Skin Science - Toronto Star - June 23, 2005
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Skin Science - Complex lotions and potions claim they can give you youthful skin free of wrinkles and blemishes. But do they work?

By Leslie Inglis

I’m under house arrest. My blinds are closed and I’m shackled to my couch with ice packs on my face.

No, I didn’t get into a bar fight. I’ve just completed my fourth session of photodynamic therapy, used in the treatment of acne. 

I’m 40 and acne has plagued me since I was 11. Over the years, it has fluctuated between mild to moderately severe. My father suffered from severe acne as a teenager. My mom likes to say she couldn’t see his face for the pimples. Knowing the family history, she took me to see a good dermatologist in my early teens which I am quite certain prevented more serious acne, scarring and self-esteem problems.

Toronto cosmetic dermatologist Dr. Lisa Kellett says at least 90 per cent of us will suffer from acne at some point in our lives. Often it is confined to teenagers and young adults. However, adults can continue to experience acne well into their 30s and 40s.

Hormones, heredity, increased stress, oily cosmetics and environmental factors can all play a role in the development of acne.

“People do not have to suffer. Although there is no known cure for acne, it is important to realize that there are many treatment options,” Kellett says.

Just over a year ago, I began exploring the available options. I had no idea of the mammoth project I was about to embark on.In the past couple of years, there has been an explosion in acne treatment options, ranging from affordable topical creams to expensive lasers to suspicious “miracle cures” sold over the Internet. 

After spending $150 on a bottle of unidentified herbal tablets from Pakistan, which gave me a sore throat, I decided to focus on remedies that originate closer to home. 

I stopped my prescription acne medication at the beginning of my research to see how my skin would fare. My skin tends to be dry and my acne consists of a variety of blackheads, whiteheads and cysts around my cheeks, jaw and neck area. In addition, my acne fluctuates with my hormones. 

First stop was my local pharmacy where I discovered a plethora of products specifically designed for acne-prone skin. I realized I couldn’t possibly sample every product and give credence to their effectiveness. I was, I must admit, so excited with the samples, that in the beginning I was trying many of the products at the same time. My skin had never been so clean, or so irritated. 

Contrary to popular belief, acne is not caused by poor hygiene. Scrubbing and over-cleansing can actually dry out and irritate skin, making acne worse. 

Over-the-counter remedies and cosmetic lines specifically designed to treat acne range in price from $10 to more than $200. But don’t assume the more costly product will be more effective. Most of the ones I tried had the same active ingredients – salicylic acid and/or benzyl peroxide. 

Also be wary of product claims. Many claim they are tested by scientists or dermatologists, but on closer inspection, these studies may be biased, as some are carried out by the companies in their own laboratories. 

I’m not saying that the products will not work, just pointing out that these studies, while an excellent marketing tool, are not proof of product superiority. 

“Although salicylic acid can be quite drying and irritating to the skin, some people with mild acne do fine with just these products,” says Toronto physician Dr. David Eisen, who has specialized in the treatment of acne for the past 16 years.

 “Benzyl peroxide is the most effective non-prescription acne medication available,” says Eisen. “It is a potent anti-inflammatory medication, which can reduce the number and size of outbreaks in people with mild inflammatory-type acne. However, if acne is not improving, is causing emotional distress, or causing complications such as scarring or pigmentation changes, a person should consult with an acne specialist.” 

Over-the-counter remedies are generally not for severe acne but what is called uncomplicated acne. 

It wasn’t enough for me. About six weeks into my trial of over-the-counter products my acne had worsened and I had to resume both an oral and topical antibiotic. 

Just as the type and severity of acne is unique to each individual, the management should be as well. There is no one-size-fits-all treatment. 

“If a person is properly assessed and educated, then the treatment plan can be individualized,” says Eisen, adding “compliance with the treatment plan is vital to the outcome.” 

There are a host of prescription medications that may give better long-term results if over-the-counter products are not enough. 

Topical and oral antibiotics, anti-inflammatory creams, hormone treatments including certain oral contraceptives and Accutane are just some prescription treatments. 

All medications carry some degree of risk of side effects, some more serious than others. Talk to your doctor or pharmacist before starting any treatment. You can contact Health Canada at 1-866-225-0709, to find up-to-date medication information. 

Finally I turned to photodynamic therapy, one of the latest, most technically advanced acne treatments. This is what left me housebound for days, but my before and after pictures reveal fabulous results. 

Called Blu-U Photodynamic Therapy, it destroys acne-causing bacteria on the skin, shrinks oil glands and enlarged pores. Cosmetic dermatologist Dr. Martie Gidon was the first in Toronto to use this treatment about one year ago. 

Levulan, or 5-aminolevulinic acid, is applied to the skin affected by acne. This sensitizes the skin to light, specifically a non-ultraviolet blue light. The skin is exposed to the blue light for about 8 minutes, which leaves the skin pink and is followed in a few days by peeling. For best results, three to five treatments, two to three weeks apart, are recommended. Full treatment costs about $1,800. 

Gidon has used the treatment on well over 100 patients now and says she is seeing considerable success. 

At 40, I’m not just fighting acne but skin damage and wrinkles. I’ve just finished my fourth treatment and it has taken five years off my face. My skin texture is smoother, sun damage has dramatically faded, fine lines are gone, the scarring is reduced and so has the degree of acne. I now have one pimple on my cheek. Not a great big open sore, but a pimple. 

It is pricey. But if you can have this treatment, go for it. I look in the mirror and I can’t believe the difference. 

I was told there would be no down time, but I was also told that for 36 to 48 hours I had to completely avoid sun and bright light exposure because the Levulon remains active for that long. 

After my third treatment, I was about to jump in the car and drive three hours in the sunlight to visit my parents, but Gidon vetoed that idea. She recommended I travel at night unless I was prepared to wear a balaclava. I chose night driving.

Gidon says many people have the treatment on a Friday, giving them to weekend to heal and then return to work the following Monday. 

Having lived with acne for as long as I have, I recommend seeking medical advice right away if your acne is causing you physical or emotional distress. Don’t wait until you get severe acne. The earlier you seek treatment, the less likely you’ll get scarring and other complications.

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