August 6, 2009


Acne is a chronic, inflammatory condition of the hair follicle. It is characterized by comedones (white and blackheads), papules, pustules, nodules, and cysts.

This is a common skin problem in adolescents as well as in adults. It affects 40-50 million people in the United States.

There are four major factors associated with the pathogens behind acne. These are increased sebum production, increased keratinocyte proliferation, abnormal desquamation, and colonization by Propionibacterium acnes, resulting in inflammation.

Acne grading is based on the number, type, and extent of acne lesions. Depending on the severity of the condition, we prescribe treatments that will target the particular causative mechanisms causing an individual’s acne condition.

Routine endocrinologic testing is not necessary. Indicators of hyperandrogenism often include menstrual dysfunction, hirsutism (excessive hair growth), or polycystic ovarian syndrome in adult women.

In all cases, we at Park Avenue Medical Spa recommend deep cleansing of the pores to eliminate the sebum and prevent infection. Exfoliation further helps to reduce hyperkeratosis. In addition, we often add light peels to a cleansing facial in my N.Y. practice.

Mild acne can be successfully treated with a topical retinoid with or without a topical antibiotic. Prolonged use of topical antibiotics can induce antibiotic resistance.

There are multiple topical retinoids, like adapalene or tazarotene which give excellent results.

Benzoyl peroxide is a bactericidal and is effective in treating acne to end the development of P. acne resistance. It is available alone or in combination with topical retinoids or antibiotics.

Topical antibiotics, like clindamycin or erythromycin show efficiency and are available in gels or creams combined with retinoids or benzoyl peroxide. Studies indicate that they have comparative efficacy in reducing acne lesions.

Treatment of moderate acne will require a more aggressive approach. Systematic antibiotics are often added to a topical regimen. The most commonly used antibiotic is tetracycline and its derivatives.

Oral contraceptives containing estrogen and progestin have also been effective in reducing acne in women.

I often incorporate spironolactone when treating acne patients in my Westchester practice. This medication inhibits the biosynthesis of testosterone and blocks androgen receptors, thus eliminating the androgenic pathway of acne production.

Severe acne will need a combination of treatments, including synthetic antibiotics, topical retinoids, topical benzoyl peroxide and hormonal manipulation in women. Oral isotretinoin is indicated in severe nodulocystic acne or treatment-resistant moderate acne. Depression and suicidal behaviors have been reported in patients taking isotretinoin. Other treatments include intralesional corticosteroids, injections, chemical peels, IPL treatments, and photodynamic therapy.

At Park Avenue Medical Spa, we utilize both glycolic and salicylic acid peels. The salicylic acids have a strong comedolytic effect and penetrate deep into pores.

Photodynamic therapy utilizes a photosensitizing agent and used correctly shows positive results.