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Why is Acne So Difficult to Treat?

Active acne & acne scarring are challenging to cure but very treatable.

Multi-modality treatment of acne and acne scars.

What causes acne breakouts?

Acne vulgaris is the most common skin disease affecting approximately 80% of Americans. Twenty percent of those affected experience the more severe forms of acne. This psychologically debilitating problem affects primarily teenagers and adult women alike. The main causative factor is a genetic predisposition to the condition. Other components of the disease include the P. acne bacteria, overactive oil glands, malfunction of the pore-clearing mechanisms, hormonal disturbances, and inflammation. Active acne outbreaks also cause inflammation of the skin and subcutaneous tissue leading to the deposition of pigment and spots at previous outbreak sites.

Why is the treatment of acne breakouts so important?

Unchecked, the inflammation caused by active acne is a major contributing factor leading to the characteristic scarring of the cheek or temple area. Treatment regimens that do not address each of the four components of active acne can lead to early recurrence, disappointment & psychological stress. Ongoing untreated acne inflammation leads to scarring that is permanent and difficult to treat. While chronic in nature, acne scars of the face can also be very debilitating to patients and their self-esteem.

Why do over-the-counter products stop working after a while?

Today’s over-the-counter acne treatments typically address the bacterial component of acne and clogged pores but leave other components untreated. The sebaceous gland over-activity, hormonal component, and pigmentation issues are rarely addressed without prescription strength medicines. Further, the acne bacteria often become resistant to the over the counter acne products. Treatment regimens that do not address each of these components predictably lead to early recurrence and disappointment.

What can be done to more effectively treat or manage acne breakouts?

Prescription strength skincare and facial peels are the basis of a proactive acne program. A program that addresses all four causes is typically most successful in mild to moderate cases. Some of the medications typically used include prescription strength retinoid medications for suppression of the sebaceous gland, benzoyl peroxide and topical or oral antibiotics for treating P. Acne, exfoliators like salicylic acid to address pore dysfunction, and spironolactone or oral contraceptives for hormonal imbalances. In more severe cases, oral Accutane or photo-therapy treatments are useful adjuncts to other commonly used medicines. Recently, the side effects associated with Accutane use have led to diminished popularity with patients and doctors alike.

How can Lasers & Light Treatments help to treat acne breakouts?

Phototherapies with broadband light or lasers with or without photosensitizing medicines have risen in popularity to fill this gap. Photodynamic therapy combines various broadband light wavelengths with Levulan® to suppress the bacteria and oil glands. This treatment is usually done in a series of two weeks apart and works by selectively destroying the P. acne and sebaceous glands when exposed to light. A period of 5-6 months of decreased outbreaks and reduced oil production is typical after a series of treatments.

What are some of the treatment options for acne scarring?

Acne scarring, the long-term sequelae of poorly managed acne is one of the most underestimated conditions in terms of its negative effect on self-esteem. The characteristic tethered, depressed or “ice-pick” scars can be very disconcerting to patients. In the past, aggressive resurfacing procedures such as Dermabrasion or laser resurfacing were used to improve their appearance. While effective, these treatments were associated with prolonged recovery and were not applicable to darker skin types. Surgical release of scars is also a useful adjunct. Contemporary acne scar management utilizes fractional lasers to partially resurface the skin while reducing downtime. This treatment stimulates collagen production to improve scars while leaving areas of normal skin to accelerate healing. This version of laser resurfacing is also well tolerated in darker skin types without the side effects of earlier resurfacing treatments. Micro-needling treatments are a new non-laser treatment for acne scarring with a short 48-hour recovery. While still a challenging condition to treat, a concerted effort at addressing each of the components of acne can lead to significant clinical improvement and patient satisfaction.

For more information about active acne or acne scar management, contact us at Further, the acne bacteria often become resistant to over-the-counter acne products.