Acne and rosacea are two seemingly different skin conditions that have one important thing in common: both are chronic and extremely common skin conditions. However, dermatologists recommend that with proper diagnosis, treatment and a healthy dose of good, old-fashioned skin care, acne and rosacea can be less of a nuisance for patients.
Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Jenny J. Kim, MD, PhD, FAAD, associate professor of dermatology at the University of California, Los Angeles, (UCLA) David Geffen School of Medicine in Los Angeles, discussed the latest treatments for acne and rosacea and how ongoing research into the causes of these conditions holds promise for future therapies.
"Sometimes it is hard for patients dealing with acne or rosacea to understand why, even with ongoing treatment, they cannot get rid of their symptoms forever," said Dr. Kim. "I explain to them that these conditions are similar to having any chronic disease, like having diabetes – there is no cure yet, but we can control the symptoms. Just like insulin helps maintain a diabetic's blood sugar, patients with acne and rosacea need to find a treatment regimen that works for them to maintain clear skin."
Acne: An Equal-Opportunity Skin Condition
It is estimated that 40 million to 50 million Americans are affected by some form of acne. While acne is commonly associated with teenagers struggling with the growing pains of adolescence, this skin condition can strike at any age. In fact, Dr. Kim emphasized that it affects adults in their 20s, 30s, 40s and even in their 50s, especially in women and even in people who never had acne as teenagers. The causes of acne include excess oil production, skin inflammation, skin cells in the hair follicles that shed too quickly and an increased number of the acne-causing bacteria Propionbacterium acnes. However, hormones also influence both oil production and the shedding of skin cells, thereby contributing to the formation of acne lesions. For example, when androgens (the male hormones present in both men and women) over-stimulate the oil glands and hair follicles in the skin, hormonal acne flares can occur.
In the past, most cases of acne were treated solely with antibiotics. While these treatments can be very successful, a growing concern about long-term antibiotic use is that bacteria are evolving to become resistant to these medications. As a result, the development of other effective therapies and combination therapies has evolved.
For example, Dr. Kim noted that some of the newer therapies for acne are anti-inflammatories, which can be used in some cases to lessen the severity of acne. Controlled-release of lower dose doxycycline is a newer anti-inflammatory oral medication that some dermatologists use to reduce the redness and swelling of acne. Combination therapies, which may include an anti-inflammatory and antimicrobial effects that can decrease resistance and are more convenient to use for patients, has made combination therapeutics increasingly common treatments used to manage acne.
Another newer approach to treating acne is the use of lasers and light-based technologies as a complementary treatment to traditional medical therapies. Dr. Kim noted that these technologies include the pulsed-dye laser, red and blue light, and photodynamic therapy, which target the sebaceous (or oil) glands and can reduce acne flares. While Dr. Kim does not recommend lasers and light-based technologies as first-line therapies for acne, she believes it is a promising new area of research.
"Patients are becoming increasingly concerned about the long-term use of oral medications to fight acne, so lasers and light sources appeal to them," said Dr. Kim. "The problem is that there are limited large, prospective, well-controlled studies that demonstrate the effectiveness of laser and light technology at this point, so that will be
an area we need to explore in the future." "It's very likely that with the advancement in dermatologic research, we will see sebaceous gland targeting lasers in the future that will be effective for the treatment of acne."
Dr. Kim added that many patients are concerned about scarring that can result from acne, and many acne scars can be very aggressive and difficult to treat. For mild scarring, retinoids, chemical peels, microdermabrasion, and lasers can give mild improvement. In addition, fillers can be used successfully to fill in depressed areas and improve the appearance of scars.
Another therapy that is approved by the Food and Drug Administration (FDA) for acne scarring is fractional laser resurfacing. This laser technology works by targeting damaged skin in columns of microscopic treatment zones, which include the outermost and underlying layers of skin known as the epidermis and the dermis. Fractional laser resurfacing thermally damages the tiny columns of scarred skin while the surrounding healthy skin is left intact.
"One of the main benefits of fractional resurfacing is wound healing and increased collagen production that reduces acne scars," said Dr. Kim. "However, most patients will notice only a modest improvement in acne scarring and multiple treatments are required. For more severe scarring, such as deep 'ice pick' scars, several acne surgical procedures can be used – including punch grafting or punch excision – to remove, raise, fill or separate the scar tissue from the underlying skin. These surgical procedures in combination with other therapies, including lasers and fillers, can produce improvement for severe acne scarring."
Rosacea Triggers and Treatments