At Utah’s Alpine Dermatology, we have yet to meet a case of acne that we couldn’t beat. We offer numerous treatment options that are customized to your particular case of acne. We make every effort to find the most effective, gentle, convenient and affordable regimen possible. Our Certified Nurse Practitioner, Carolyn Sironen, specializes in the treatment of difficult cases of acne. She has been trained very closely by Dr. Eberting and consults with her whenever necessary in order to find the best regimen for each and every patient she sees in Utah.
What is acne?
Acne is an abnormality in a few things: too much sebum production (oil), too strong of an inflammatory reaction TO the sebum(white blood cells that come in to attack the sebum make pus), too many bacteria called Pityrosporum acnes (P. acnes), and too many hormones acting on the sebaceous (oil-producing) glands which then makes them produce too much oil.
Who gets acne and why?
There are two main “types” of acne: 1. Teenage acne and 2. Adult acne. Teenage acne usually begins with the onset of puberty and is usually heralded by a few blackheads around the nose and hair-line. This often progresses to more inflammatory and cystic lesions. It is important to treat acne when it starts so it is never allowed to scar. Acne is treatable and no one needs to have permanently scarred skin.
Adult acne is usually seen in women in their early to mid-thirties up into their sixties! Yes, you can still get acne even into your sixties! Adult acne tends to have a hormonal cause to it and its’ treatment is often based on this
What does acne look like?
Both of these types of acne can cause the following types of lesions on our skin: comedones (black heads), pustules (white heads), inflammatory papules (pink bumps) and cysts (big, painful lumps in and under the skin). By an abundance of hormones, the sebaceous glands are encouraged to grow and make more oil. The bacteria that breaks down the oil, P. acnes, comes in and breaks it down into some very inflammatory and irritating compounds…these compounds then get your immune system all revved up to attack and clean them up…and this is where the pus comes from. All of these steps in the formation of acne are targeted in effective treatments for acne.
Are there conditions that look like acne, but are not typical acne?
Yes. There are several conditions that can mimic the appearance of acne, but are not acne and do not respond to a typical acne regimen. This is why it is important to be evaluated by one of our providers to determine what you really have and how best to treat it.
Is it okay to pop my zits or to pick at my face?
NOOOOOOOOO! In general, unless you have frank pus sitting on top of your zit, DO NOT TOUCH IT! This is much easier said than done, but if you understand what is going on inside of your skin when you pick at it, you may never do it again. When you pick at a zit and apply pressure and squeezing to a pimple, you are often causing the pimple to rupture INSIDE of the skin. All that sebum, and the inflammatory crud that the P. acnes broke it up into, AND the P. acnes are very exciting to your immune system. Your immune system sends in white blood cells to clean up the mess. The mess gets taken care of, but while the white blood cells are getting rid of the bad stuff, they also release enzymes that digest your collagen and elastin…this equals a SCAR!! So, next time you have the urge to pick; sit on your hands!
There are many effective treatments for acne, but in general, we will list them by category in order of least effective (for milder cases) to most effective (for the worst cases).
- Over the counter topical treatments: Benzoyl peroxide and salicylic acid are the mainstays of OTC acne treatment. They are effective in mild cases and when combined with prescription topical treatments.
- Cosmeceutical grade Over the Counter: Our favorite is the M2 kit. This product is a sweet combination of Mandelic and Malic acids (from apples and almonds). We love to use this in people who have mild acne or a textural abnormality to their skin. For the right patient, it can be a lifesaver.
- Topical prescription treatments: the list of this is extensive and there are mamy to choose from based on the severity of one’s acne and their skin type. It is important that we find something that works, but doesn’t irritate your skin too much
- Oral antibiotics: In general, there is a point at which no amount of topical treatment will give you enough improvement without more aggressive therapies like antibiotics. We will ALWAYS make every effort to treat your acne with topical regimens IF we can. Sometimes though, this is not realistic and stronger options can be used
- Hormone Modulation: There are a few systemic medications that are used to decrease the androgenic effects(testosterone-like effects) of your own hormones. In the right patient, this is an amazing treatment. This treatment does require follow-up and some monitoring.
- Accutane: This is the most-effective drug in the world for the treatment of acne. It is also the most regulated drug in the world. Despite this fact, this medication is necessary for many people in whom less aggressive therapies did not work. Because of its’ regulation status patients who are on accutane must be registered in the I-pledge program; a government program for monitoring. This requires visits with us every 30 days while on accutane. Obviously, there are many other issues to be discussed if you do need to take accutane and this is something we will do with you when you come in. Accutane is extremely effective and can be life-changing in many people. Accutane is thought to cure acne in 40 to 60 percent of people.
- Chemical peels: Chemicals, such as glycolic acid or salicylic acid, applied to your skin help remove dead skin cells, unclog pores, remove whiteheads and blackheads, and can generate new skin growth. These chemical peels are often used with acne creams or gels for better penetration of the medication. Depending on strength of the chemical, side effects of chemical peels range from temporary redness, blisters, scaling and crusting to scarring, infection and abnormal skin coloring.
- Light therapy: The Omnilux blue and red lights for the treatment of acne is well-known. In general, regular use of these two wavelengths of light will give you about 20% more improvement on top of whatever else you are doing. We usually use the acne lights in conjunction with other modalities. It is a way of putting a turbo button on your treatment. This treatment is not covered by insurance. This is an extremely safe treatment with no know side effects that can be used by those who wish to avoid stronger, systemic treatments. This is not an effective treatment for cystic acne.
- Light therapy WITH chemical peels or microdermabrasion: By exfoliating the top layer of the skin and then treating it with the red and blue light you can expect to get even more improvement in your acne. We like to use a light chemical peel or dermabrasion prior to your light treatment. The red and blue lights will be alternated with each treatment. We like to do a series of treatments as close together in time as your skin will tolerate. This is followed by regular maintenance treatments. This is a great treatment option for individuals who do not want to be on an oral/systemic medication, for people who are nursing, and for people who are allergic to the systemic medications. The amount of you’re you are exposed to the light and many other factors are critical in getting this treatment to work and this is why it is important to go to a provider who is very experienced with this treatment. This treatment is not covered by insurance.
- Microdermabrasion: This type of treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or “polish” the skin’s surface. Then, a vacuum removes the crystals and skin cells. The procedure exfoliates and unclogs pores. Similar to chemical peels, microdermabrasion is often used with other acne treatments to increase their effectiveness. This is similar to the effect of a chemical peel, and can be used to maximize the effectiveness of your topical regimen. Our office carries the “Personal Microdermabrasion” device so you can do medical-strength microdermabrasion at home. This device is actually quite strong and you need to be trained in its use so you do not burn your skin. This treatment is not covered by insurance.
- Photodynamic therepy: this is a treatment that requires the application of aminolevulanic acid (a naturally-occuring chemical found in our bodies, but at a much higher concentration) which is a “photo-sensitizing” chemical. This means it reacts to certain wavelengths of light to cause inflammation in the treated areas. It is kind of like getting a sunburn and side effects can include swelling, redness and crusting. This treatment is not covered by insurance and cost approximately $350 and usually requires a few treatments.