The most important goal of any acne treatment is prevention of scarring. Acne scarring arises from skin textural changes (e.g. divots, ice-pick scars, boxcar scars) as well as pigmentary changes (e.g. redness or hyperpigmentation). To prevent skin textural scarring, it is critical to prevent and avoid manipulation of inflammatory acne lesions, namely cysts and nodules which are often tender to touch. Dr. Ting’s goal is to keep your complexion clear with the least amount of oral systemic medication whenever possible. However, in many cases, topical medications alone may not be sufficient to control inflammatory lesions. For more resistant and inflammatory acne, Dr. Ting may utilize oral antibiotics such as doxycycline or minocycline to achieve maximal anti-inflammatory effects and/or hormonal medications such as birth-control pills or spironolactone to minimize hormonal trigger. Symptomatic and tender cysts may be treated with intralesional steroid injection. For patients who failed conventional topical and oral acne therapy, Dr. Ting may recommend photodynamic therapy or isotretinoin (Accutane) as a last resort.
Dr. Ting will customize a skin care routine for you depending on your complexion (oily vs. dry, fair skin vs. ethnic skin) with a combination of prescription topical medications, vitamin C/glycolic acid facial pads, medicated cleanser, oil-free sunscreen, fading creams and/or medical acne extraction. Your personalized skin care routine supervised by Dr. Ting will facilitate a more even skin tone, mitigate enlarged pore sizes, and achieve a smoother skin texure. Medical aesthetician is available for make up consultation, acne facials and/or microdermbration to achieve best clinical and cosmetic outcome.
Once your acne is in remission, Dr. Ting will assist to minimize acne scarring via intralesional steroid injection of hypertrophic scar if needed and review scar revision options including fractional CO2 laser or TCA chemical peel. Dr. Ting is a well-known dermatologic surgeon in Northern California and beyond for his expertise and experience in fractional CO2 laser resurfacing for acne scarring for both fair-skin and ethnic skin individuals.
Frequently Asked Questions (FAQ) about Acne
Does diet matter? Maybe. There are recent medical literature that suggests non-organic dairy products such as milk, cheese, yogurts, and ice cream may exacerbate acne. Nowadays, many milk cows are given shots of growth hormones and it is thought that subsequent absorption of these growth hormones via consumption of non-organic dairy products may trigger excessive sebaceous gland activities on the skin. Also, there is recent evidence that diets high in glycemic content, e.g. candy bars and some soft drinks, may predispose one to have more acne lesions. In short, try to consume only organic dairy products and avoid food items that are rich in sugar content.
Does oral antibiotics make oral contraceptive pills (OCP) less effective? There is a common misconception that oral antibiotics make OCPs less efficacious in preventing pregnancy. In general, the failure rate of OCPs is in excessive of 1%. The best clinical studies have not demonstrated significant impact made by oral antibiotics to the effectiveness of OCPs. If it is critical that pregnancy be prevented while taking both OCP and oral antibiotics, Dr. Ting suggests that you should use a backup method for contraception such as male latex condom.
How important is face wash for acne? Cleaning one’s face is an important part of the acne skin care routine, particularly at the end of the day to remove dirt, perspiration, skin debris, and makeup (if applicable). Dr. Ting will recommend a specific face wash depending on your skin type (oily vs. dry, redness vs. pigmented). Most of us spend no more than 2 seconds washing our face. Therefore, utilizing Clarisonic brush as part of your skin cleansing routine can be quite helpful which forces you to wash your entire face and clean the pores for 60 seconds via ultrasonic vibration.
What to do with acne in the setting of sensitive/dry skin? Dr. Ting will customize a skin care routine which incorporates gentle face wash and minimally irritating topical acne prescription medications. Most over-the-counter moisturizers may be too greasy for acne-prone skin. Therefore, Dr. Ting recommends application of Dermesis toner/cream (derived from research done at a UCSF lab) which facilitates skin barrier repair by replenishing calcium ions externally.
What to do for women who experience hormonal trigger of acne? Hormonal influence of acne in women is strongly suggested by the presence of inflammatory acne lesions in the perioral and jawline regions of the face. In fact, many women report premenstrual flare of acne. Two of the most efficacious adjunctive OCP therapy for acne are Yasmin and Yaz. Both medications contain drosperidone which is an anti-androgen and can mitigate hormonal trigger of acne for women. As an alternative, spironolactone may be considered as it is a potent anti-androgen medication and can effectively mitigate hormonal influence in acne for women. While on spironolactone, Yasmin or Yaz, one should avoid diets high in potassium content (e.g. banana, kiwi fruits, sports drink such as Gatorade or Propel) to minimize symptoms of hyperkalemia which may be manifested by muscle cramps, tingling sensation or even heart palpitation). Higher doses of spironolactone may infrequently lead to menstrual irregularity and/or breast tenderness, both of which will resolve once spironolactone is discontinued.
How does photodynamic therapy (PDT) work for acne? PDT works through photochemical reaction between Levulan (naturally-occurring break down compound of red blood cell) and a blue light source (~410nm wavelength) which #1 eradicates p. acnes bacteria which are responsible for triggering inflammation around hair follicles and #2 reduces activities of the oil glands thereby minimizing oily complexion. Dr. Ting has treated more than 2,500 patients with photodynamic therapy (PDT) for acne and other indications for the past few years. PDT has become a great alternative for patients who wants to augment their conventional therapies of oral antibiotics and topical medicated creams and to avoid Accutane. Dr. Ting has the experience to precisely prescribe the appropriate mix of incubation time (duration of Levulan application on face) and exposure time (duration of a blue light source exposure) to maximize the clinical results and minimize discomfort.