The scarlet pimpe(rne)l

Aesthetic Medicine is becoming, each day, more effective and new less invasive procedures for treating several conditions are now used. Dr. Joanna Karamon gives us her views on a new approach to acne treatment.

Due to my personal, professional and now lately also academic reasons, I have been dealing with a wide range of dermatological issues and concerns, the latest of which being the rather dreaded acne.

Raise your hand if you’ve ever had that one totally inopportune outbreak, or that one massive pimple appearing just before an important social event. Raise your hand if you lost count of the amount of times your parents told you “Stop eating chocolate. Chocolate gives you zits.” Or the amount of times you heard “Stop picking!” being screamed at you in the most crowded places.

Well, I will definitely be raising my hand for all the above, and more. Having passed through a rather pimply teen and early twenties phase, I have personally been on the receiving end of just about every lotion, potion and medication under the sun to help get rid of my acne, and it is this experience which has made me very empathetic with anyone dealing with this same condition.

Acne is basically caused by several factors, often working in conjunction to unbalance the normal cycle of healthy sebum production, dead skin cell shedding and provision of a healthy, protective, microbiome environment.

Sebum is the oily substance our pores produce which is so reviled in our teenage years and so craved when we hit those later decades characterised by a dry and wrinkled skin. Sebum overproduction is caused by hormonal imbalances and this together with the dead and fragmented skin cells we naturally shed can cause plugs to form in the pores. This, in itself, can already cause irritation and inflammation of the congested pore, but when you add the main villain to the mix, things get really messy.

Enter Propionibacterium Acnes, an oxygen-tolerant anaerobic bacterium, the most common bacteria found in acne lesions. Because it is anaerobic, it can survive in an oxygen-deprived environment and can therefore cause those horrible abscess-like cysts, and this is also what makes it more resistant to some of the more conventional antibiotics.

So what makes it so difficult to treat?

Firstly, getting the whole hormonal balance right when your body is still in its hormone-developing mode is not easy, and sometimes taking hormonal supplements may not be both socially and medically appropriate. Diet does play a role and any nutritionist will tell you that following a diet which reduces inflammation and hormonal fluctuations will help control acne … and diabetes … and cardiovascular disease … and any other number of health issues. We are what we eat, so ‘junk in’ will inevitably throw ‘junk out’ all over your skin.

Other options for sebum production control are vitamin A derivatives such as Isotretinoin, both topically or orally, the topical version having the added benefit of restoring collagen production and potentially helping with scarring.

Controlling the skin shedding, or rather helping to clear the dead cells, is possible through good exfoliation. This can be done by mechanical scrubbing (with any number of natural and commercial products), as well as with chemicals such as salicylic acid. You just have to walk down the aisle of any supermarket or pharmacy to see the endless range of exfoliants available on the market. Not to mention the number of cosmeceutical companies claiming to be the next best miracle treatment. Some are most definitely better than others but the general rule of thumb is that anything developed, not just tested but truly developed, by a dermatologist should be a good choice. The most famous brand that springs to mind is the one developed by Dr Zein Obagi, whose range notwithstanding some amazing PR and marketing, does deliver results.

Lastly, killing the bacteria without killing our good protective microbes is the final challenge. Oral antibiotics from the tetracycline or macrolide family are most commonly prescribed, often for prolonged courses as the bacteria is also fairly slow-growing.

Topical macrolides can also be used and for adult acne even topical metronidazole has been effective, however both orals and topicals can have a whole range of side effects. The latest, less invasive option for eradicating the bacteria is ionising the surface of the skin with plasma technology.

A single 5-min treatment produces anti-bacterial radicals which sterilise the surface of the skin, can be repeated on a regular basis, and has zero downtime. The added benefit of this treatment is the cell regenerative effect of the plasma “shower”, which helps to significantly reduce the inflammation, redness and scarring.

Laser and IPL (Intense Pulsed Light) treatments can also be effective but care must be taken with light-based therapies and darker skin tones to avoid pigmentation disorders.

The trick to successful acne treatment is getting the balance correct in combining just the right amount of each treatment option without overwhelming the patient with complicated schedules, restrictions and excessive side-effect-causing medications. Sometimes less is more, and sometimes mother does know best, so stop picking and start scrubbing!

Joanna Karamon

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Dr Joanna Karamon is a consultant in General and Family Medicine – Luzdoc International Medical Service; Aesthetic Medicine and Travel Medicine; Medical Director – Medilagos (Rede Luzdoc)