- The Washington Times - Tuesday, December 3, 2002

Light can be a burden for those with acne or the scars acne leaves behind, illuminating their condition for all to see. Now, doctors are turning to light to treat the stubborn skin condition.
Laser light treatments represent one of several new weapons available to fight acne and acne scarring.
The Smoothbeam laser, created by Wayland, Mass.- based Candela Corp., earned the U.S. Food and Drug Administration's approval in October, and a treatment based on radio-wave frequencies could soon follow suit.
Acne is caused by the skin's hair follicles clogging with oil and dead skin cells. These follicles are connected to sebaceous glands that secrete the oil, known as sebum.
The condition is commonly thought to be the worry of the teenage set, but acne can strike at any age.
Doctors disagree over what factors inflame acne, such as stress and diet, though the former is considered more of a trigger than the latter. Certain medications, such as anti-depressants, occasionally trigger outbreaks, and women can develop acne because of hormonal changes, such as during pregnancy or menstrual cycles.
All agree that hereditary factors play the largest role in whether a person will suffer from prolonged acne.
Dr. Tina Alster uses lasers as part of her District cosmetic surgery practice, both to reduce patients' wrinkles and, more recently, to combat acne.
"We haven't built lasers specifically for acne," the dermatologist says. Years of reducing wrinkles, though, showed a curious side effect to the treatments. The patient's sebaceous glands shrank after wrinkle treatments with lasers.
That opened the door for the new therapy.
"If it's not under control with the topical agents, its good for laser," says Dr. Alster, who has been using laser therapies on acne patients for about a year on a limited basis. "It's nice to have another option now."
Such laser treatments also stimulate the skin's collagen-producing cells, which improves the skin's texture and plays a role in smoothing out acne scars.
The process is quick and more uncomfortable than painful. A topical numbing agent is used, and each beam of light is preceded by a blast of a cooling agent called cryogen, which prevents the top layer of skin from burning. The skin may appear pink after a treatment, but the damage is negligible.
"You create a controlled thermal wound, not a burn," Dr. Alster says of the laser treatments, which aren't covered by most insurance plans.
Most patients receive a single treatment, though they may come back over time for more laser sessions. Only time will tell if the treatments provide temporary or permanent relief.
Prices for acne scar treatment range from $500 to $600 for a series of three sessions; laser treatments for acne scarring start at $250 for a small area and grow to about $600.
Dr. Alster says topical agents and then oral antibiotics to kill bacteria remain the first line of defense against acne. If both methods fail, the patient is a candidate for Accutane, the most potent anti-acne drug available.
Some patients shy away from that drug's side effects, which can include dry skin, joint pain, depression and, in extremely rare cases, loss of eyesight, night blindness or double vision. The latter should be reversible once the medication is stopped.
Laser treatment isn't the only new weapon in the war against acne.
Dr. Michael Kaminer, a dermatologist based in Chestnut Hill, Mass., has begun treating acne patients with a device that emits concentrated waves of radio frequency.
The FDA recently approved the technology to treat wrinkles, Dr. Kaminer says, but now he and other doctors are seeing the method's benefits in treating acne.
Like lasers, the device heats small portions of the skin, about one square centimeter at a time, either reducing or destroying the troublesome sebaceous glands that he calls vestigial, or no longer needed.
Early data showed it can improve active acne in a significant percentage of people, says Dr. Kaminer, who began using the device on acne patients about six months ago.
Patients feel slight pain during the procedure, which he says lasts 30 minutes to a little less than an hour.
"Accutane does a great job for two-thirds of the people who take it," he says. Already, you have a third of the people who might benefit from another acne [fighter]."
Acne breaks down into four basic types: Pores blocked by oil secretions and dead skin are called whiteheads; blocked pores that collect dirt are blackheads; swollen spots in which the pores become inflamed or infected are pimples; and thick lumps below the skin's surface caused by secretions built up within hair follicles are cysts.
Acne's aftermath can be as devastating as the outbreaks themselves. Acne scars can leave permanent damage on a person's psyche and damage social interactions.
Scar revision, much like acne treatments, also is getting a boost from lasers.
Blemishes on the face may seem inconsequential when compared to life-threatening situations, but those whose teenage years have been forever marked by acne will say otherwise.
Chevy Chase resident Greg Estrada developed acne when he was about 13 years old. Today, at 39, little trace of that condition remains. He can thank an array of scar-revision treatments for that, including laser work and more conventional techniques, including dermabrasion.
The emotions the condition wrought still linger.
"It's hard to explain what it does to your head," says Mr. Estrada, who runs a support group for those with acne scars. It meets once a month in Chevy Chase.
"I was very shy. I didn't speak up in class," Mr. Estrada says of his teenage years. "You get shoved to the sidelines of life."
His condition lifted at age 25 after he took Accutane. He started the support group last year after hearing of a friend's suicide, which he blames, in part, on her battles with acne, unrelated to Accutane.
The group offers camaraderie and a nurturing atmosphere. It also serves as a forum for swapping the best tips on scar revision.
Mr. Estrada says those considering such work should try established methods, such as subcision, excision and dermabrasion, before opting for the latest techniques.
Subcision involves having a small needle break up the scar tissue underneath the skin's various depression-type pits. Excision, which is best for jagged-edge scars, requires a doctor to cut out the scars and patch the skin with stitches. Dermabrasion involves scraping off the top layer of skin, letting new, smoother skin grow in its place.
"I found the low-tech procedures are much more cost effective," Mr. Estrada says.
They are bloody, though, and the patient must wear bandages for up to two weeks while the skin recuperates.
Mr. Estrada would like to get more scar revision work done, though he knows to most people's eyes his skin looks as clear as the next person's.
"If I had more money, I'd do more things. It's an expensive hobby, more expensive than golf," says Mr. Estrada, whose confidence has been restored to a point where he is performing stand-up comedy at local venues.
Accutane may have stopped Mr. Estrada's acne in its tracks, but not everyone is eager to take the medication.
Dr. Allen Gaisin of Kaiser Permanente in Fair Oaks Medical Center in Fairfax says Accutane's side effects persuade some to seek out alternative acne treatments. It shouldn't be ruled out so quickly, though.
"The likelihood of it causing depression is rather remote," Dr. Gaisin says. "But there are cases where people went on it and got depressed, then went off it and didn't have depression anymore."
Because of fear of significant complications, the medication should never be taken by women trying to get pregnant.
Dr. Gaisin says newer medications, such as the topical agent Tazorac, are proving effective in combating acne. Also, he says the newest derivatives of Retin-A, an established acne medication, are a "significant improvement" over previous drugs.
Experts suggest modest acne can be fought by washing one's face twice a day with a gentle cleanser, using over-the-counter products containing benzoyl peroxide or salicylic acid and keeping hands and hair away from the face as much as possible. Washing the face too often, or too rigorously, can irritate the skin and cause more clogged pores.
Mr. Estrada says those with acne scars shouldn't despair.
"Even with the worst-case scenario, there's plenty of hope," he says.
For information on Mr. Estrada's support group or for his links to area doctors, visit www.geocities.com/grege20815.


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