Current Treatments of Acne: Medications, Lights, Lasers, and a Novel 650-Microsecond 1064nm Nd: YAG Laser

Michael Gold, MD, David J. Goldberg, MD, JD, Mark Nestor, MD, PhD

Journal of Cosmetic Dermatology, September 2017, Volume 16, Issue 3

Summary

The treatment of acne, especially severe acne, remains a challenge to dermatologists. Therapies include retinoids, antibiotics, hormones, lights, lasers, and various combinations of these modalities. Acne is currently considered a chronic rather than an adolescent condition. The appropriate treatment depends on the patient and the severity of disease. The purpose of this study was to review current therapies for acne of all severities and to introduce the 650-ls 1064-nm laser for the treatment of acne.

1 | INTRODUCTION

Acne vulgaris is the most frequent reason that people consult a dermatologist.1 Acne affects 85% to 90% of teenagers,2 children aged 7-12 years,3 and adult men and women, including those with skin of color.4,5 Among adults who have acne, 64% are in their 20s and 43% are in their 30s. Prevalence is higher among women than men.68 Gollnick et al.9 and the Global Alliance to Improve Outcomes in Acne10 have suggested that acne be considered a chronic disease rather than a “simple, self-limiting affliction of adolescents”. This assertion is based on the known characteristics of a chronic disease: an extended course, recurrence or relapse, slow onset or acute outbreaks, and negative effects on quality of life. Acne persists into adulthood in up to 50% of affected patients and has negative sequelae such as anxiety and depression, social withdrawal, scars, and persistent hyperpigmentation.10

2 | PATHOGENESIS OF ACNE

Acne is a multifactorial disease of the pilosebaceous unit. The development of acne lesions has been attributed to four pathogenic factors: androgen-induced overproduction of sebum, colonization of the pilosebaceous duct by Propionibacterium acnes, abnormal keratinization in the follicle, and discharge of inflammatory mediators into the skin.8 The first stage is the development of a microcomedone in the pilosebaceous unit. This is a plug that forms because of increased production of sebum and keratinocytes that line the hair follicle. Accumulation of sebum and sloughed keratinocytes results in the formation of larger, visible comedones. At the same time, P. acnes colonizes the pilosebaceous duct, triggering the release of inflammatory mediators into the surrounding tissue and a response by immunocompetent cells, further contributing to the development of comedones.8,11 Acne most often occurs in the face, neck, back, and chest, all areas with many pilosebaceous units.12,13

3 | TREATMENT OF ACNE

The traditional monotherapies for mild to moderate acne are topical retinoids and antimicrobial agents such as antibiotics and benzoyl peroxide (BPO).

3.1 | Retinoids

Members of the Global Alliance10 state that retinoids should be considered the basis for treatment of all acne patients except those with the most severe disease. Topical retinoids (e.g, tretinoin, tazarotene, adapalene) help to normalize the abnormal differentiation and

Gold MGoldberg DJNestor MSCurrent treatments of acne: Medications, lights, lasers, and a novel 650-μs 1064-nm Nd: YAG laserJ Cosmet Dermatol2017;16:303318https://doi.org/10.1111/jocd.12367

Table of Contents

Hyperpigmentation

Photos Courtesy of Cheryl Burgess, MD.

Photos Courtesy of Jennifer Parker-Porter, MD.

Learn more about treating hyperpigmentation today.

Vascular Lesions

Photos Courtesy of Dr. Guilia Kasimova.

Photos Courtesy of Michael Gold, MD.

Learn more about treating vascular lesions today.

Rosacea / Redness

Photos Courtesy of Yelena Kipervas, DO.

Photos Courtesy of Dr. Nabil Fakih.

Learn more about treating rosacea and redness today.

Hair Removal

Photos Courtesy of Dr. Andrew Nnadi.

Photos Courtesy of Steik Spa.

Learn more about treating hair removal today.

PFB

Photos Courtesy of Dr. Michelle Henry.

Photos Courtesy of Wendy Roberts, MD.

Learn more about treating PFB today.

Scars

Photos Courtesy of Dr. William Watfa.

Photos Courtesy of Bradley Bloom, MD.

Learn more about treating scars today.

Autoimmune Disorders

Photos Courtesy of Dr. Passeron.

Photos Courtesy of Dr. Sakhiya.

Learn more about treating autoimmune disorders today.

Skin Rejuvenation

Photos Courtesy of Catie Cutler, LE.

Photos Courtesy of Chesahna Kindred, MD.

Learn more about skin rejuvenation today.

Acne

Photos Courtesy of Michael Gold, MD.

Photos Courtesy of Michael Gold, MD.

Learn more about treating acne today.

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• Support external auditors and other required outside reporting requirements
• Participation in quarterly inventory reconciliations
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• Knowledge of MS Excel (V-lookup, formulas, pivot tables).
• Strong interpersonal and communication skills
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• Bachelor’s or master’s degree in Accounting a MUST, good understanding of GAAP
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Senior Accountant:

• Provide support to the Controller and the management team
• Own day-to-day financial accounting functions, including A/P, A/R, expense tracking
• Assist in establishing and maintaining policies & procedures in accordance with GAAP and Aerolase policy
• Key contributor to the month-end close process, ensuring accurate and timely monthly, quarterly, and year-end financial statements.
• Assist in the preparation of management reports – (cash management, various projections, month end reporting package)
• Involvement with the annual budget process
• Use of financial reporting software
• Support external auditors and other required outside reporting requirements
• Prepare and submit payroll
• Participation in quarterly inventory reconciliation to the perpetual
• Ad hoc projects

• Strong knowledge of the monthly close process and technical accounting

• Detailed oriented, with ability to see the big picture

• Experience in continuous improvement and accounting best practices

• Self-starter who can work independently and employ time management skills to meet deadlines.

• System savvy – ability to learn new financial software

• Intermediate knowledge of MS Excel (V-lookup, formulas, pivot tables).

• Global consolidations experience a plus

• Strong interpersonal and communication skills

• Sound judgment and problem-solving skills

• Bachelor’s or master’s degree in Accounting a MUST, good understanding of GAAP

• 3+ years’ experience working as a staff/senior accountant

• General Ledger/Operational Accounting experience a must

• Extensive knowledge of Quickbooks and other reporting software

• Prior involvement with system implementation

• Prior public accounting experience (any size firm) a plus

• Industry experience a plus

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