Prescription acne medication

Acne Vulgaris is associated with hormonal changes typical to adolescence and early adulthood due to increase levels of testosterone hormone levels typical  to teens and young adults of both genders. Acne is an infection of the sebaceous glands and hair follicles on skin surface. It typically affects the surface of the face, back, armpits, neck or other sweaty areas.  Acne can have several levels of severity in terms of surface size of affected skin, type of breakout and depth of lesions.  If an acne cyst becomes severely inflamed, there is a good chance that it will rupture and scarring may result. Prescription acne medication can be very helpful in the prevention of acne breakouts and with treatment of existing acne to avoid scaring and shorten acne breakout duration. Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all the above. With most prescription acne medications, improvement may appear only four to eight weeks after treatment begins, and at times the skin condition may get worse before it gets better. Prescription oral acne medication should be avoided during pregnancy especially during the first trimester.

The American Association of Dermatologists (AAD) publishes useful guidelines and information for treating severe acne. This includes useful information regarding possible side effects and wise words of cautiousness and things that are good to know about these available acne treatments.

Prescription acne medication can be divided into:

• Topical – creams and lotions applied to the skin –  may be prescribed for mild to severe acne.
• Oral prescription acne medication – (Systemic – works internally through the full body) prescribed to treat severe acne and may be used for moderate cases too.  It is very important that patients treated with oral prescription acne medication be in constant medical supervision as side effects can be harmful if left undiagnosed.

Topical prescription acne medication

If acne doesn’t respond to Over the Counter (OTC) topical treatments such as Benzyl Peroxide meant to dry up the oil, kill bacteria and promote sloughing of dead skin cells, a doctor or dermatologist can prescribe a stronger lotion.

There are two main types of topical prescription acne medications:

1. Topical products derived from vitamin A – work by promoting cell turnover and preventing plugging of the hair follicles.

Topical Retinoids are a common derivative of vitamin A used in topical prescription acne treatment. Retinoids work by unclogging  pores and preventing whiteheads and blackheads from forming as they increase oxygenation in treatment area hence preventing growth of the P. acne that thrives in an anaerobic environment ( without oxygen) . Topical retinoids can cause skin irritation, in addition, increased sun sensitivity of the skin is another common side effect. It is important to use sun protection and follow the dermatologist’s directions to maximize effectiveness. Topical retinoids currently prescribed for acne treatment in the United States include: Tretinoin, Adapalene, and Tazarotene. When using Tazarotene it is extremely important to combine treatment with a secure contraceptive regimen as it is known to cause skeletal birth defects.

1. Topical antibiotics – work by killing excess P.acnes bacteria on the skin, hence preventing acne bacterial infections.

In most cases, a combination of both topical types is required for optimal results. A number of benzoyl peroxide, an OTC topical, combined with prescribed antibiotic medication are available, including different dose combinations of benzoyl peroxide and clindamycin (Benzaclin, Duac, Acanya) and benzoyl peroxide and erythromycin (Benzamycin). Some side effects of topical treatments include: stinging, burning, redness or peeling. A dermatologist can assist with reduction of these side effects by using a short application duration gradually increasing the dose or switching to another medication.

Oral prescription acne medication

Oral prescription acne medication can be classified as:

• Oral antibiotics
• Oral contraceptives
• Isotretinoin (Accutane)- Oral retinoid.

Oral Antibiotics
Oral antibiotics are prescribed for patients with moderate to severe and persistent acne. They work by reducing the P. acnes bacteria population, hence, decreasing inflammation. Treatment dosage with oral antibiotics varies; usually the dosage is reduced as acne conditions improve. In most cases, antibiotics are prescribed for a duration of about six months or less. When using oral antibiotics the P. acnes bacteria might become resistant to the specific antibiotic medication. If resistance occurs, an alternative antibiotic or alternative treatment should be prescribed. Some research has demonstrated that combining topical treatment using Benzyl Peroxide along with oral antibiotics, reduces the incidents of resistance to the antibiotic drug. Oral antibiotics may cause some common side effects, these include: upset stomach, dizziness or skin discoloration. These drugs also increase the skin’s sensitivity to the sun and may also reduce the effectiveness of oral contraceptives. According to a report on the AAD web site most common oral antibiotics used for treatment of acne in the United States include:

• Erythromycin. This antibiotic is effective against a broad spectrum of bacteria, including P. acnes. The most common side effect is irritation of the gastrointestinal tract.
• Tetracycline and its derivatives. Tetracycline reduces the inflammatory lesions of acne. Tetracycline should not be taken by pregnant or breast feeding woman as it can affect the development of the child’s bones and teeth, causing skeletal defects. Long-term, low-dose tetracycline therapy may be continued for many months to suppress acne. Higher doses may be prescribed for very severe acne.

Two available synthetic derivatives of tetracycline are doxycycline and minocycline. Doxycycline is especially effective in treating inflammatory acne. It can cause sun sensitivity in some patients. Minocyline is often effective in treating acne that has not responded to other oral antibiotics. Minocycline also seems to produce fewer incidents of antibiotic resistance.

Oral Contraceptives.

Oral contraceptives are a treatment option for the improvement of acne in women. Commonly used oral contraceptives for treatment of acne include a combination of Norgestimate (progesterone hormone) and Ethinylestradiol (Estrogen commonly used in medications) Common names of these medications include Ortho-Cyclen, Ortho Tri-Cycle. Side effects common to contraceptives include: headaches, breast tenderness, nausea and depression. The most serious potential adverse effect of these medications is a slightly increased risk of heart disease, high blood pressure and blood clots.

Isotretinoin (Accutane)

In sever acne cases, when antibiotics are not effective, for example in cases of deep cysts, Isotretinoin (Accutane) which is an oral retinoid drug. Isotretinoin is a powerful prescription acne medication reserved as a last resort option.  Isotretinoin/Accutane is very effective, but people who take it need close supervision by a dermatologist because of the possibility of severe side effects. It is associated with severe birth defects, therefore women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Additional common side effects of Isotretinoin may include: dry membranes in eyes, mouth, lips, nose and skin, as well has itching. Other side effects may include nosebleeds, muscle aches, sun sensitivity and poor night vision. The drug may also increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels. Even though it has not been clinically proven there have been reports as if Isotretinoin may be associated with increased rates of depression and suicide. This following link proves no significant link between depression and Isotretinoin: http://archderm.ama-assn.org/cgi/content/abstract/136/10/1231

This link claims reduction of depression following treatment with Isotretinon:

http://www.eblue.org/article/S0190-9622(87)70166-2/abstract

An alternative assumption could be made claiming that if indeed patients who consume Isotretinon are those that suffer from depression, this could be as a result of the fact that these are also the acne patients that suffer from the most aggressive and disfiguring type of acne.

Alternative methods for treatment of acne

The TriPollar solution

Alternative methods of acne treatments are available suitable for patients who are not willing or capable of adhering to a daily treatment regimen. Alternative acne treatment are also a relief for those who have failed medical management and for patients who prefer to avoid long-term drug treatment due to concerns or experience with the significant side effects associated with prolonged treatment using  isotretinoin and other acne medications. Alternative acne treatment options include laser therapy, phototherapy and TriPollar radio frequency. A study recently published following the treatment of moderate to mild acne using TriPollar RF technology, demonstrated that TriPollar Radiofrequency (RF) technology is a safe and effective solution for the treatment of acne vulgaris. (http://informahealthcare.com/doi/abs/10.3109/14764172.2011.564626)

The patients that participated in the research showed an average of 42% decrease in acne vulgaris lesions after six weekly treatments as well as at a follow-up visit four weeks later. Having a safe and effective alternative acne treatment provides additional options for acne patients and broadens the options of available acne management.

Treatment of ageing skin that is aimed at correcting damage of years includes noninvasive, mildly invasive and invasive procedures. When searching for options, not all possibilities are suitable for all. Therefore, when selecting a treatment for ageing skin it is important to find out in advance are there any possible side effects? What are these side effects? Is there down time? Pain level?

Treatment of ageing skin includes the use of dermal fillers, botox, skin resurfacing, and more invasive surgical procedures. Lasers can be used to address issues of pigmentations, discolorations, abnormal skin growths etc’. The most effective treatment of ageing skin would probably combine the use of anti ageing technologies that induce strengthening of the skin from within with skin surface treatments that remove old skin damage and expose newer skin. Fine spot corrections can include the use of dermal fillers and botox for deep wrinkles.

One non invasive technology for treatment of aging skin uses Radio Frequency (RF) energy for facial contouring and skin tightening, inducing heat in the treated area, this heat stimulates the body’s own collagen generation and in addition, tightens the existing collagen. The result is an improved skin texture along with reduced laxity of the skin.

Combining radio frequency non invasive treatment with a more aggressive treatment of skin resurfacing (using laser or radio frequency fractional treatments), will result in the benefits of collagen build up from within due to the RF treatment and renewed skin surface. However, this combined treatment will require a healing period due to the skin resurfacing and does involve minimal down time.
Treatment of ageing skin also includes prevention of further damage. This will include good hydration by drinking plenty of water, eating healthy food, physical activity, avoid smoking and excessive drinking and most important of all BE HAPPY.

With proper attention and treatment, ageing signs of the hands can be reduced

Most women and some men (metrosexual men…) apply facial creams, eye creams and other anti-ageing treatments to reduce the signs of ageing of the face and body. However, hands, that are also an important age indicator, are failed to be addressed by many. Hands are the most exposed body part to ageing elements like water, house-hold chemicals and the sun, major skin ageing inducers that can be dealt with through proper measures. When dealing with ageing of hands, the symptoms include: ageing spots, thinning of the skin, general thinning of hands and protruding veins. The skin in general, including skin of the hands, produces less collagen as we age hence causing thinning of the skin, thus causing the veins to protrude and the hands to look bonier.

With proper attention and treatment, ageing signs of the hands can be reduced and the hands can look a few years younger. For those of you still young with beautiful hands, make sure to take measures to postpone ageing of hands by applying sunscreen to your hands twice a day. It is also important to wear gloves when washing dishes or if handling house hold chemicals. This will protect your hands from dryness and from the harsh effects of cleaners, detergents etc’.

To help with dry skin, apply cream at night and wear cotton mittens over the cream to enhance absorption.
A few technologies and some invasive methods have been introduced to address the different aspects of ageing hands. Combination of technologies will enable a full spectrum of treatment, however it is important to understand these options in order to ensure the correct sequence of treatment protocol as one technology can interfere with the effectiveness of other technologies if performed in an inappropriate order, timing etc’.
Photorejuvination technologies ( IPL and fractional laser) are well established methods for skin rejuvenation. These methods can help with the reduction of age spots and general improvement of skin appearance of the hands due to induction of new collagen growth and removal of age spots. Healing from photo rejuvenation treatments can take a few weeks because the skin is purposefully damaged to cause superficial skin injury, that induces scabbing, peeling and healing.
Dermal fillers, which are normally deployed for facial wrinkles, can be used for the hands too (for example Restylane) in order to restore “plumpness” and improve the general appearance. If you decide to combine dermal fillers with photorejuvination technologies, it is important to undergo the photorejuvination treatment prior to the use of dermal fillers to ensure that you do not interfere with the dermal filler’s action. It is also important to allow the hands to completely heal before undergoing the next type of treatment.
For treatment of protruding veins on the hands, an invasive cosmetic surgery is available where the veins are removed (of course the doctor will asses the blood vessels on the hands to ensure that the surgery does not damage the blood supply). This surgery requires a long healing duration (a few months) and is usually performed on one hand at a time.
A non invasive safe technology for the improvement of hand appearance is TriPollar RF (Radio Frequency). TriPollar RF treatments can be performed during lunch break short  office visits with no down time and with no need for healing. These treatments induce formation of new collagen in the dermis, hence improving skin texture and resulting with smoother, younger looking hands. TriPollar RF treatments can be combined with photorejuvination treatments to enable removal of age spots along with improvements of skin texture. If combining these two technologies, make sure that the hands have completely healed after the photorejuvination treatments before starting the Tripollar treatment protocol.

Voss Andreae sculptures are inspired by his scientific knowledge

The exhibition “Bodies”, that has been circling the planet, takes the integration between science and art a step further and turns science into the art pieces.
However, art and science are further linked by art work that is inspired by biological and physiological structures. Julian Voss-Andreae is an artist that combines his scientific background with his creations. He studied physics at the universities of Berlin, Edinburgh and Vienna and focused on Quantum physics for his graduate research. Voss Andreae has created large sculptures that are inspired by his scientific knowledge. Among his sculptures is the installation Unraveling Collagen.  According to Voss Andreae: “Unraveling Collagen is based on the structure of collagen, the most abundant protein in humans. In this sculpture I placed the initial emphasis on the structural role collagen plays in our bodies. The triangular cut-outs reveal the dominant force lines, reminiscent of contemporary steel construction. Collagen is mostly known for its role in aging: It is responsible for skin elasticity, and its degradation leads to wrinkles that accompany aging. During the creation of the piece, I departed from the actual molecular structure and opened up the intertwining helices towards the top which connects the piece metaphorically with aging.”
It is quite fascinating and symbolic that Voss Andreae chose to create the unraveling collagen rather than “healthy young collagen”, it is the natural process of nature and is actually a truer symbol of life and time line of the living body rather than a perfect intact triple helix collagen fiber.
“Fighting” the aging process of the collagen is the target of technologies in the beauty and aesthetic industry. It is the desire of most ageing women and men too, to slow down the signs of ageing and to repair the damage already done; this is achieved by stimulation of new collagen growth and tightening of the existing collagen hence mending of the “unraveling” collagen.

Collagen is mostly known for its role in aging

Slyle-M Clinic staff. Ms. Muraki Hiroe second from LEFT

Ms. Muraki  Hiroe, of Style-M and the Matsukura clinic in the fashionable Omotesando Hills district in Tokyo Japan, has been voted as the No1 aesthetician 2 years in a row by a few magazines in Japan.
Being voted as the No 1 Aesthetician in Japan is not a trivial or minor honor, taking into account the high value the Japanese culture places on beauty, body care, aesthetics of appearance, generally talking the art of beautifying the body to its highest level.Ms Muraki Hiroe studied in Tokyo and is still in the process of studying while working as an aesthetician for the past 15 years. Ms Hiroe does not see herself as a master, she acknowledges that her wide and diversified knowledge along with her constant search for methods and technologies that obtain results in an effective and efficient way, are what placed her on top of the ladder. According to Ms. Hiroe, many aestheticians are into general healing and treatments that will be pleasurable for the minute, while her focus is on the obtaining lasting results.
Ms. Hiroe’s advice to beginning aestheticians is to invest in education and strive to achieve higher levels of knowledge. The more one knows, they will understand what they are doing and how to combine the best methods to obtain the best treatment protocols. Ms. Hiroe wants to focus on different good treatment methods and combine them to obtain the best results.

Ms. Hiroe treating with the apollo device

To a question regarding her favorite present treatment, Ms. Hiroe answered without hesitation “The apollo is my favorite now”. (I stressed while I presented the question to Ms. Hiroe that she does not have to answer ” the apollo” just to please me…). Ms. Hiroe loves working with the apollo because she sees wonderful results, it is very pleasant for the client being treated and there is no pressure and stress while treating.
At present, Ms Hiroe is studying a method that works through adjustment and very specific alignment of the bones and muscular structure to improve structure and facial contour (This is very different than chiropractic work). She works mainly on the facial structure and is just about to take examinations.  We wish you luck Ms Muraki Hiroe, we are sure you will do very well.

Aging is unavoidable fact of life – everyday we are all getting older. However, it is not age itself that bothers us, but the visible signs of aging that can make us feel old despite the fact that we feel young and vital. The health and look of our skin – whether on our face or on our body – plays a significant part in how old we feel and is seen as the most common indicator to others of our age. Facial wrinkles,  neck décolletage and hands are one of the most visible signs of skin aging. Over time they tend to get more visible. Wrinkles aren’t an illness! But wrinkles can alter the way we look, and this may change the way we feel about ourselves. Wrinkles usually start as fine lines. They tend to get deeper over time. Wrinkles are often noticeable on the face. Lines tend to form on the face in the places our skin folds when we smile or make other facial expressions.
 

The aging process of the skin occurs in two different ways, (Intrinsic and Extrinsic skin aging). Intrinsic aging is what we get from our parents and is inevitable and pre-determined. The skin will become thinner, less elastic and essentially dryer as a consequence of skin aging. This is a direct result of a reduction in the overall production of collagen. This decrease combined with gravitation will lead to sagging of the skin.
Skin will become dryer as a consequence of aging because the dermis is stripped of its ability to retain moisture. In addition, the process will lead to a substantial reduction in the sweat glands and sebaceous glands, all of which ordinarily lead to moist, plump skin.
Although the extent of the process will vary, skin aging will predominantly become apparent at age 30.
Extrinsic aging is associated with exposure to various toxins and environmental elements. The foremost and most detrimental element is the sun. UV sun rays associated aging, often known as ‘photo aging’ will cause a number of fine lines on the face, wrinkles, age spots, freckles, enlarged pores, broken capillaries and rough, uneven skin tone.

Infrared (IR) radiation

 Infrared (IR) radiation is a form of electromagnetic radiation whose wavelength is longer than that of visible light. The name means below red. Visible red light is the color of the longest wavelengths of visible light that we can see with naked eyes.

IR radiation is divided into 3 different bands according to wavelength:

• IR-A: 700 nm–1400 nm (Near-infrared)
• IR-B: 1400 nm–3000 nm
• IR-C: 3000 nm–1 mm

Infrared radiation is popularly known as “heat” or sometimes “heat radiation”, since many people attribute all radiant heating to infrared light and/or to all infrared radiation to being a result of heating.

Infra Red Laser Skin Tightening
In the last 10 years various non-invasive and non surgical treatments modalities have been developed for aging skin. Most of the advanced dermatology clinics are using lasers, radiofrequency (RF), IR lasers and a combination of the above to treat aging skin. All these methods are aiming to heat the deep skin layer in order to shrink redundant or lax connective tissues through the mechanism of collagen denaturation.

How does Infra-red laser work on aging skin?

Infra-red laser utilizes infrared light to heat the dermis well below the skin’s surface by heating up the water content in the skin. This heating can cause immediate collagen contraction by the denaturization of collagen. During the procedure, the outer skin’s surface (epidermis) must be protected through continuous cooling by means of active cooling. After the procedure, new collagen growth results in further tightening and the development of a more youthful, complexion with less fine lines, folds or looseness of the skin. People with dark skin should avoid the treatment.
  

Who should not undergo this procedure?

There are various contraindications which are similar to other light based technologies such as:
Women who are pregnant or breastfeeding are not suitable candidates.

Since the treatment heats the tissue under the skin’s surface by Infra-red light, dark skin absorbs most of the energy in the uppermost skin layer, which can cause burns. In such cases RF procedures are optimal since RF is considered as ‘color blind’ technology which is suitable also for dark skin type and color.  
Large areas of loose or redundant skin, such as after massive weight-loss may be better suited for TriPollar RF treatments or for surgical approaches in severe cases.
 
Also, until further studies have been carried out it is advisable not to have treatment directly over dermal filler products.
 

 
What sort of practitioner can perform this treatment?

Only suitably trained medical professionals should perform infrared laser skin tightening procedures.  

For more information see also: Titan™ skin tightening review