Acne Control

Acne is a chronic inflammatory disease of the sweat glands and hair follicles. It effects patients of all ages. It results from multiple factors, but the abnormal degree of keratinization or epidermal cell stickiness is one of the most important factors. This leads to a high degree of clogging pores which, in turn, leads to the sequence of redness, inflammation, infection, pustule, rupture, and scarring. This should be viewed as a sequence and acne may be present at any stage and end there or progress from inflammation all the way to unsightly scars. Open or closed comedones (whiteheads and blackheads), papules, pustules, hyperpigmentation, spots, nodular or cystic lesions all can be present. Hormones can stimulate the condition as well as some drugs.

The goals of treatment are to reduce the degree of stickiness and clumping of the exfoliated, oily epidermal skin cells and to decrease inflammation and the bacteria. This is an ongoing process. All treatments work mostly by preventing new acne. The existing blemishes heal on their own. The improvement process takes time and you must be patient. There are often initial "flare-up" periods when you start a program or new product and your acne will often get worse before it gets better. This process can be frustrating. You may need to change and modify products or usage several times before the "right combination" is obtained. This is why you need a professional to evaluate and initiate and regularly follow-up your program. This way the least amount of time is wasted and you don't lose time "experimenting" on this or that product.

Our office offers an intensive and comprehensive approach to acne treatment which is outlined below. Dr Romano's approach is a combination of internal and dietary recommendations, and topical skin care interventions With strict adherence to the following regimen you can expect 90-100% clearing of your condition by the end of two months.

1. Initial Consultation and Evaluation

A thorough evaluation is necessary. Every patient has unique skin anatomy and conditions that will require a customized and highly individualized treatment program. You need to establish a relationship with your skin care specialist as you will need to work together closely. We perform a Comprehensive History and skin exam. This involves an in-depth history of your acne and examination of your skin. We assess the nature and distribution and type of acne, breakouts, pigmentation, spots, scars, irregularities, and other related factors

2. Treatment

Treatment consists of recommending supplements, office treatments, and your home program which eventually leads to clearing your acne then instituting a maintenance program. Once your acne is controlled, surgery for treating scars or irregularity, if present, may be considered.

The following are our basic recommendations that will be customized for each patient:

A. Lifestyle and Diet

Low fat diet, low carbohydrates, high fiber
Avoid unfavorable carbohydrates (Read Zone Diet or visit www.zoneperfect.com )

B. Aggravating Factors

These are factors known to aggravate acne and you may want to see if any of these effect you:

Vitamin B-6 and B-12 may worsen acne.
Inorganic Iron should be avoided, this inactivates Vitamin E.
Female hormones antagonize Vitamin E.
Iodine supplements may cause or worsen acne.
Carbonated soft drinks.
Milk contains hormones that can aggravate acne.
Certain medications such as anticonvulsants, lithium, oral contraceptives.
Topical or internal steroids.
Sunlight can mask your acne but the effects are temporary and ultimately, more harmful causing hyperpigmentation of healing lesions which then become very difficult to treat.
Cosmetics can aggravate acne. Look for "non-comedogenic" or "non-acnegenic" and be careful to completely remove all makeup each night.

C. Supplements:

There are numerous supplements that have been shown to have a positive effective on the acne process. Some of these remedies were introduced as far back as the 1940's. These have all been evaluated and tested in scientific studies and reported in the literature.

Folic Acid 5-10 mg/ day.
Vitamin A 300,000-500,000 units/day (be aware of over dosages. Men need more than women).
Vitamin E 400-800 mg/day. (Deficiencies effect absorption of Vitamin A).
Pyridoxine 50 mg twice daily, especially for premenstrual and menstrual acne.
Zinc 90-135 mg/day.
Selenium 200 micrograms daily.
Omega-6 Essential Fatty Acids. This is obtained through Flaxseed Oil tablets.
High Chromium yeast (Chromax) 400 micrograms daily.

D. Topical Products

There are numerous products known to have a beneficial effect on acne. These may be part of your in office treatments or home program or both. They may involve prescription medications, our own custom formulations, or current well known acne treatment products. These are all applied directly to the skin and to the breakouts.

Retin-A is very beneficial and comes in different strenths, formulations and doses.
Topical antibiotics such as Cleocin-T, Brovoxyl, ProActive, Benzoyl Peroxide and others are helpful and prescribed by your physician as needed.
Cortisone injections may be applied directly into the acne pustule in extreme and difficult breakouts.
Azuleic Acid and Salicylic acid
Bioglycolic acne gel
Skin silk
Sunscreens

E. Oral Medications

These need to be determined and prescribed by Dr. Romano or your dermatologist.

Accutane. This should be determined and prescribed by your dermatologist
Antibiotics. Tetracycline, Minocycline. These seem to be very helpful in small daily doses and once an improvement is obtained and maintained, then begin to wean yourself off.

F. In Office Skin Treatments

These are treatments that are provided by our office. This is usually the most important and critical part of the program, and that which will demonstrate the most benefit to you.

Glycolic acid treatments are extremely beneficial in reducing oiliness and cell clumping that leads to blocking pores and infection and the whole cascade of the acne process.
Bleaching treatments and creams decrease the pigmentation and spots which are often the after effect of a healing acne lesion and very noticeable and unsightly.
Monthly or bimonthly facial treatments using enzymes and/or glycolic acid peels of at least 40% exfoliate unhealthy cells and clean the pores to prevent cell clumping.
Deep pore cleansing including manual extractions of pustules, whiteheads and blackheads cleans out acne-prone pores to prevent breakouts before they start.
Masks containing calming and anti-inflammatory ingredients including kaolin clay, tea tree oil. lavender oil, charcoal, and aloe vera decrease redness and infection.
Post extraction misting with Lucas machine and tea tree oil is uselful for its deep penetrating antibacterial effect.
Medical grade cosmetic and cover-up make-up. This is excellent for both men and women and adds that last little benefit that makes a hugh difference.

G. Home Care Program

This is an extremely important part of acne care and treatment. Your attention to the home program and agressiveness with this can make or break your successful outcome. This must be performed day and night. Proper adherence is mandatory to insure success of treatment. This is highly customized, but basic products and interventions include:

Deep cleansing
Glycolic wash
Benzoyl peroxide 5% to 10% as tolerated
Sunscreen
Weekly masks to exfoliate and deep clean

3. Maintenance

Once acne is under control other things can be done to improve the skin smoothness and color as well as prevent further breakouts:

Microdermabrasion smoothes the skin and decreases pigmentation and scarring
Skin lightening and bleaching program.

4. Surgical Interventions

There are numerous procedures and interventions that can be performed once your acne is under control and quiescent. These are aimed at further smoothing the skin and removing irregularities, scars and wrinkles and include:

Filler substances such as Collagen, Dermalogen, Silicone and others have been injected underneath to raise and smooth depressed scars.
Chemical peels. These range from light, effecting the epidermis only, to deep. They remove a certain depth of your skin cell layers and so doing, smooth the skin. They range in chemicals from Jessner's, TCA (trichloroacetic acid) to phenol. The strengths are variable, and so also are the healing and down times that may range from several days (the weekend peel) to 7-10 days.
Dermabrasion (now occasionally referred to as "macro"-dermabrasion. This is a much deeper and mechanical removal of the upper skin layers to even the skin and remove scars and irregularities.
Laser resurfacing. There are several different types and light energy sources for laser treatments. The most common is the CO2, or carbon dioxide laser. Erbium and other lasers have been used as well. These are known to be aggressive and provide a deep scar removal effect, but many think the dermabrasion works as well and heals faster.
Subcision is a term used to describe the under cutting of a depressed scar. In theory this releases the depressed scar to raise up, but in practice, you usually have to add something to fill in the subcised area to effect the raising.
Punch and suture is a technique is used to actually cut out depressed and unsightly scars, then stitch them shut. The scars are less and usually dermabrasion or laser is performed at the same time to decrease scarring.