In selecting a device to treat active acne, dermatologists must think beyond papules, pustules, and cysts to address patients’ concerns about existing or potential scarring, as well as minimizing the risk of post-inflammatory hyperpigmentation (PIH). Coupled with a good skincare regimen and topical therapies, the strategic use of devices can set patients on the right path, according to Michael H. Gold, MD, Medical Director of Gold Skin Care Center and Tennessee Clinical Research Center in Nashville. Ahead, Dr. Gold answers questions about selecting the device that is right for your practice and how to best use it in the acne patient population.
WHAT’S THE FOUNDATION OF TREATMENT FOR PATIENTS WITH ACNE?
A good skincare regimen for patients with acne starts with an effective but gentle cleansing routine that will remove oil and cleanse the skin deep within the pores, says Dr. Gold. “We recommend the Clarisonic brush with a gentle cleanser. Both CeraVe and Cetaphil make some excellent soapless cleansers, which have been shown to be useful for patients with acne. After cleansing, patients can apply their topical acne prescription medications.” In many cases, there will be the need for a gentle and lightweight moisturizer to help soothe the skin and ease any dryness that can occur from medications, he observes.
“Moisturizers with growth-factors such as Neocutis Bio-gel can work very nicely alongside acne medications because of its gentle healing abilities. The last step daily is a broad-spectrum zinc oxide or titanium dioxide-based sunblock with an SPF 30 or higher. Patients will be more compliant if they find a stable block that is cosmetically elegant—EltaMD sunscreens have a wide range of physical blocks that maintain a nice texture and non-greasy feel. The new CeraVe sunscreens are gaining in popularity as well,” according to Dr. Gold.
ARE THERE ANY SPECIAL CONSIDERATIONS FOR DARKER SKIN TONES?
A good cleansing routine, a gentle moisturizer, acne topicals, and SPF are basics for any skin tone, regardless of color, Dr. Gold acknowledges. Proper education on the importance of sun protection is important. “Many patients with skin of color believe they do not need to wear a sunscreen, but they do. Acne treatments for skin of color can be more extensive because skin of color tends to be prone to post-inflammatory hyperpigmentation and most patients will want to address both conditions,” he says. Good dermatologic care is needed to address the acne concern and the PIH concern. “At times, no matter which skin color we are dealing with, lasers and light-based therapies may also be useful.”
HOW DO YOU ADDRESS SCARRING CONCERNS IN PATIENTS?
“In today’s world, we are more comfortable with lasers and light sources, no matter what the skin color. So if someone has acne scars, we begin discussions about energy-based systems and what they can do,” says Dr. Gold. “Typically, we use fractional technology, whether non-ablative (four to six treatments done every month), ablative fractional treatments (one to two total treatments), or sublative fractional technology—bipolar RF therapy (two to three treatments on average). Sublative technology using the eMatrix from Syneron, has helped many patients of all skin types improve their acne scars with minimal downtime,” notes Dr. Gold. Ablative fractional devices, especially some of the more sophisticated ones that can deliver superficial and deep treatments together, are becoming much more popular to handle scars. “These include the Lumenis UltraPulse and Lumenis AcuPulse devices, as well as the Syneron CoRE2 device. Scars vary in depth, and these devices allow individualization more than others on the market,” Dr. Gold observes.
WHAT DEVICES DO YOU USE FOR ACNE IN THESE PATIENTS?
For those suffering from acne, Dr. Gold will use medicines first and in addition, will add light-based therapy to help speed the process of clearing. “Several devices have shown to be effective for acne itself, and clinical research has confirmed their safety and efficacy,” states Dr. Gold. “Blue light works very well. Clinical studies have shown that the BLU-U from DUSA was superior to topical antibiotics in one study. Patients find blue light simple and effective. As well, pulsed light with vacuums—both the Isolaz (Solta Medical) and the Aclera (Palomar Medical) are pulsed-light devices, which have been used successfully for speeding up the acne clearing process.” With these devices, a vacuum apparatus takes the skin into closer contact with the pulsed light source as well as “cleansing” the pores. Studies suggest that acne clearing with them can begin within two to five days of a treatment. Patients come in every two to three weeks for this and many see incredible results in just a few sessions, states Dr. Gold.
WHAT ARE SOME UNIQUE ISSUES IN SELECTING A DEVICE SPECIFICALLY FOR ACNE?
Acne devices are different than many other lasers and light sources, says Dr. Gold. “We are dealing with a younger clientele for the most part and so, therefore, costs are an important consideration. This is a cash-based therapy as there is no insurance coverage for these devices and treatments. And we are not ‘curing’ acne, so one must make sure the patient is aware of this going into the procedure. We have incorporated all of these devices into our medical practice and use them in combination with our medical therapy,” he says. “Our patients have spread the word on what light therapy can do with acne and it has helped keep these machines busy almost each and every day all day long,” Dr. Gold states. His advice is always the same with acne devices: “keep the prices reasonable, don’t over-promise, and these will be extremely happy clients.”
WHAT HAVE YOU LEARNED THROUGH EXPERIENCE WHEN IT COMES TO USING THESE DEVICES ON PATIENTS WITH ACNE?
Dr. Gold has helped thousands of patients over the years by using acne devices. “They work. We keep the costs down and make sure that we are tailoring our medical and light-based therapy to the individual—and it works,” he says.
WHAT AT-HOME DEVICES DO YOU RECOMMEND?
There are a variety of home devices that are useful for acne, Dr. Gold observes. “We like blue light sources and recommend the Tria and Tanda products the most for acne. Home devices do not replace doctor visits or devices but can augment the therapies, and patients are happy to use these with physician recommendation. Not all of the home devices are the same, and price is important in deciding to use these,” alerts Dr. Gold.
As well, Dr. Gold recommends that all of his patients with acne use the Clarisonic brush. “This is one of the most significant advances in dermatology and our acne patients find it invaluable for skin cleaning,” he concludes.