The "A" Train

Lasers for Acne

As much as the laser community wants us to believe that lasers treat acne. The fact is the cost does not justify the result....However, that may change in the future.

http://www3.interscience.wiley.com/cgi-bin/fulltext/119408075/PDFSTART?CRETRY=1&SRETRY=0

Topical and oral treatments remain the best protocols for acne

http://atrain.typepad.com/atrain/2009/03/acne-now-classified-as-a-chronic-disease.html

Acne: Now Classified as a Chronic Disease

According to The Acne Global Alliance, acne is now classified as a chronic disease that needs appropriate diagnosis and long term strategies to effectively treat.

The Alliance says that acne effects 85% of the World's Population in the age of 12 to 24.

So how do you treat this disease? The Alliance recommends the following (and I am paraphrasing).

Mild Acne     - 1st Choice - Topical retinoid
                   - 2nd Choice - Azelaic acid, salicyclic acid, physical extraction
                   - Alternative for women - see 1st choice
                   - Maintenance - Topical retinoid

Moderate Acne     - 1st Choice - Topical retinoid + topical antimicrobial
                           - 2nd Choice - Azaelaic acid, physical extraction
                           - Alternative for women - see 1st choice
                           - Maintenance - Topical retinoid

Severe Acne     - 1st Choice - Oral antibiotic + topical retinoid and/or benzoyl peroxide
                       - 2nd Choice - No consensus among experts so they default to first choice and azelaic
                       - Alternative for women - Oral antiandrogen + Topical retinoid and/or topical                                                                           antimicrobial
                       -Maintenance - Topical retinoid and/or benzoyl peroxide

Disfiguring Acne  - 1st Choice - oral isotretinoin
                          - 2nd Choice - high dose oral antibiotic + topical retinoid and/or benzoyl peroxide
                          - Alternative for women - High dose oral antiandrogen + topical retinoid and/or                                                                            topical antimicrobial
                          - Maintenance - Topical retinoid and/or benzoyl peroxide

This is alot of information to digest, but the bottom line is that a topical retinoid is your best weapon when fighting acne.

Please do not use this information to self diagnose and treat your acne. But, use this information to talk to your dermatologist as the best ways to treat your condition.

I often hear from frusterated people that lament they have tried man of these therapies and are not getting results or that they cannot tolerate the retinoid. There is no one best way to treat everyone's acne, but requires a trial by fire mentality to best approach your condition. Your doctor has the insight and training to help your search for the best path to treatment....so, don't lose faith after a couple of visits!

Cell Receptors are the Key To Understanding Retinoids

At the American Academy of Dermatology Annual Meeting in San Francisco, Dr. Sewon Kang presented some of his prolific research on retinoids. The thing that I liked the most about his speech was his definition of a topical retinoid:

"any molecule that, by itself or through metabolic conversion, binds to and activates the retinoic acid receptors, thereby eliciting transcriptional activation of retinoic acid-responsive genes that results in specific biologic responses (Kang & Voorhees. Fitzpatrick's Dermatology in General Medicine [7th Ed.]. 2008)."

He went on to further explain that Vitamin A enters the skin where it is stored and esterfied. It is then oxidized into retinoic acid where it is received in the nucleas of the cell. (For a visual representation of this event click here).

He went on to point out that keratinocytes are divided faster in retinoid treated skin which is the main reason to use a retinoid.

There is also a general misconception that retinoids thin the skin. In a study that was conducted by Dr. Kang, skin biopsies show that the skin doubled in thickness.

The last thing he pointed out was, "Topical retinol elicits a retinoic acid-like epidermal histology (hyperplasia and spongiosis), but, unlike retinoic acid, it doesn’t cause significant erythema."

Therefore, it is my hope that we can get doctors to think about carrying an over the counter retinol as a great alternative to prescription strength retinoids.

You can read the full Dermatology Times article here.

Another Good Reason Not To Use A Tanning Bed

Yikes! http://www.newsobserver.com/front/story/1436088.html :)