Medesthetics Special

AR Supplement

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Working with Estheticians attacked only a fraction of the acne problem. I would estimate that oral antibiotics at best provide only 20% to 30% of the needed acne solution."2 Topical Antibiotics. The FDA warning on clindamycin states: "Orally and parenterally administered clindamycin has been associated with severe colitis which may result in patient death. Use of the topical formulation of clindamycin results in absorption of the antibiotic from the skin surface. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin. Studies indicate a toxin(s) produced by clostridia is one primary cause of antibiotic-associated colitis."3 These types of warnings make many patients wary of topical antibiotics, and just as with oral antibiotics, topical antibiotics are a temporary solution for acne. Retinoids. Retinoid preparations work well for acne by addressing its root cause with their comedolytic action. An esthetician can take the time with an acne patient that most physicians cannot. How Esthetic Acne Specialists Get Results Research has shown that acne patients often do not adhere to physician-prescribed medication regimens and that more frequent visits by patients is associated with increased compliance.5 6 An esthetician can take the time with an acne patient that most physicians cannot by seeing the patient every two weeks for a two- to three-month period of time. This schedule increases the patient compliance rate, which is a key factor to getting results. A non-medical skincare professional can be incredibly effective in treating mild-to-moderate acne without the use of 18 July/August 2012 | ACNE & ROSACEA any prescriptions. My acne clinic has no medical doctors on staff, yet, according to an independent survey that was done in 2007, we clear the acne of more 90% of our clients within six months' time. Following is our treatment protocol. 1. We educate clients on lifestyle issues, drugs, medications and comedogenic ingredients that can exacerbate acne. 2. We assign homecare regimens based on the type and severity of acne. We use formulations with mandelic/lactic acid, vitamin A propionate, and, to a lesser degree, glycolic and salicylic acids. We couple this with the use of benzoyl peroxide, starting slowly so the skin won't get so irritated in the beginning and getting more aggressive with use as the skin adapts. 3. We do light TCA-based chemical peels with extractions. During the appointment, we adjust the frequency of homecare product usage to prevent the skin from adapting to any regimen. It takes a three- to four-month period of time to achieve clear skin with this protocol. Advantages of Working With an Esthetician There are several advantages to working with an esthetician who is versed in acne management. 1. It frees up your time to treat other medical and cosmetic patients. 2. It generates new patients by providing a new stream of referrals from satisfied patients. Continued on page 24 © Thinkstock/Istockphoto Yet many of the clients in my clinic have tried at least one retinoid product to no avail. One problem is that some acne patients are given the cream form of Retin-A that includes isopropyl myristate, a highly comedogenic ingredient.4 For others, the prescription retinoid often makes the skin so sensitive and irritated that the patient abandons using it before it becomes effective. Isotretinoin. When the aforementioned strategies do not work, the physician's next step is often to prescribe a round of isotretinoin. Although it can be the silver bullet for some acne sufferers, we have seen people in our clinic who have completed rounds of isotretinoin, only to break out again. Furthermore, thanks to increased regulatory action, some patients and physicians are wary of taking the next step to isotretinoin.

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