medical acne

Blue Light / Photodynamic Therapy

Photodynamic therapy (PDT) is a treatment used by dermatologists to treat pre-cancerous lesions of the skin, acne, inflammatory rosacea, sun damage and photoaging. For sun damage related issues, this light is used in conjunction with a chemical that squeezes into unhealthy cells, and when it is exposed to the blue light, causes those cells to crust up and shed. This treatment is minimally invasive and has good outcomes with removing sun damaged and precancerous lesions from the skin.

What conditions are treated with the blue light / PDT?
◦ Actinic keratosis.
◦ Sun damage.
◦ Photoaging.
◦ Acne.
◦ Inflammatory rosacea.

What to expect during your PDT appointment?
◦ First your skin is cleansed.
◦ A prescription solution called Levulan is applied to the treatment areas.
◦ After 30-120 minutes (exact amount of time determined by your physician), the face is wiped with saline, goggles are placed over your eyes, and the treated skin is exposed to a special blue light.
◦ During this treatment, you may feel some burning or heat, but usually it is very tolerable.
◦ Sunscreen should then be applied, and for 48 hours you should avoid fluorescent lighting and natural sunlight.

What to expect after your PDT treatment?
◦ Within a few days you may get scabbing, crusting, inflammation and peeling.
◦ If any suspicious lesions persist in the weeks after the procedure, your dermatologist may take a biopsy.
◦ Wear sunscreen and avoid the sun for the week after the procedure, while your skin is healing.

Who is or isn't a good candidate for PDT?
◦ History of a porphyria.
◦ History of lupus.
◦ History of other photosensitive disorder.

Risks and side effects:
◦ If you have a history of cold sores, the virus can be reactivated by the light treatment and the infection can spread throughout the treated area; this could lead to scarring.
◦ Discuss this with your doctor; it may be recommended that you take a preventive dose of an antiviral medication.
◦ Scarring, infection and blistering is rare.
◦ The most common side effect is tenderness, inflammation, scabbing, crusting and peeling.

PDT and acne and inflammatory rosacea:
◦ The medicated solution Levulan may or may not be applied; when applied patients get more inflammation afterwards, but the clogged pores and pimples clear up much quicker.
◦ We advise 3-4 treatments every 3-4 weeks for the best results (if using Levulan); severe cases may require 5 treatments.
◦ It is usual to continue getting treatments every 3 months to maintain the improvement.
◦ Depending on the severity of the acne, the dermatologist may use a laser light (V-beam laser) rather than the blue light to penetrate deeper.
◦ This treatment is not covered by insurance for the treatment of acne or rosacea.

Chemical Peels

A chemical peel is a technique used to improve the appearance of fine lines, acne scars, discolorations or other surface changes of the skin on the face, neck or hands, and can be used to reduce breakouts and treat acne During the appointment, you will cleanse your face with a gentle cleanser, and then a chemical solution will be applied to the skin that will first cause it to become red, then tight, and then exfoliate and eventually peel off over the course of 5-10 days. The degree and duration of peeling will vary based on the strength of the peel. The new, regenerated skin is usually smoother and less wrinkled than the old skin, but is temporarily more sensitive to the sun.

The three basic types of chemical peels:
◦ Superficial peel: Alpha-hydroxy acid or another mild acid is used to penetrate only the outer layer of skin to gently exfoliate it. The treatment is used to improve the appearance of mild skin discoloration and rough skin as well as to refresh the face, neck, chest or hands.
◦ Medium peel: Glycolic or trichloroacetic acid is applied to penetrate the outer and middle layers of skin to remove damaged skin cells. The treatment is used to improve age spots, fine lines and wrinkles, freckles and moderate skin discoloration. It also can be used to smooth rough skin and treat some precancerous skin growths.
◦ Deep peel: Tricholoracetic acid or phenol is applied to deeply penetrate the middle layer of skin to remove damaged skin cells. The treatment removes moderate lines, age spots, freckles and shallow scars. Patients will see a dramatic improvement in skin appearance but it will involve more peeling and a longer healing time.

Who is not a candidate for a chemical peel?
◦ Active cold sore or herpes simplex infection on/near the area to be treated.
◦ Nursing or pregnant.
◦ Have taken Accutane in last six months.
◦ Have psoriasis, eczema, dermatitis or rosacea in the treatment area.
◦ Have used Retin-A, Renova, prescription skin care products, products that contain ascorbic acid, bleaching or skin-lightening agents or other acid-based products in the last 48 hours.

Are chemical peels painful?
◦ Chemicals peels sting but do not cause a great deal of pain.
◦ The gentlest peels use alpha-hydroxy, glycolic, salicylic, lactic or fruit acids are also gentle but still may cause stinging, redness, irritation and crusting.
◦ Trichloroacetic acid is a stronger peel and sting/burn more than those the gentler peels.

What are the complications or potential side effects of a chemical peel?
◦ Temporary or permanent change in skin color, particularly for women on birth control pills, who subsequently become pregnant or have a history of brownish facial discoloration.
◦ Scarring.
◦ Reactivation of cold sores that can spread throughout the treated area.

What to expect after a chemical peel?
◦ The day of the peel your skin may be pink.
◦ The next day your skin may feel tight, as if it will crack if you laugh too hard.
◦ In the following days, your skin may flake or peel. The degree of this will depend on the strength of the peel.

After care:
◦ Gentle skin care is recommended during the healing phase.
◦ Avoid exfoliants and retinoid creams.
◦ Gentle cleansers are ideal during this time, with gentle moisturizing.
◦ Sun exposure should be kept at a minimum.
◦ No smoking during the healing phase; this can prolong healing time and cause infection and scarring.
◦ DO NOT PICK the peeling skin; the skin will shed when the new skin is ready.