Acne as a Fashion Accessory

In one of the more bizarre fashion statements ever, Malasyian designer Moto Guo sent his models down the Mens Fashion week runway in Milan last week, with pimples on their faces, not covered up with tons of make up, but highlighted as a fashion accessory.

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Apparently the designer wanted to remind people its okay to be human. Reaction to Guo’s   fashion statement has been mixed, with some commentators applauding his efforts to normalise taboo skin conditions like acne, others saying, trying to make acne “cool” trivialises a condition that causes many of those who have it significant emotional trauma.

I believe highlighting acne as a real problem, even in this somewhat unusual way, is a good thing. Acne is the commonest health problem experienced by young adult women and men and young adult women in particular are four times more likely to suffer from chronic treatment resistant acne.

We all need to speak about this more, so that those with acne don’t feel isolated and alone in their struggle to get clear skin. Everyday I receive a dozen photographs of young adult women and men with acne who come to our Clinics for help. I am so pleased that we now have a solution to offer them.

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Adult Acne – “Like an Epidemic”

Below is a story from the Telegraph London I have republished.  Adult Acne has been on the rise for a number of years now, but rarely gets the attention that such a common and distressing condition deserves. I have been on a mission for some time now to raise awareness of this condition, which is 4-5 times more common in adult women than men and much more treatment resistant.

SGA ( Sebaceous Gland Ablation ) has been a godsend for our clients with Adult Acne and breakouts over the past four years and it is my goal for 2016, that everyone in Australia and New Zealand who has Adult Acne, will hear about SGA and find a permanent solution for their Acne and enjoy clear skin.

Wish me luck!

Vicky Eldridge breezed through her teenage years and twenties without so much as a blotch or blemish. But two years ago, aged 34, the unthinkable happened; she began to be plagued by spots.

“They started on my chin and came up around that time of the month, then lasted longer and longer until they were there all the time,” says Eldridge, now 36, who lives in Chelsea. “Dating was out of the question; I wouldn’t want to meet anyone with my face looking like that.”

“I tried everything to cover them up. Before then, I had always taken my nice, smooth skin for granted. I was miserable, embarrassed and self-conscious. I would apologise to friends in advance about it – if my skin was bad, I would even stay in. Dating was out of the question; I wouldn’t want to meet anyone with my face looking like that. I grew depressed, low and very emotional.”

As the editor of a beauty magazine and someone who prided herself on knowing how to look good, her shame was all the more marked; at worst, Eldridge would call in sick when she had a particularly “horrific” breakout.

And as extreme as her case sounds, Eldridge is just one of an increasing number of people in Western countries affected by adult acne, an affliction doctors and dermatologists agree is on the rise, largely due to an increase in stress and poor diet.

Dr Stefanie Williams, medical director of Eudelo (European Dermatology London), does not mince her words on the subject. “It is like an epidemic. We have so many sufferers [in this country]. It is important to acknowledge that it is a skin disease. It is not normal and not a right of passage.”

Indeed, a study of 92 private dermatology clinics last year found a 200 per cent rise in the number of adults seeking specialist acne treatment. A quarter of those who visit their doctor have skin problems – from acne to psoriasis or eczema – and women are five times more likely than men to be affected by late-life acne, due to fluctuating hormones during pregnancy, the menstrual cycle and changing methods of contraception (the pill, coil or patches) – Cameron Diaz and Victoria Beckham have, notably, suffered.

Acne is caused by the over-production of oil from sebaceous glands, usually driven by changes in hormone levels, leading to blocked and inflamed pores.

Low-level changes in stress have long been linked to problematic skin as the hormone cortisol contributes to breakouts. Dr Nick Lowe, a consultant dermatologist believes it is this stress that is fueling the rise, especially in women who are working full-time while simultaneously raising families. “There are so many triggers; perceived shortness of time, general instability in lots of parts of the world, women being pressured at both work and home.”

Eldridge agrees mounting stress was integral to the onset of her acne. “Skin is a reflection of what is going on in the inside and I was burning the candle at both ends. I was working long hours, partying and not sleeping enough. It was definitely a contributing factor.”

As well as causing physical scars, the emotional impact of poor skin can reverberate through relationships, work and home life. The British Skin Foundation found that 95 per cent of acne sufferers say it impacts their daily lives and 63 per cent experience lower self-confidence.

Vicky managed her acne with treatments and a strict diet
Vicky managed her acne with treatments and a strict diet 

Vicky switched to a diet with an emphasis on healthy eating and fresh vegetables. After committing to giving up alcohol and avoiding dairy and sugar, where possible, she finally saw an improvement in her skin.

After three months, her cystic acne subsided and a prescription vitamin A cream saw off the rest of her breakouts.

Now Eldridge is spot-free, 10 months sober and has been known to leave the house without make-up for the first time in years.

“It was a long slog and there was no one quick fix,” she says. “Making the dietary changes certainly had a dramatic impact and then the cream finished it off. I know it will need maintenance but my face looks amazing now and there is no scarring.”

Republished from The Telegraph London

 

Sebaceous Hyperplasia

My post today is about Sebaceous Hyperplasia, a condition seen more commonly in middle age but it can affect young adults as well. It is a benign condition ( meaning it does not create any harm ) but it can be a significant cosmetic problem for some people. Each lesion appears on the surface of the skin as a lump, as each lesion is a sebaceous gland that has grown out onto the skin. In the centre of each lump is a pore, which is generally enlarged.

The biggest problem with Sebaceous Hyperplasia is that nobody treats it ( which I still find extraordinary ) and if you do find some one who does, the chances are they will over treat the lesions with a laser. Over the years I have had clients who have gone to multiple doctors only to be told there is nothing that can be done.

Well the good news is, there is something that can be done. Sebaceous Hyperplasia is very readily treatable with gentle diathermy ( a heat and seal treatment ) and provided the treatment is down very gently, the cosmetic result is very good.

Gentle Diathermy for Sebaceous Hyperplasia will be available at all my Clearskincare Clinics in the coming weeks.

Sebaceous hyperplasia 1

Sebaceous Hyperplasia

Free Online Acne Consultation Service

I am really excited to tell you that within one week, my new free, online Acne Consultation service will be up and running. I have had a dream of offering this service for a long time, as I have been offering online consultations for my Clinics for a number of years. I have been inspired by an American website called Yo Derm ( agree, terrible name ) which is offering online Acne Consultations for $59, not so much for its service, which I think is a little limited ( I believe there is a lot more to managing Acne than giving people prescriptions ), but for its resounding endorsement of telemedicine, which is the name for conducting consultations via mobile, web or email, rather than face to face.

Diagnosis and management of Acne is ideally suited to telemedicine as the physical examination is visual and can be performed almost as effectively via photography.

I am completely passionate about giving every person with Acne the opportunity to clear their skin. This blog was the start of this mission and my online consultation service is the next key step.

So, from October 17th, 2013, you will be able to email me your photos and the answers to a small number of clinical questions and I will email back to you an individualised treatment plan. My next post will have my email address and instructions regarding what information I will need to assess your case.

 

I have posted some information about telemedicine from the Yo Derm site, which you might find interesting :

Effectiveness of Telemedicine

Telemedicine for dermatology patients is a great tool because skin conditions can be readily examined in digital still or video images,”1 said Armstrong, who also serves as director of the health system’s teledermatology program. “Our study found real and beneficial differences in the vast majority of teledermatology cases we analyzed,” said Armstrong. “With rapid improvements in interactive mobile platforms, connectivity speed and visual clarity, telehealth services like dermatology will play a bigger and bigger role in improving the quality of care and the access to specialty services that people deserve no matter where they live.”1

April Armstrong, M.D.http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6127

Benefits of Telemedicine

“(Teledermatology) represents an excellent novel approach to treatment of a huge underserved patient group. Many people with moderate to severe acne live in areas without access to a dermatologist and may not be able to afford traditional care or may not even be aware that effective treatments are available. By using modern technology, acne treatment can be delivered remotely to this population to provide significant medical as well as psychological benefits at a significant cost savings.”

James Clint Jones, M.D.

Technological Advantages

“(Regarding teledermatology) In addition to increasing efficiency, the technology is a boon to patients and primary care providers seeking consultation, particularly those in medically underserved or remote areas. Travel time to a dermatologist is eliminated and there is no waiting.”2


California Healthcare Foundationhttp://www.chcf.org/publications/2009/12/storeandforward-teledermatology-applications

Patient Satisfaction

“Patient satisfaction with care received through teledermatology was equivalent to that with face-to-face dermatology.”3

Hsueh, Eastman, McFarland, Raugi, and ReiberTeledermatology Patient Satisfaction in the Pacific Northwest

Effectiveness of Online Acne Care

“Delivering follow-up care to acne patients via an e-visit platform produced clinical outcomes equivalent to those of conventional office visits.”4

Watson, Bergman, Williams, KvedarA Randomized Trial to Evaluate the Efficacy of Online Follow-up Visits in the Management of Acne

 

 

What is Sebaceous Gland Ablation?

Sebaceous Gland Ablation is an exciting new treatment for active acne. The root cause of all types of Acne and breakout is overactive sebaceous glands. We have approximately 1200 sebaceous glands per square centimetre of skin. Only a tiny fraction of these are affected by Acne.

Many treatments can be effective for controlling Acne and traditional medical treatments have focussed on “normalising” Acne affected sebaceous glands. One of the biggest shortcomings of traditional medical treatments for Acne has been our lack of understanding of the fundamental cause of Acne, therefore, most of the treatments have been bandaids, rather than cures. Isotretinoin, known as Roaccutane in Australia, is a very powerful and effective acne controlling drug, but even with it, researchers are unsure as to why it produces long term sebaceous gland suppression. If Isotretinoin was not such a powerful drug, with so many potential serious side effects, there would be no reason to search for alternative treatments, as it is a highly effective treatment for Acne, particularly in males with severe Acne. Unfortunately, it is not quite so effective for females, who often relapse after experiencing brief remissions. One study of Isotretinoin use in women with adult Acne documented a 40% relapse rate on stopping the drug, with those women experiencing a worsening of their Acne. Many of my patients and their parents and partners are frightened of the potential serious side effects of Isotretinoin and for my patients with milder, but annoyingly persistent Acne, Isotretinoin seems to be too extreme a treatment to undertake.

One of the things that has always puzzled me about Acne is why do sebaceous glands malfunction in such a large number of people? If you think about how effectively the human body works throughout our lives, our hearts keep beating, our brains keep thinking and our lungs keep breathing and we don’t even have to worry about it. Yet 85% of teenagers and more than 20% of adults suffer from malfunctioning sebaceous glands, and some of the unlucky ones, to an extent where they are permanently scarred. These tiny organs, almost insignificant in importance for the human body, can cause so much trouble.

When I first learned about Sebaceous Gland Ablation, it seemed such an obvious solution to Acne, I felt foolish I hadn’t thought of it. Like many treatments though, it is very important for it to be “placed” amongst the myriad of Acne treatments available.

Acne is a very complex condition to treat. Because there are so many different forms of Acne and a number of factors that can exacerbate it, it is not a case of there being a “one size fits all” solution.

Sebaceous Gland Ablation will find it’s place amongst the proven medical treatments – tretinoin, adapelene,  benzyl peroxide, the oral contraceptive pill and oral antibiotics, as an effective treatment for Acne. I like to use the analogy of laser hair removal versus waxing versus shaving. All are effective as methods of hair removal, but a client’s choice of a preferred method of hair removal is usually governed by the degree to which they view their hair as a problem.

I have many, many patients who are sick and tired of breaking out. For them, Sebaceous Gland Ablation will be the perfect solution.

 

SGA Case Study

I will be bringing you regular posts about our growing experience with Sebaceous Gland Ablation. With any new treatment, our knowledge base grows as we treat a wider and wider range of skin types and acne presentations. One of the first clients I treated was a fellow staff member ( MR ) who had been suffering from persistent treatment resistant acne since giving birth to her first child 3 years ago. She could not remember a time when her skin was clear and free of lumps under her skin. She had tried many of our treatments, with some improvement, but was still never breakout free. Here are her notes from the day of her treatment and the week after:

16/02/2012 – Thursday

Before: It is the morning of my SGA treatment. I am excited but a little worried about the pain. Fingers crossed this works as I am sick of my stubborn acne. It is very embarrassing that a grown woman still has acne.

Directly after treatment: What a relief! The treatment was not uncomfortable. I barely felt the needle entering the breakout and once the RF started it was very bearable. I am a little bit red with some slight swelling. The skin feels slightly sunburnt and there is tightness when I smile but not at all uncomfortable.

PM: There is still slight swelling and my skin feels a little bumpy but I’m very excited to see the results. No pain or tightness now.

 

17/02/2012 – Friday – A cyst that has NEVER come to the surface is starting to make a head. I am beyond excited about this as it means it is working! The cyst is a problem as it is a normal breakout and each time it comes up it never forms a head so I can’t get rid of it, finally I will be able to CLEAR my skin! My skin is quite bumpy and all I want to do it pick!

 

18/02/2012 – Saturday – That terrible cyst finally came to a head. After a warm shower I used the Easy Squeeze and I managed to finally clear it. I then used the Easy Squeeze to clear the other breakouts that had come to a head. My skin still feesl bumpy and has started to flake but I can see it is working.

 

19/02/2012 – Sunday – No swelling today. A few more breakouts have come to a head so I used the Easy Squeeze again. Skin is still bumpy, I just want to pick, but I know I can’t.

 

20/02/2012 – Monday – Lots of flaking today, no redness and no swelling. The usual redness around my breakouts is starting to fade as well.

 

21/02/2012 – Tuesday –  Where the 2 cysts were there is a slight graze and some flaking. Both heads have been removed so I am excited to see what they will look like when they clear. I still have to resist picking.

 

22/02/2012 – Wednesday

I had a lot of flaking this morning but I am starting to see that my skin is  not as red. Not as bumpy which is great as I don’t want to pick.

 

23/02/2012 – Thursday

Today I looked in the mirror and I can see a huge improvement. I can also feel a huge improvement. My skin is not as bumpy to tough. There is still some slight flaking but this is now almost gone.

(On a side note – removing the larger cystic pimples has allowed me to feel the smaller bumps along my chin which I didn’t worry about before ). I can’t wait for another treatment to get rid of these too!

 

What MR describes is very typical of the response we are seeing following SGA treatments. It is very common for the skin to feel lumpy for around 10 days after the treatment. It is also common for a breakout to occur after the treatment as the treated gland expels it’s contents up to the surface of the skin. We recommend an extraction three to four days after the treatment and then a peel seven days after treatment.

 

 

Sebaceous Gland Ablation – A History

Electrosurgery is a very common procedure in modern Medicine. Electrosurgical devices are routinely used in Operating Theatres around the world to cut, dissect and ablate tissue. In Dermatology and Plastic Surgery, electrosurgery has been a preferred method ( over excision ) for removing benign skin lesions, due to the superior cosmetic results of electrosurgery. Electrosurgery is the most efficient method of removing tissue as it cuts and coagulates ( seals ) the tissue at the same time, minimising bleeding. Electrosurgery has also long been used for removing lesions below the skin’s surface, such as superficial blood vessels. In the mid 1980’s Dr Toshio Kobayashi began researching the use of electrosurgery for the removal of lesions below the skin’s surface in Japan. His initial work concentrated on hair removal, but the advent of laser hair removal shifted his attention to other intradermal ( in the dermal layer of the skin ) lesions. In 1986, he published a paper on Electrosurgery and the treatment of telangectasias ( intradermal blood vessels ). In 1988, he published a paper on Electrosurgery and the treatment of axillary bromhidrosis and hyperhidrosis ( excessive underarm sweating ). In 2007, Dr Kobayashi published a paper on Electrosurgery and sebaceous glands, for the treatment of facial seborrhoea ( excessive oiliness ). Whilst his work went unnoticed by the rest of the medical profession, Dr Kobayashi had begun treating acne patients with electrosurgery to eradicate their acne. Sadly Dr Kobayashi died shortly after he published his 2007 paper and his work could easily have been completely lost. Dr Ahn, his colleague in Korea has continued Dr Kobayashi’s ground breaking work with SGA and has successfully treated over 3,000 acne patients over the past 4 years.

Here is Dr Kobayashi’s 2007 paper ( click on the link to open ):

Selective Electrothermolysis of Sebaceous Glands

Sebaceous Gland Ablation – What to expect during and after a treatment

During treatment, a fine probe is inserted into the acne lesion and once correctly positioned, a short burst of surgical diathermy is delivered. For most people, they feel the heat of the diathermy but it is very localised and very short. We are able to adjust the intensity of the diathermy for each person, so they can tolerate the treatment. Most clients have stated they found the treatment quite tolerable and are happy to return for further treatments. There can be some bleeding from the acne lesions during treatment and sebum is extracted from the gland after it has been diathermied.

After treatment, the skin is “bumpy” at each treatment point and remains bumpy for 7- 10 days after the treatment. There is no pain or discomfort after the treatment and the skin generally looks less inflammed within a few days of an SGA treatment.

All clients at my Clinic are on prescribed home care routines for their skin, and these are continued whilst they have their SGA treatments.

Sebaceous Gland Ablation – Results

Here are some before and after photos from a study by Dr Ahn from Korea, showing his results from three SGA treatments, spaced one month apart. He presented this study at the World Congress of Dermatology last May. I met Dr Ahn at a conference last November and undertook my SGA training in January in Korea. I am looking forward to having my own before and after photos to show you in a few months time. itunes error fix Some of these before and afters demonstrate a very common problem in the aftermath of successful remission in acne, post inflammatory hyperpigmented scarring. This can be corrected with a programme of prescription creams, which I will detail in another post.