Dr. Alexander Rivkin
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FAQ’s – Acne Skin Treatments

WHAT IS ACNE?

Acne is a chronic inflammatory disease of the sebaceous glands that are associated with hair follicles. Each follicle contains a tiny hair and multiple sebaceous glands. Acne occurs when these glands become clogged with sebum, an oily substance that normally is released out to the surface of the skin through the hair follicle. As a result of the clogging, bacteria and inflammatory cells build up inside the gland. This causes redness, swelling and pus – a pimple. Acne that is deep in your skin can cause hard, painful cysts. Hormonal changes may cause the skin to be more oily, thus acne is most commonly found in teenagers but can affect anyone, including babies. Pimples are mainly found on the face, neck, back, chest and shoulders.

HOW DO I AVOID ACNE?

There are many misconceptions about the causes of acne. Acne does not result from too much dirt on the skin i.e. uncleanness. It is often hereditary. Nor does it come from eating a lot of junk food. Research does not show that chocolate, nuts and greasy foods cause acne. However, diets that are high in refined sugars may be related to an increase in pimples. Different doctors have different views regarding the importance of your diet in skin management. It is always important to eat a well balanced diet, however a strict diet by itself will not clear your skin.

The black in a blackhead spot is dried oil and shed skin cells, not dirt. For a normal level of skin care, it is advised that you wash your face twice a day. Excessive scrubbing of the face can in fact be counter-productive and make acne worse. Those with oily hair may be recommended to regularly shampoo. Additionally, avoid greasy cosmetics and creams. For women, taking off make-up at night is advised, as is searching for water based formulas.

HOW DO YOU TREAT ACNE?

Acnetreatment depends on whether you have a mild, moderate or severe type of acne.

First and foremost, one can follow the instructions above and organize regular facial treatments from a licensed aesthetician. It is important you don’t try to remove your pimples yourself, as infection, inflammation and scarring may result.
For those suffering from mild acne, Benzyol peroxide 2.5% gel is the best initial treatment in decreasing the organized concentration. For mild to moderate acne, topical tretinoin (Retin-A) is usually the next step in treatment. Retin-A is an established solution to acne, decreasing the stickiness of skin cells and relieving obstruction of the sebaceous glands. Oral antibiotics such as Doxycycline are also an effective treatment. In cases of moderate acne, these treatments work well when used in combination.

WHAT IF THE ACNE DOESN’T RESPOND?

In cases where this treatment is unsuccessful, light based acne therapy should be the next step. We recommend Blue Light and Intense Pulsed Light (IPL) treatments. These effective treatments are mostly painless and maximally effective against the acne bacteria that build up inside obstructed sebaceous glands and cause inflammation.

Blue light works by directly killing the bacteria causing acne, using a strong narrow band LED light that penetrates through the epidermis. This is a painless treatment that only takes around fifteen minutes. Intense Pulsed Light treatments target both acne bacteria and the secretions of overactive sebaceous glands. The treatment lasts just thirty minutes and is involves minimal discomfort, leaving the patient without swelling or bruising.

WHAT IF MORE SEVERE ACNE DOESN’T RESPOND?

In severe cases of acne, Isotretinoin has been the standard medication for many years, limiting the function and size of sebaceous glands and thinning the epidermis. Isotretinoin (13-cis-retinoic aid or Accutane) is taken orally over the course of twenty weeks. It is a very effective solution for severe cases of acne, but is associated with both irritating and serious side effects. Fortunately, the new and effective Photodynamic Therapy has emerged as an effective alternative to Accutane, without the side effects.

WHAT IS PHOTODYNAMIC THERAPY?

Photodynamictherapy (PDT) uses a topical photosensitizing chemical (amino levulonic acid or Levulan) that is absorbed by the skin. When the skin is then exposed to blue light, the light penetrates deeper and is very effective in destroying bacteria and hyper pigmented or abnormally reproducing cells It is effective in the treatment of pre-cancerous spots, sun damaged skin, acne, warts and other diseases.

Photodynamic therapy shrinks oil-producing sebaceous glands and decreases bacteria on the skin. This reduces the production of pimples. During PDT the skin is washed several times and the activated levulonic acid is applied,for an hour, followed by exposure to blue light for about 20 minutes. We recommend that PDT treatments are performed in the late afternoon or evening, and that you spend the following day indoors. After PDT a small amount of the Levulan remains on the skin for up to 24 hours. Redness and itching may be caused by exposure to sunlight, so we do not advise leaving the house or even sitting next to a window on a sunny day for 24 hours after the treatment. Patients can leave the house on the subsequent day, but should use sunscreen and a hat.

Most people experience some burning or itching in the hour following the procedure, although this can last a few days. Additionally, patients are likely to experience swelling around the eyes for up to 48 hours as well as peeling of treated skin. These issues should quickly resolve, are easy to counteract and are not serious.

HOW MANY PDT TREATMENTS WILL I NEED?

The number of treatments you will need will largely depend on the severity of the acne and your response to treatments. In some cases, patients are fully cleared of acne after three monthly treatments, although the acne may recur. Recurrence of acne, if treated aggressively, should be easier to resolve than initial therapy.

Photodynamic therapy is a proven, tested solution to acne that has treated the most severe cases of pimples, including patients who have failed Accutane. Additionally, PDT is not associated with the severe medical and psychiatric possible side effects of Accutane.


11645 Wilshire Blvd., Suite 800, Los Angeles, CA 90025  |  (310) 443-5273

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