Expert Q and A: Avoiding the Angst of Acne at Any Age
An interview with Jenny J. Kim, MD, PhD.
What's new in acne treatment? continued...
We’re also combining devices with medical treatment. So we can use a topical
medication that will penetrate into the [gland] where the acne is occurring and
that makes that oil gland light up, and then you come in with either laser or
light-based technologies. These include the pulsed-dye laser, red and blue
light, and photodynamic therapy, which target the sebaceous (or oil) glands and
can reduce acne flares.
But I don't think they should the first line of therapy. The problem is that
there are limited large, prospective, well-controlled studies that demonstrate
their effectiveness, so that will be an area we need to explore in the
What about scarring?
We can’t really predict which acne will lead to scarring. It’s not always
the severe acne.
Acne scars can be very aggressive and difficult to treat. For mild scarring,
retinoids, chemical peels, microdermabrasion (which uses tiny rough grains to
buff away the surface layer of skin), and lasers can give mild improvement.
Another therapy that is approved by the FDA for acne scarring is fractional
laser resurfacing. It thermally damages the tiny columns of scarred skin, while
the surrounding healthy skin is left intact.
The fractional photothermolysis is nice in that it’s safe in all skin types.
But it's not like magic; you can’t get rid of that scar immediately. You need
multiple treatments. And they are usually not covered by insurance, so can be
For deep scars we use fillers to fill in depressed areas. The collagen and
hyaluronic acid filler appear to be very good.
For more severe scarring, such as deep "ice-pick" scars, several surgical
procedures -- including punch grafting or punch excision -- can help to remove,
raise, fill, or separate the scar tissue from the underlying skin. They’re
usually used in combination with other therapies, including lasers and
What about skin care?
Use a mild cleanser and sun protection that is non-irritating to the
Don't traumatize your skin with scrubs, astringents, or alcohol-based
products. Wait five or 10 minutes before putting on medication after washing.
If you’re going to buy cosmetics, use products that don't clog the pores --
they'll be labeled "oil-free" or "nonacnegenic" or "noncomedogenic."
I find that products containing salicylic acid are useful. Separating
treatments, such as using salicylic acid or benzoyl peroxide in the morning and
a retinol-based product at night, might be helpful if you have sensitive
Newer hydroxy acids (aka glycolic acids) appear to be better tolerated and
the nice thing is that they have been shown to inhibit enzymes called
metalloproteinases in our skin. This breaks apart collagen so that could help
prevent acne scars.
Cosmeceuticals that contain natural products and have anti-inflammatory
properties, such as licorice, oatmeal, soy, and feverfew, could be useful. But
natural doesn’t always mean good. A lot of natural things cause allergic
reactions. So it’s very important to consult your dermatologist and discuss
what you’re using.
Kim has consulted for several companies that make skin care products,
including Allergan, Medicis, and Stiefel.