New Advances In Understanding of Acne

acne_perplexedYou may wonder why I write about acne so much.  There are several reasons, including popular demand based on the number of questions I receive, not to mention much ongoing research that is still being published on the subject.

The volume of questions I receive about acne is not unusual.  Acne is the single most common skin illness for which patients visit doctors in the United States.

An estimated 40-50 million Americans suffer from acne at any point in time. This includes 95% of teenage boys and 85% of teenage girls.

Somewhat not surprisingly, acne has been shown to cause significant psychosocial burdens for teenagers.  Such burdens include body image issues, anxiety, depression, and poor self-esteem, all of which are quite understandable when you think about them.

acne_diagramResearch over the past decade has shifted the medical thinking on acne from a purely infectious disease to an inflammatory disease.  Yes, doctors still feel that plugging of pores with formation of whiteheads and blackheads, excessive oil (sebum) production, bacterial colonization and the development of pimples are the most visible manifestations of acne.

The most exciting aspect of the newer acne research is that there is a subclinical process of inflammation going on underneath the skin that precedes the formation of even the earliest whiteheads or comedones. When researchers took biopsies of what appeared to be normal skin in known acne patients, they discovered multiple indications of inflammation.  This finding explains why 28% of acne breakouts appear in areas of what was previously thought to be normal skin.

boy_acneSo, whether the acne severity varies from mild whiteheads to severe cystic disease, recent research shows that all acne lesions are in fact inflammatory.  Also, even “normal” skin in acne skin has inflammation going on under the surface.

What do we do next based on this information?   Since there are multiple aspects to the formation of acne, the current consensus among skin researchers is that combination treatment is the best approach.

When most patients with acne problems reach the door of Maine Laser Skin Care, it is because they have tried multiple approaches with limited success.  Others specify that they do not want to use antibiotics or intense therapies like Accutane.

In my initial evaluation and consultation, I always emphasize that greater benefits can be achieved if we combine treatments with different but complementary ways of working on the underlying acne.  Laser therapy can result in remarkable improvements, but always work best in combination with other treatments.  Part of my consultation will also involve what I think are the best combinations for you.

Sometimes, the topical products need to be changed, doctor_consult especially if previous products used resulted in side effects.  On other occasions, combining low dose antibiotics may be best.  Since all people are different in their individual severity of acne as well as their previous history, I will craft an individual approach for that individual patient.

Certainly, based on these research findings, more studies are needed, especially to find newer therapies that may directly target subclinical inflammation.  From my involvement with the American Society of Laser Medicine and Surgery, I know that specific research is in progress to investigate in more depth how laser energy may improve skin inflammation in both acne and other inflammatory skin diseases such as rosacea.

Stay tuned, because this blog post is unlikely to be my last one on this subject.  If you or anyone you know is afflicted with acne, simply call us at (207) 873-2158 to schedule a free consultation and individual assessment of this troublesome condition.

About Dr. John Burke

John Burke M.D. has practiced medicine for over 25 years, and is the founding partner of MidMaine Internal Medicine. He established Maine Laser Skin Care in 2004 after devoting years to learning the latest in laser and dermatologic technology. Dr. Burke has treated patients from all over the United States. He is one of Maine's busiest practitioners in laser treatments, and in the use of Botox for upper facial lines and excessive sweating.
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