A while ago we discussed acne and scarring and at home solutions to combat breakouts while in isolation. As we move into the next phase of covid reopening, we can start considering treatments in the clinic to go along with what we are doing at home.
In-clinic procedures for active acne vary from facials (currently restricted) to chemical peels to laser treatments. The appropriate treatment plan can be established through a consult and assessment with your medical esthetician or with your dermatologist. But, let’s discuss a little first.
When acne is to the point that regular medication such as topicals or antibiotics are no longer helpful, I have found the next step is either PDT or isotretinoin or hormonal therapy(in women) . These treatments are effective for acne and each have their own set of positives and negatives. Once acne is clear, then steps towards reducing scarring should be reviewed with your medical esthetician and/or your dermatologist.
Without a doubt, the most intense, but effective treatment is PDT, or PhotoDynamic Therapy. Quite often 2-3 sessions, 1 month apart will shrink the sebaceous glands and kill off bacteria. In most cases, acne is gone, although a pimple here and there may still occur. During the session, the skin is prepped and a medication called Metvix (often covered through your drug plan) is applied, occluded, and left to incubate for 2-3 hours. The medication is activated with Aktilite (or other laser or light-based device such as BBL), a light activated device made specifically for PDT. There is a post-protocol to follow, but acne and even some acne scars will start to reduce even after 1 session. Most patients need 2 sessions, with results being successful over 90% of the time.
Facials, when we are able to start treating again, are perfect for reducing blackhead accumulation, pustules and inflammation. They provide a deep cleanse, hydration and balance the skin. They can be performed alone or as the perfect accompaniment to any of our other treatments, especially chemical peels or silk-peel microdermabrasion.
Chemical peels and silk-peel microdermabrasion are all effective to reduce congestion, brighten up the skin and I find that chemical peels are specifically effective at reducing scarring and acne equally, making it the perfect go-to when our patients are anxious to reduce scars but are still finding their acne to be too active to start a laser scar reduction treatment plan. Silk-peel microdermabrasion requires no downtime, but when performing chemical peels, we suggest not having any important events happening for up to a week or so due to mild or moderate peeling.
When we talked about scars before, I mentioned that there are different types of scars. In most cases, we have certain lasers for specific types of scarring. For example, if the patient has redness left after the pimples are gone, we need to use lasers that will remove the red from the skin. The Laser Genesis with the Excel V KTP laser combination works very well, with anywhere from 3-6 treatments to clear the skin. With post -inflammatory hyperpigmentation, or brown discoloured areas (PIH), the BBL or the Excel V or Gentle Max Pro can be very effective, and the appropriate laser and settings will be chosen for each specific skin type and level of pigment. And for recessed/depressed scars, we find the ProFractional laser ideal for all skin types.
Microneedling and Microneedling with PRP (Platelet-rich plasma) are non-laser treatments for texturized scars that can also have a positive effect on redness and discolouration as well. By stimulating your own collagen, we are able to raise recessed scars and flatten raised scars. Although we can’t promise perfection, the ability to smooth the skin’s surface also reduces the shadows that accompany recessed scars, making the skin brighter and more healthy looking. The ProFractional Laser is the most comprehensive resurfacing laser providing optimal collagen stimulation with each and every session. With the ability to add heat for lighter skin tones, thus adding more collagen stimulation, the ProFractional laser is extremely customizable with less side effects than any other resurfacing laser on the market.
Dermatology treatments for some specific types of scars can be addressed through TCA CROSS (for ice pick scars), subcision with or without fillers (for depressed/recessed “boxcar” scars), and punch/simple excision for stubborn small scars. These options can be discussed with your dermatologist.
In the end, the first step will be to see your medical esthetician or dermatologist for assessment and education into the best personalized options for you. Thankfully in this day and age, we have many great treatment options to offer and our clinic has a special expertise and years of experience treating both acne and acne scars. Call us at 416-633-0001 x2 to book your consultation.
~ Sheri Roselle, Medical Esthetician, Toronto Dermatology Centre
