommended. TIME Approximately 30 minutes for the face. RESULTS Post treatment the skin appears sunburnt but within two to three days it can be concealed with light make-up. After about five days the skin looks smoother, younger and radiant. RISKS The risk of hyperpigmentation is lower than with fractional CO2, but still sun protection and sometimes whitening creams are advisable. |
ADULT ACNE |
There is no single reason for adult acne, elaborates Dr Anwar Al Hammadi, “Usually multiple factors play role in causing adult acne; bacterial infection and hyperactivity of oil secreting glands and hormonal changes are the main causes of classical acne, however, some other factors may play a role,” he says. Oil from moisturizers or cosmetics, pressure from sports helmets or equipment, backpacks, tight collars, or tight uniforms, environmental irritants, such as pollution and high humidity, squeezing or picking at blemishes, and/or hard scrubbing of the skin may also contribute. |
ACNE SCARS |
Before commencing with any procedure or cosmetic treatment to treat acne scars, Dr Al Hammadi emphasizes that it’s important to control any active inflammatory pimples. “If there’s any active acne, medical treatment can be given until the condition becomes stable which will also improve and heal some of these marks over time,” he says. Next the appropriate acne scar treatment is selected depending on scarring or post inflammatory pigmentation. “Deep pitted scarring is more difficult to clear in comparison to superficial scarring,” he notes, adding, “A few treatments can be modified based on case severity and type of scarring and these include: excision and punch replacement graft in which the acne scar or cluster of small scars, is removed with a scalpel.” The resulting "hole" is either sewn together or replaced with a patch of normal skin from elsewhere on the body. Excision, he adds, is particularly effective for ice-pick scars. Subcision is another method whereby after numbing the skin, a probe is inserted beneath the acne scar, which Dr Al Hammadi explains will loosen it from the surrounding tissue and this allows the scar to be elevated to the level of the normal skin. “Subcision is used for depressed acne scars such as a boxed scar or rolling scar,” he says. Fillers have been used traditionally to enhance facial volume; however Dr Al Hammadi says that dermal fillers can actually be injected beneath a depressed acne scar to elevate it to the level of the surrounding skin. These fillers, he stresses, are most effective for rolling scars. “The benefit from soft tissue fillers are that they usually last from 3 to 18 months, depending on the material used,” he notes however the treatment must be repeated to maintain the appearance. |
CHEMICAL PEELING |
One of the most common acne treatments, points out Dr Al Hammadi is chemical peeling. “Glycolic acid, salicylic acid or trichloroacetic acid is applied to the skin to remove the top layer and generate new skin growth beneath the acne scars which in essence lifts the scar to the level of the surrounding skin, minimizing its appearance,” he says, “In general, "medium" or "deep" peels are used to treat acne, meaning that the peel is designed to affect the deeper layers of the skin.” |
TIME 15 to 30 minutes and depending of the severity of the case an average of three sessions is needed with four to six weeks interval between each session RESULTS Results vary from patient to patient depending on how many sessions are done; the ultimate result is clearance of most black and white heads and acne lesions resulting in a healthier, glowing skin RISKS It is a safe procedure; however, dyspigmentation is a possible risk especially in darker skin and those over-exposing the skin to sun light. Bandages may be required for several days. |
ACNE ANATOMY |
According to Dr Sanjay Parashar, Specialist Plastic Surgeon and Founder/ Director of Cocoona Centre for Aesthetic Transformation acne vulgaris starts with the accumulation of thick sebaceous material inside the gland forming blackheads and whiteheads. “This gets infected by Propionibacterium acnes and then the sebaceous material is converted into pus forming a micro-abscess,” he explains, “The abscess either subsides leaving the nidus inside that can erupt again or it bursts out, shattering the overlying skin and eventually causing scars.” Manual squeezing can have the same effect; “At times it forms unhealthy tissue called granulation tissue which remains inside for a long time and then forms a lump of scar tissue,” he says; “The resulting scars can be shallow crater, punched out scars, hypertrophic scars or Ice picks scars.” |
MICRO-DRAINAGE AND MICRO-EXTRACTION |
Micro-drainage is a procedure done to release the pus before it ruptures, elaborates Dr Parashar; “It is done with magnification and small needle,” he says and once the pus is drained out, the surrounding skin heals well with minimal discolouration and scarring. “The technique is done under magnification with the help of very fine needle and allows egress of the trapped material along with its wall which if left behind causes recurrence of acne,” he says and once this material is extracted, topical medications prevent reoccurrence of cysts and black heads. “An ideal candidate for this procedure is an individual with extensive black heads, cysts, inflamed and infected acne while contra-indications include acne rosacea and acne conditions which are not associated with black heads and micro-abscesses. TIME 20 to 30 minutes per session and requires repeat sessions depending upon the severity of acne. This office based procedure needs to be repeated every week for at least four to six WEEKs. RESULTS It minimizes acne significantly and there is mild redness that can be covered with makeup, no other downtime. There is mild redness that can be covered with makeup, no other downtime RISKS Minimal but there can still be recurrence of acne, skin inflammation and/or hyperpigmentation CONTACT Cocoona Centre for Aesthetic Transformation 04-3941090 |
EXPERTS PROFILE |
Dr Sanjay Parashar, Specialist Plastic Surgeon and Founder and Director of Cocoona Centre for Aesthetic Transformation, has been in plastic surgery since 1993 and undergone training and worked in India, Australia, USA, South Korea and Bahrain. Working in the UAE for six years to date, his specialty is in aesthetic surgery and craniofacial surgery. Dr Anwar Al Hammadi is a consultant dermatologist and is also a skilled double board certified cosmetic surgeon by the American Board of Dermatology and the Royal College of Physicians and Surgeons in Canada. He brings 10 years of clinical experience in treating all types of common and uncommon skin disorders including: acne, warts, psoriasis, vitiligo, eczema, hair and nail disorders, skin cancers and infections, and birth marks. Dr Anna Petrus-Mallory, General Practitioner, specialises in non-invasive aesthetic procedures such as laser removal of hair, veins and tattoos, Thermage, Fraxel, fractional CO2 laser, Botox and chemical peels. She completed her medical training in the UK, Poland and Italy and has a Diploma in Aesthetic Medicine and is a member of the American Academy of Aesthetic Medicine. |
PIMPLE BUSTERS |
Eve Lom’s Dynaspot is comprised of natural extracts of fennel, chamomile, tea tree and yarrow oils to dry out spots overnight, whilst soothing and healing the skin. NIMUE Purifying Youth Mask is a clay based mask that offers the beneficial antiseptic, soothing and healing properties of Tea Tree and Chamomile oil. |