Acne Treatment

Melbourne Eastside Dermatology is a dermatologists-led specialist practice in managing acne and acne scarring.   All patients should be seen and assessed by dermatologists or dermatology nurse practitioners for medical therapy of acne and consideration of acne scarring therapy.

ASSESSMENT OF TEENAGE ACNE
Acne is commonest amongst teenagers due to the surge of hormonal-skin changes.  Dermatologists will usually undertake a relevant medical and family history.  Important medical conditions such as Polycystic Ovarian Syndrome (PCOS) or rare endocrinology conditions (such as congenital adrenal hyperplasia) will need to be ruled out.

ASSESSMENT OF ADULT ACNE
Some patients experience acne since young and others will have a later onset in their life.  In adult acne, more emphasis will be put on assessing whether there are any external triggers (such as lifestyle, diet, make up , skin care, working conditions, weight training supplements or medications) that are modifiable.  Severe persistent cases are also more likely to require investigation  Medical therapy is also going to be centered around the personal circumstances such as planning for pregnancies, work or active lifestyle.

MEDICAL ASSESSMENT OF ACNE
While these are not always or routinely performed, there are tests such as blood tests to rule out hormonal problems, and imaging modality including ultrasound to rule out Polycystic Ovarian Syndrome.

NON-PHARMACOLOGICAL THERAPY OF ACNE

• Dietary modification – including avoiding excessive dairy/sugar/high GI diet.
• Lifestyle modification – avoidance of hot humid environment.
• Makeup modification – light lotion-based makeup is better than oil-based.
• Skin care advice – Active ingredients in non-prescription skin care include Salicylic Acid, Retinol, Benzoyl Peroxide.
• Avoidance of supplements that trigger acne – these include high energy based weight training supplements, testosterone or anabolic steroid.

COSMETIC THERAPY OF ACNE

• Superficial chemical peels including Salicylic Acid, Lactic Acid and Retinoid.
• Lower level light therapy (LLLT) using a combination of blue and red LED light treatment using our SmartLux device.

MEDICAL THERAPY OF ACNE

Your treating specialist practitioners may prescribe a variety of treatment

• Topical antibiotic
• Topical retinoid
• Topical Benzoyl peroxide
• Oral antibiotic
• Oral contraceptive pills
• Oral hormone-reducing tablets such as Spironolactone
• Oral retinoid (such as Isotretinoin)
• Steroid injection for acne cysts

ISOTRETINOIN THERAPY

This remains the most effective oral medication treatment. This is a form of active vitamin A (Retinoid) oral therapy.

• In Australia, this requires specialist dermatologists (FACD) for prescription and a specific retinoid number for dispensing by pharmacists.
• Majority of patients will have completely (or close to completely) clear skin at the end of treatment course.
• Treatment course range from 6 to 18 months, sometimes longer, depending on tolerability.
• Commonest side effect are dry lips, dry skin and sunburn tendency – All patients will experience this and usually manageable with lip balm, moisturiser and regular sun protection.
• Some patients will experience some acne worsening in the initial treatment.  This is very important to manage and dermatologists may prescribe oral antibiotics or steroid to reduce this.
• Depression has been widely publicised as being a potential side effect of this treatment.  However, the this is very rarely seen and this will be discussed with any patients before commencing treatment.

ACNE CYST

As specialist dermatologists, we often encounter many severe cases of acne cysts that are huge, sometimes painful and most importantly frequently leave behind permanent scarring.

• Steroid injection directly into the cysts will likely be used and this usually shrinks the cysts almost instantly within a few days.
• Treatment after will include medical therapy to avoid the recurrence of these cysts.  Isotretinoin is frequently used for this reason.
• We would recommend to avoid excision of these cysts as these will cause scarring (even the biggest cysts are likely going to reduce with a simple injection).  Please seek specialist dermatologists treatment before undertaking any procedures.

Acne Scarring Treatment

The general rule is that acne has to be managed medically to the point that it is clearing well before scarring is to be treated.  However, established scarring may also be treated early as it is always easier to treat fresh early scars before they become thick and difficult to manage.

TYPES OF ACNE SCARRING

• Hypertrophic and keloid scars (common on chest, back, shoulders and jaw).
• Atrophic scars (where tissue is lost) – this would include ice-pick scars, box scars, rolling scars

We currently offer the following options for acne scarring treatment.

Non-energy devices or treatment

• Micro-needling for small areas scars
• Steroid injection to reduce cysts
• Steroid injection to reduce thickened/keloid scars
• TCA CROSS topical surface chemical ablative therapy (excellent for ice-pick scars)
• Needle subcision for tethered scars (where scars are bound down to deep tissue)

Low downtime energy-based devices treatment

• Venus VIVA nano-fractionated radiofrequency treatment
• PicoWay Resolve acne scarring treatment

Ablative laser therapy is sometimes required for deep scarring. This will require a significant downtime and frequently produce  post inflammatory pigmentation for darker skin patients.  Please note we currently do not provide these ablative laser therapy (such as CO2 or Erbium laser) .  We would liase with suitable colleagues to perform these if required.