Non-medicamentous options for treatment moderate to severe acne and acne scars.

Acne is a chronic, multifactorial inflammatory condition of skin which results in inflammatory papules, pustules “pimples” and various spots on face, neck, shoulders, upper arms, and chest. Mild acne can be treated with topical medications: both prescribed and non-prescribed ones. However, moderate and severe acne may need oral or so-called systemic medications that include antibiotics, oral contraceptives, antiandrogen therapy (Spironolactone) and Isotretinoin (well known under the brand name “Accutane”). Each systemic medication has pros and cons and its own side effects. Lots of people do not want to take any oral medications and seek some alternatives. Luckily, these alternatives do exist and may really change the course of the acne and help to alleviate its consequences such as scarring, dyschromias, oily skin and enlarged pores.

The most common effective non–medicamentous treatment options for acne and scar management include High Intensity focused radiofrequency microneedling and Superficial fractionated radiofrequency (knows as Sublative Radiofrequency Resurfacing).

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This treatment method is based on using the controlled graded heating of sebaceous glands as well as tissues of acne scars at different levels of depth and temperature with a usage of the radiofrequency. The clinical trials showed 90% of improvement after 3 months (once 3 treatments with 4 weeks in interval were done). As a result, improvement of inflammatory acne and reduction of acne scars were observed.

Often, two modalities are combined in order to make the treatment even more effective.

https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.12195 Park, J. Y., Lee, E. G., Yoon, M. S., & Lee, H. J. (2016). The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin. Journal of cosmetic dermatology, 15(2), 102-107.

Also, the conventional microneedling can be used for the acne scars treatment

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Microneedling

The second option is intense pulsed light, which is shortly abbreviated as “IPL.” The treatment is based on the idea that IPL destroys the Propionibacterium acnes(Cutibacetriumacnes). Moreover, it also increases the graded impact on blood vessels which supplies the sebaceous glands. Thus, it reduces the production of sebum, redness as well as inflammation on affected areas.

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Laser Treatment

Another method is photodynamic therapy (PDT). A photosensitizing agent is applied on affected area by acne and is given up to 1 hour to incubate on the skin. The used agents are usually 5-aminolevulinic acid (ALA) or a 20% solution of methyl aminolevulinate (MAL). The incubation time can be reduced due to heating of the skin which is called Temperature-modulated photodynamic therapy. The purpose of incubation period is to allow the photosensitizing agent be absorbed into skin and sebaceous glands. After, red light, blue light or sequential combination of both lights is being shone onto the skin for approximately 15 to 20 minutes. The light activates the photosensitizing agent which, as a result, removes acne bacteria and shrinks oil glands. 

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Photodynamic Therapy

Lastly, low level light (laser) therapy can be suggested as treatment method.  Phototherapy with visible light (blue light, red light, or combination of both lights) can be essential in treating acne. Usually, the mechanism involves the absorption of light, especially blue light, by porphyrins produced by P. acnes as well as acts as endogenous photosensitizers. The following interaction with blue light forms free reactive radicals and Singlet (toxic) oxygen species which leads to the bacterial destruction. Meanwhile, red light is used to penetrate much deeper tissues. It can have an impact of the sebum secretion of sebaceous glands and change the behavior of keratinocytes.

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Low-level Light Therapy