Effective Dermatologist Office Treatments for Acne

Home acne skin care products and prescription medications are essential to treat moderate or severe acne. However, often, specific procedures in the dermatologist office are also needed to control acne and reduce the brown discoloration and spots that remain after acne blemishes go away. Chemical peels and blue light acne treatments can help.

What is a Chemical Peel?

Although chemical peels have been around for a while, they are still very helpful to rejuvenate skin, treat acne, acne scarring and some kinds of pigmentation. Chemical peels use the application of a surface agent to create an injury at a specific depth to exfoliate and regenerate tissue. There are three types: superficial, medium and deep-depth peels, which correspond to the depth of penetration in the skin. The depth of penetration is directly responsible for the kinds of problems they can treat, the recovery time and the risk of side effects. Superficial peels include the alpha hydroxy acid (glycolic acid), beta hydroxy acid (salicylic acid), lactic acid and superficial Jessner’s peels. Mid-level chemical peels include mid strength trichloracetic acid (TCA). Deep chemical peels include high strength TCA and phenol. With recent advances in lasers, mid or deep level chemical peels are less commonly used because of the somewhat reduced predictability compared to laser resurfacing.

The three levels of peels are very different in terms of usefulness for a specific skin problem, recovery period, risk of side effects and discomfort during the procedure. The type of complications--infection, scarring, pigment problems and redness—are similar but the risk and severity of these complications increase significantly with the strength of the peel. Recovery time and discomfort also increase with the strength of the peel.

In this post, I will cover superficial chemical peels to treat active acne, leftover spots and discoloration from old acne blemishes. We will cover deeper chemical peels and laser resurfacing for acne scars later. How do you tell the difference between leftover spots and discoloration from old acne blemishes and real acne scars? Simple—true acne scars are either raised above or depressed below the level of the surrounding skin, or have permanent texture changes like loss of pores. You can determine this by looking at your skin at an angle in cross lighting. Just because you have brown or red spots after a pimple goes away does not mean you have scarring. Your dermatologist can tell you whether you do or not.

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Superficial Chemical Peels Help Acne, Spots Leftover from Acne and Discoloration

Superficial chemical peels give a fresher, smoother surface, improve a variety of conditions--acne, and plugged pores, melasma, some kinds of brown pigmentation, sun damage, fine lines, and milia cysts. Glycolic or salicylic acid chemical peels are the types of peels most commonly used to treat acne. Acne skin peels help remove plugs from pores and both treat and prevent acne. They are usually combined with acne surgery, which is the removal of acne plugs using sterile instruments. For improvement with superficial peels you will need an initial series of treatments, usually a minimum of 8 treatments at 2-4 week intervals. For best results, you will need maintenance peels once every 4-8 weeks. There is mild itching or stinging during procedure, and mild-moderate discomfort if draining deep tender cysts.

Immediately after a glycolic or salicylic acid superficial peel, your face may feel flushed and be red for several hours. The skin feels tight for a day or two and then lightly peels around day five. Small crusts may form on some acne lesions as they dry up. There is mild itching or stinging during the procedure, but patients tolerate this well.

Most acne patients do very well after a superficial chemical peel, as long as certain precautions are followed and patients who are at increased risk for complications are evaluated by a dermatologist before the peel. A detailed medical history is used to rule out certain patients who are not good candidates for a chemical peel.

A partial list of conditions that may affect safety of a chemical peel includes:

• Cold Sores
• Sun Sensitivity
• Keloid Scars
• Diabetes
• Eczema
• Sensitive Skin
• Seborrehic Dermatitis
• Rosacea
• Lupus
• Lichen Planus
• Psoriasis
• Facial Warts
• Past allergic or other reaction to glycolic or salicylic acid
• Current open/crusted areas
• Areas treated with freezing, surgery, or cautery within the past month
• If you are a "picker"
• If you are unable to or refuse to avoid significant sun or tanning bed exposure
• If you are or might be pregnant

We give very detailed instructions for both before and after the peel regarding sun and wind exposure, specific skin care products and topical medications to use or avoid, and other things that may cause complications such as waxing. These are my instructions in my clinic; your dermatologist may give you different instructions.

How to Have a Better Acne Chemical Peel

If you have had any of the following in the week before your peel, let your dermatologist know before your peel:

• Hair coloring, perm wave or straightener.
• Significant sun or wind exposure.
• Used a depilatory, wax, facial hair bleach, or received electrolysis, IPL or laser treatments.

Before your peel:

• Don’t use any retinoids (Retin A/Refissa/Differin/Tazorac) for at least two nights prior to peel.
• Don't use any glycolic, salicylic or lactic acid, or retinol containing products—like our Clear Skin Serum, Correcting or Intensive Correcting Serum, Perfecting Complex, Line Diminisher) mask, exfoliant (Antioxidant Enzyme Peel), or any OTC acne treatment the day before and day of the peel.
• Do not shave the treatment area the morning of the peel, if possible.

How to Care for Your Skin After Your Chemical Peel

Follow your dermatologist’s advice for care after your peel. Here is what we tell our patients:

The day of your chemical peel

• If skin is itchy, tender, has white or red discoloration apply the 2.5% hydrocortisone topical steroid sample that we gave you immediately, that evening and the next morning.
• Ideally, it is best if you do not apply make-up the day of the treatment.
• You may develop a few more acne bumps during the first eight weeks. This is normal.

The evening of your chemical peel

• Wash and moisturize with Dr. Elaine's recommended cleanser and moisturizer.

The following morning after your chemical peel

• Repeat the evening procedure with the addition of Dr. Elaine's recommended toner.

The evening of the day after your peel

• Return to your regular recommended program.

The fourth day after your peel

• Use Dr. Elaine's Gel Mask or Antioxidant Enzyme Peel to exfoliate flaking skin.
• Do not pick or peel the skin.
• You will be more sun sensitive, avoid sun exposure.

Patients with any degree of natural pigmentation are at risk of brown pigment developing after any chemical peel and they must be treated with special precautions. One way to determine if you are at risk for pigment problems is this simple test--when you get a scratch, and it heals does it turn light or dark? If dark, you are at risk for pigmentation.

Blue Light Acne Treatments with ClearLight Acne Photo Clearing

ClearLight Acne Photo Clearing uses non-invasive high intensity blue light to improve inflammatory acne, which includes red and pus bumps. The light activates bacteria fighting compounds called porphyrins, starting a chemical reaction that produces peroxide, which destroys the P. acnes bacteria. ClearLight is given as a series of eight treatments, either once or twice a week. It is important to complete all treatments or acne will not improve. Improvement commonly starts by the 2nd-5th treatment. It usually helps control acne for four to six months; after that, another treatment series may be necessary. Treatment feels like a mild to moderate warming sensation. ClearLight usually clears 60-70% of mild to moderate red bumps and pus bumps in 8 weeks. Blackheads, whiteheads and deeper cysts are not cleared. Approximately 15-20% of patients do not improve due to other types of bacteria or causes of acne. There are usually no side effects or down time. Occasionally an acne flare up occurs between the second and sixth treatment, usually resolving before the last treatment.

For more severe acne, and to get longer lasting improvement ClearLight Acne Photo Clearing can be combined with Photodynamic Therapy (PDT). This is the application of a medication to the skin before the light treatment. It takes an average of 3-4 treatments spaced 3-4 weeks apart for best results. There is mild to moderate burning or stinging, lasting up to 24 hours, but a numbing cream is used before treatment to reduce discomfort. After ClearLight/PDT there is swelling and redness for 2-5 days. Flaking, crusting or blisters may occur, healing in 7 days. You will be sensitive to all forms of light, including sunlight, sunlight through car window glass, and indoor light for 72 hours. Sunscreens does not protect against this sensitivity. You should avoid all sun exposure, including sun exposure through car window glass. ClearLight or ClearLight/PDT may not be used if you are or have: using medication that prohibits exposure to sun, porphyria, iron storage disorders, seizures, or photosensitivity diseases such as lupus. Pregnant women are not treated with ClearLight/PDT.

Do Chemical Peels or Blue Light Acne Treatment Cure Acne?

Acne is a chronic, ongoing disorder. All of our treatments, including glycolic peel/acne surgery aim to help control acne, not cure it. New lesions will form, old ones take a while to fade, and scars may be permanent. We may also recommend treatment with prescription medications for good acne control. It is important to use the recommended home skin care treatment. Therefore, you have to keep up the good fight.