Acne Treatment. What is New?

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