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Acne Treatment.What is New?
Prof. Osama B MoawadBy
a point prevalence of up to 100% among adolescents and often persists into adulthood, with detrimental effects on self-esteem.
Sixty percent of all acne cases are so-called ‘physiologic acne’, the other 40% are those that need continuous help by a specialist to prevent physical or psychological scarring
Sunlight Improve Acne
Up to 15% of acne patients notice that sweating causes a deterioration in their acne, especially if they live or work in a hot humid environment; for example, for a cook, ductal hydration may be the responsible factor
Sweating exacerbate Acne
PMS Causes Acne Flare
High Glycemic and Dairy Products exacerbate Acne
classification/grading scale (encompassing thenumbers and types of acne lesions as well asdisease severity) serve to facilitate therapeutic decision and assess response to treatment
What & Where
White Heads
Black Heads
Clinical Examination
Hirsutism
Late Onset Acne
Acanthosis
Alopecia
Obesity
Non Inflammatory acne
Mild Inflammatory Acne
Severe Inflammatory Acne
Nodulo-cystic Acne
Severe Nodulo-cystic Acne
Acne Fulminans
Acne Conglobata
Hidradenitis supprativa
Follicular Occlusion Tetrade
Acne Excoriee Fes Jeunes Filles
Acne Mechanica
Black HeadsWhite Heads
Nodulo-cystic AcneInflammatory
Acne ExcorieeAcne FulminansInflammatoryNodulo-cystic Acne Excoriee
FACE and Neck
Upper Chest
Abdomen
Shoulder and Upper Arm
BackBack
Buttocks
Groin
Thigh and Legs
Less Common Acne TypesDrug Induced
Occupational
Chloracne
Neonatal
Infantile
Topical systemic
Non ablative
Minimally ablative Ablative
Surgical
Acne Treatment
Topical Acne Treatment is the standard
Topical Acne Treatment
• Retinoids• Benzyol Peroxide• Antibiotics• Dapsone• Combinations• Miscellaneous
Retinoids+ Antibiotics is the Best
Acne Control- Topical
Acne Control- Topical
Retinoids+ Antibiotics is the Best
Retinoids+ Antibiotics is the Best
Mild-Moderate Non Inflammatory Acne
Retinoids+ Antibiotics is the Best
Mild-Moderate Non Inflammatory Acne
Retinoids+ Antibiotics is the Best
MSI Offers a Better Penetration of
Transdermal Drug Delivery System
Active ingredients
Stratum Corneum
Transepidermal is the main route while transappandageal route represent only 1% mainly for ions and large polar molecules
STC Modifier
Anti-Acne Masks
STC Modifier
It increases the penetration of topical treatment and Improve wide pores and superficial acne scars
Dermal Roller- STD
STD
Phonophoresis or Sonophoresis
CavitationHeatingAcoustic microstreaming
STD
No Needle Mesotherapy or Electroporation
It helps the penetration of anti-acne and whitening agents
Acne Control- Topical
Mild-Moderate inflammatory Acne
No Needle Mesotherapy or Electroporation
It helps the penetration of anti-acne and whitening agents
Systemic Acne Treatment
Systemic Acne Treatment
Oral Antibiotics
Hormonal Therapy
Androgen receptor blockers
Oral Isotretinoin
TetracylineDoxycyclineMinocyclineLymecyclineBactrimClindamycinRoxithromycinAzithromycin
• Oral Contraceptives• Low-dose corticosteroids• Spironolactone• Flutamide• Gonadotropin-releasing hormone
agonists• Cyproterone acetate (CPA)• ?????Finesteride
Hormonal Therapy
Severe Acne failed to Systemic Antibiotics
Acne Control Systemic- Isotretinoin
Acne Control Systemic- Isotretinoin
Severe Acne failed to Systemic Antibiotics
Severe Acne failed to Systemic Antibiotics
Acne Control Systemic- Isotretinoin
Acne Control Systemic- Isotretinoin
Physical and Psychological scarring
Physical and Psychological scarring
Acne Control Systemic- Isotretinoin
Physical and Psychological scarring
Acne Control Systemic- Isotretinoin
Non Ablative/Ablative Acne Treatment
Non Ablative
• Light
• Laser
• Radiofrequency
Minimally Ablative
• Diamond Peel
• Superficial Peels
• PDT
Ablative
• Medium Depth Peel TCA
• CO2 Laser
Non Ablative Acne Treatment
Light
PDT
Laser
PDT
Radio-frequency
Blue LightMedical SPA
kill P. acnes and/or causes disruption of sebaceous gland function, and anti-inflammatory the effect that it is potentiated in PDT
•PhotochemicalP. Acne
•photothermalSebaceous glands
•photoimmunologicSebaceous follicules
Light Based Technology
These light sources have wavelengths that correspond to an absorption peak of P acnes endogenous porphyrins causes death
Narrow Band UV
Broad Band IPL
KTP 532nm
Pulsed Dye Laser 595nm
Red light at 610-635nm
90-150u 90-150u 280u
450u 550u
RED MIXED BLUENon thermal, non laser light emitted diode (LED)
is a new Acne treatment option
BLUE LED
Violet and Blue Light
• 90u-150u penetration• Penetrate deeper than UVA• Confined to the epidermis• Can Kill Bacteria• Not effective in PDT• Prevention rather than treatment
RED LED
Red Light
• Penetrate deep (550u)• Anti inflammatory• Healing• Effective in treating both
inflammatory and non inflammatory acne
Phototherapy with mixed blue-red light showed better treatment response than blue light alone.
RED and INFRARED LIGHT
Visible light as monotherapy is not recommended for the treatment of comedonal, severe papulopustular and conglobate
acne.
Mild Inflammatory
RED and INFRARED LIGHT
530nm-700nm yielding photothermal/and or photochemical
IPL/ELOS
IPL/ELOS/
Mild Inflammatory Acne
IPL/ELOS/
Mild Inflammatory Acne
IPL/ELOS/
Mild Inflammatory Acne
IPL/ELOS/
Mild Inflammatory Acne
IPL/ELOS/
Mild Inflammatory Acne
IPL/ELOS/
IPL/ELOS/
Moderate Inflammatory Acne
IPL/ELOS/
Moderate Inflammatory Acne
IPL/ELOS/
Moderate Inflammatory Acne
IPL/ELOS/
Moderate Inflammatory Acne
IPL/ELOS/
Moderate Inflammatory Acne
And Acne
Vascular
Pulsed KTP 532
Pulsed dye 585
LP PDL 595nm
Pigmented
QS 1064nm
Soft Laser
Mid Infrared
Nd:YAG 1064nm &
1320nm
Diode 1450
Erubium glass 1540nm
Non Ablative laser Acne Treatment
1064nm Nd YAG, KTP532nm and 590nm Pulsd Dye Laser
Kill P.acnes, reduce vasculairy and modulates inflammatory response
Vascular Laser
Kill P.acnes, reduce vasculairy and modulates inflammatory response
Kill P.acnes, reduce vasculairy and modulates inflammatory response
Vascular Laser
Vascular Laser It heals excoriations
Selective Non Ablative LASER:
Pigmented Skin Laser
Soft Laser Peel
is a rapid effective treatment for both inflammatory and non inflammatory can lesions
QS 1064nm Nd: YAG+ Carbon Lotion
Soft Laser Peel
Acne Excoriee
Soft Laser Peel
Acne Excoriee
Soft Laser Peel
Acne Excoriee
NEAR INFRA RED
•1064nm Nd YAG Laser
MID INFRARED
•1230 nm Nd YAG•1450nm•1540nm Erbium
Water is the chromophore but no selective damage to sebaceous gland
Mid Infra-red Lasers
Destroying sebaceous glands secondary to water heating
Moderate Inflammatory Acne
Mid Infra-red Lasers
Acne Control
Mid Infra-red Lasers
Moderate Inflammatory Acne
Acne Control
Mid Infra-red Lasers
Moderate Inflammatory Acne
Acne Control
Moderate Inflammatory Acne
Mid Infra-red Lasers
Acne Control
Moderate Inflammatory Acne
Mid Infra-red Lasers
Acne Control
Photodynamic Therapy
Photosensitizer
Red light Infra-red light LED Laser IPL
Short acting photosensitizer multiple sessions
Nonablative radiofrequency (NARF)
Moderate-Severe Inflammatory acne and its scars
Reduction of sebaceous gland activity and promotion of dermal remodeling by bulk heating of the dermis
NARF
Acne Control
Nodulocystic Acne
Nonablative radiofrequency (NARF)
Nodulocystic Acne
Nonablative radiofrequency (NARF)
Acne Control
Acne ControlNonablative radiofrequency (NARF)
Nodulocystic Acne
Acne Control
Nodulocystic Acne
Nonablative radiofrequency (NARF)
Acne Control
Nodulocystic Acne with Scarring
Nonablative radiofrequency (NARF)
Acne ControlNonablative radiofrequency (NARF)
Nodulocystic Acne with Scarring
Acne ControlNonablative radiofrequency (NARF)
Nodulocystic Acne with Scarring
Minimal Ablative Technology
Diamond Peel
Salicylic acid Peel
Soft Laser Peel
Photodynamic Therapy
STD
Salicylic Acid Peels
Effective in both inflammatory and comedonal acne. It lessen post inflammatory hyperpigmentation
An excellent keratolytic agent, useful against comedones due to its strong lipophilicity and ability to penetrate the pore
Salicylic acid peel
Acne Excoriee
Salicylic Acid Peels
Acne Control
Salicylic acid peel
Acne Excoriee
Acne Control
Salicylic acid peelAcne Excoriee
Acne Control
Post inflammatory Hyperpigmentation Salicylic acid peel
Acne Control
Ablative Acne Treatment
• Medium depth TCA• Ablative Laser• Ablative Fractional laser
Medium Depth TCA Chemical Peel
Moderate Acne
Stage II TCA
Medium Depth TCA Chemical Peel
Stage II TCA
Acne Control
TCA PeelModerate Acne
TCA Peel
Acne Control
Moderate Acne
TCA Peel
Acne Control
Moderate Acne
TCA Peel
Acne Control
Post inflammatory Hyperpigmentation
TCA Peel
Acne Control
Post inflammatory Hyperpigmentation
TCA Peel
Acne Control
Active Acne
Acne Control
TCA Peel
Post inflammatory Hyperpigmentation
TCA Peel
Acne Control
Acne Excoriee
STD
Platelet Rich Plasm (PRP)Painting PRP after ablative fractional C02 Laser will hasten the healing time and yield a better out come with regards red spots , dark spots and superficial scars
Allows better penetration of PRP improving both active acne and long ternm acne scars
Fractional C02 Ablative Laser
Fractional CO2 Ablative Laser
Active Acne
It improves, active lesions, red spots, dark spots and scars
Fractional CO2 Ablative LaserActive Acne
It improves, active lesions, red spots, dark spots and scars
Fractional CO2 Ablative Laser+ PRP
Moderate Acne
Fractional CO2 Ablative Laser+ PRP
Mild Acne
Oxygen treatment can kill bacteria, push active ingredients, speed post chemical peel or fractional lasers healing time
as well as erythema
Surgical Treatment
• Incision• Drainage• Intralesional• Comedone Extraction
Conclusion
Acne is a Chronic Disease
Conclusion
Oral isotretinoin is the most effective acne treatment developed to date
Newer methods include radiofrequency, light or laser, PDT represent treatment alternatives for systemic medications
Topical TreatmentRetionds
Antibiotics
Benzyol peroxide
Dapsone
Miscellaneous
Combined Approaches= Best Results
Patient Education
Maintenance decrease relapse rate
Effective acne treatment can improve the emotional outlook of patients