Integral Clinic for Acne

In CDERMA, Dr. Ursula Piñeyro Garza and her personnel have Successfully treated acne for approximately 14 years and counts with more than 5 thousand satisfied patients with her treatments.

It is not easy to say this quantity of satisfied patients in this treatment and more when acne is not a simple business where there is a big quantity of hormonal, bacterial or sebum secreting factors, etc., and where there are also multiple types of acne. For that reason, there are no cooking recipes but a well-structured medical consultation to get to an individual diagnosis and so perform the adequate treatment which can be tailored fit for each patient.

In CDERMA we count with an Integral Clinic for Acne which counts with the diagnosis of Dr. Ursula Piñeyro, it is common to ask for clinical exams if necessary, the use of Chemical Peelings with organic substances from fruit and/or the use of phototherapy or photodynamic, as well as the use of Lasers for active lesions or for acne scars and for the latter the EXODERM here described is also very helpful to erase them. In some cases it will also be necessary the use of oral Isotretinoin to improve acne.

In some cases it will be necessary to have an inter-consultation with a specialist in hormones called Endocrinologist to correct the hormonal irregularities detected in the clinical analyses since in many cases these hormonal ups and downs produce acne among other signs and symptoms which should be corrected in order for the Dermatologic treatment to be effective.

GETTING TO KNOW A LITTLE ABOUT THE ORIGEN OF ACNE:

The acne vulgaris is a common skin illness which mainly affects adolescents, though it could also appear at any age. It is defined as a chronic inflammatory dermatosis which affects the hair follicle and its drainage canaliculus and which characterizes for presenting pimples and zits which are medically named as comedones and inflammatory lesions that include papules, pustules and nodules. In the most severe cases, furuncles and deforming abscesses can be formed which may lead to scars. It can be associated to a psychological and social deterioration since it can lead to scars and depression.

The four main physiopathology factors that influence on the acne’s pathogenesis include hyperplasia of the sebaceous gland with hyper seborrhea, abnormal follicular differentiation, and hyper colonization of the follicle with Propionibacterium acnes, inflammation and immune response.

1

Causes:

The sebaceous or skins grease secretion produced by the sebaceous glands in the follicles, serves to lubricate the skin. If the conduct of this gland which reaches the skin is closed, the result might be pimples or acne.

While the cause is not known, it is believed that acne appears due to the increment of males hormones (androgens, present in women and men) which stimulate the sebaceous glands and the presence of skin bacteria. Some cosmetics stimulate the acne, especially if they are greasy. The medication to prevent epilepsy, the contraceptive pills and steroids increase the acne.

If the personal care of the skin is not good and the acne is severe, it will be very probable that oral medication be required to control it.

2

Factors that help acne to appear:

  • The hormonal increment during adolescence (this causes the glands to block more often)
  • The hormonal changes that occur during pregnancy
  • To start or stop taking contraceptive pills
  • Hereditary factors (if your parents had acne, you might also have it)
  • Certain medications
  • Greasy makeup

Which is the medical name for the different types of zits?

  1. Closed comedo
  2. Open comedo
  3. Papule
  4. Pustule
  5. Furuncles

3

How is acne treated?

Hygienic and dietetic measures:

They are a fundamental basis to a better control of the illness. There must be an emphasis in the facial wash up twice a day with warm water and beauty soap (sometimes dermatologic soaps can be used to help control seborrhea), without scrubbing the skin in order not to destroy the lesions. Because alimentation has not been related to acne, the patients can have a normal balanced alimentation. In Cderma some magistral formulations have been designed for the washing of the face which antiseptic soap exfoliates and decreases significantly the facial sebum.

4

Education and Specific cares:

Do not apply greasy creams or makeups on the face, avoid the use of home facemasks or remedies. There should not be manipulation for the lesions since they can leave more spots and residual scars. There must not be exposure to the sun without protection while under exfoliating treatments. Do not eat vitamins from B complex, corticosteroids or androgenic hormones which could worsen the clinic picture.

Does the alimentation affect or not?

There are multiple opinions about whether food can affect in the appearance of acne or not. In multiple scientific studies it is not concluded if there are specific foods about the production of acne nor if chocolate, almonds or avocado but there are studies in countries where the consumption of complex sugars.

What should NOT be done with Acne?

Try not to squeeze, scratch, dig nor rub the pimples. Even when it is tempting to do so, it can lead to scarring and infections in the skin.

  • Avoid to use headbands, baseball caps and other tight hats.
  • Avoid touching the face with hands or fingers.
  • Avoid greasy creams or cosmetics. Remove makeup at night. The non-comedogenic products have been tested and it has been proven that they do not block the pores nor cause acne.

Description of the Conventional Acne Treatments:

  • Topic treatments (lotions, creams and gels). The first thing to be prescribed.
  • Chemical Peelings: For exfoliation, antisepsis and sebum reduction.
  • Oral antibiotics (tetracycline, doxycycline, minocycline and erythromycin), generally prescribed for moderate or severe acne.
  • Oral isotretinoin and its equivalents – reserved for the cases of severe acne.
  • Treatment with Lights (Photodynamic and Phototherapy)
  • Treatment of Acne Scars: Exoderm or CO2 Laser
  • The selection of the topic treatment should depend on the clinical of the type of acne that prevails and the tolerance of the skin.
  • The current topic therapies can be divided in three categories:
    • Antimicrobial such as: benzoyl peroxide, antibiotics (clindamycin and erythromycin).
    • Retinoids: tretinoin, adapalene, tazarotene.
    • Others: azelaic acid, Sulphur, resorcinol, abrasive agents and nicotinamide (3).

The topical treatments should be applied in all the skin that might be affected, not only in the visible lesions. These types of treatments work by preventing the formation of new lesions and not only the ones that have already been formed (17).

In the election of the ideal medication for the treatment of acne, the active principle is as important as the vehicle (cream, lotion or solution), and the type of skin of the patient. The creams are appropriate for the patients with dry or sensitive skin, since they require a non-irritating formulation and a non-drying one. For patients with greasy skin it is more indicated to use gels that have a dry skin effect, but the gels can cause that some patients present irritation similar to burnings and also, it does not allow for certain types of cosmetics to adhere to the skin. The lotions can be used with any type of skin, but they can cause drying effects or a burning type since they contain propylene glycol. The solutions are used as a vehicle for the antibiotics that dissolve in alcohol; just as the gels, the solutions work better in patients with greasy skin.

Peelings used in Acne:

Soft TCA, Glycolic acid 10% to 70%, Kojic, Resorcinol and/or Salicylic acid. This will depend of the type of acne and the stage in which it is present.

Oral antibiotic treatment:

 Antibiotics. The oral antibiotics are the first therapeutic option in the case of moderate acne. They have a bacteriostatic activity over P.acnes, but they also have a certain anti-inflammatory effect, by inhibiting the chemiotaxis of the neutrophils and reducing the quantity of free greasy acids. The most used are the tetracycline and its derivatives (doxycycline and minocycline) and the erythromycin. The habitual dosage of doxycycline is of 50 to 100 mg/day and of the minocycline is of 100 mg/day. It is important to remember that the tetracycline should be taken before breakfast, that it is phototoxic and is contraindicated in pregnant women and in children because it can produce irreversible staining of the dental enamel. The doxycycline can produce esophagitis, so the patient should not lie down until after two hours. The minocycline can also cause gastrointestinal pain, can produce a sense of dizziness, persistent cutaneous pigmentation, although not definite, particularly in patients with dark skin, and very rarely severe toxic dermatitis such as the Stevens – Johnson syndrome. The erythromycin and the rest of the macrolides are considered a second election and recommended in case of allergy, intolerance to tetracycline of lack of response to the treatment. The prolonged use of any of these antibiotics of a wide spectrum favors the appearance of vaginitis due to candida.

Hormonal treatments (Anti-androgens)

Anti-androgens. It is the treatment of choice in those women with signs of hyperandrogenism (hirsutism, intense seborrhea, menstrual alterations, and polycystic ovary), but it can also be offered in those patients with moderate acne who are already taking anovulatories as a contraceptive method. The main objective of this treatment is to block the action of the androgens in the sebaceous gland which allows the decrease of the sebum production. The most used drug for this end is the cyproterone acetate which is usually associated with estrogens. There is a commercialized combination of 2 mg of cyproterone acetate and 0.035 mg of ethinyl estradiol (Diane 35). The beneficial effect over acne starts to show after 3 to 6 months of initializing the treatment, which should be prolonged at least for a year.

 

Resistance to Insulin and Acne:

Acne is caused due to the excessive production of sebum in the skin. The sebum is actually an oil that keeps the skin soft and flexible. The greasy skin’s surface provides a favorable environment for bacteria which leads to zits. The accumulation of dead skin and hair follicles in a determined place is also one of the reasons to cause acne. The resistance to insulin has proven to be one of the factors that lead to an excess of the production of oil in the skin. Therefore, indirectly, leads to acne.

On the other hand, the high levels of insulin in the body is also believed to unleash the male hormones in women, this is, androgens. The androgens are present both in men and in women. Even in normal conditions, this hormone can lead to acne. Thus, if the androgens level increases, women get acne. The high levels of androgens also increase the production of sebum or oil under the skin. Therefore, anyway, the resistance to insulin have proven to be one of the causes for acne in men and women.

The treatment of the causes of the resistance to insulin can help in the treatment for acne caused due to it. As previously mentioned, the fact it has a rich diet in carbohydrates and sugar is one of the main causes of resistance to insulin. So, with the objective to treat acne, ones must have a diet low on refined carbohydrates and sugar. The food such as white bread, white pasta, white rice, etc. should be avoided. As a sedentary life style also increases the risk of resistance to insulin, it is essential to carry out some type of exercise daily. In the third place, if the condition is caused due to obesity, first you should lose weight a little and then have an adequate diet and an exercise regimen. It should also be taken into account that the resistance of insulin can also be caused by some base disease and the disorder, which must be treated immediately.

The Metformin is a base medication in the treatment of the resistance of the Insulin and here it must be combined with the Dermatologic treatment that has been chosen for the patient.

Oral Isotretinoin:

The adequate use of oral Isotretinoin will always be a decision between the Dermatologist and the patient; it is also a function of the physician to clearly state to the patient the pros and cons and to clarify the myths about this medication.

In cases of acne conglobate or one which does not respond to conventional treatments, oral retinoids derived from vitamin A are employed, mainly isotretinoin. Its mechanism of action is over the sebaceous gland and the follicular hyper keratosis. It is administered orally in doses of 0.5-1mg/kg of weight/day until it reaches the total dosage of 120-150 mg/kg of weight, which usually takes between 6 to 8 months. It is a medication that has many collateral effects such as chelitis, xerostomia, xerophtalmia, xerosis, facial erythema, epistaxis, teratogeny, dyslipidemias, etc., that is why some laboratory studies should be performed before, during and after treatment to have an adequate control, and women should not get pregnant during the treatment taking control with a contraceptive method.

 

Use of Technology in Acne:

Recently, the addition of technology of different light spectrums have shortened the treatments and boosted its benefits as well as polished the results to also give a very important improvement to that damaged skin which is usually present with a very hurt self-esteem, too. In short, it is not sufficient to only heal or control the acne but we have as a responsibility to beautify that skin.

It is of the utmost importance to have Phototherapy with Ultraviolet Light lamps to sensitize the skin to the treatment and to have a greater effectivity of it.

In the same way the IPL and the Laser can significantly decrease the red inflammatory spots of acne.

Correction of Acne Scars:

 The Exoderm (attenuated phenol), a millenarian technique but significantly improved in the las 15 years by the Israeli Dr. Finsti is an irreplaceable tool for the correction of acne scars to erase them in a definite way from 50 to 90%.

5

MICRO ABLATIVE FRACTIONAL LASER

The innovative benefits of the micro ablative fractional laser (fractional laser), with a miniaturized impact, allows us to adapt the treatment to each patient, according to the form and depth of the acne scars.

The laser incorporates a scanner that fractions the impact in thousands of mini columns of energy. This way, only minimal portions of skin are reached by the laser’s impact, leaving “bridges of intact skin between them”. This technology allows to modulate the ablative effect (exfoliation) to eliminate that millimeter of affected skin due to sequels of acne.

Flexible unanaDey. The surface of the greasy skin provides a favorable environment for the bacteria that cause zits. The accumulation of dead skin and the hair follicles in a determined place is also one of the reasons to cause acne. The resistance to insulin has proven to be one of the factors that lead to the excessive production of oil in the skin. Therefore, indirectly, it leads to acne.

On the other hand, the high levels of insulin in the body are also believed to unchain the male hormones in women, this is, androgens. The androgens are present in both men and women. Even in normal conditions, this hormone can cause acne. Therefore, if the level of androgens increases, this leads to acne in women. The high levels of androgens also increases the production of sebum or oil under the skin. Consequently, anyway, the resistance to insulin has proven to be one of the causes for acne to appear both in men and women.