Skin MD

A number of physical therapies are available for treating active acne. These procedures aid in faster resolution of active lesions in acne, but should not be utilized as a first-line of treatment. They are recommended to be used in conjunction with medical therapy to prevent the development of new lesions.

These are office procedures that require skill, hence should be performed only by dermatologists and trained aesthetisticians.

1. Acne surgery

Using a comedone extractor, it facilitates immediate expulsion of comedones and drainage of pus in cystic lesions.

removal of comedones

2. Hyperfrecation

Macrocomedones are usually closed comedones (whiteheads) but are occasionally open comedones (blackheads) up to 1.5 mm in diameter. Light cautery or hyfrecation after the application of local anesthetic cream (e.g., EMLA) has been demonstrated to be successful in the treatment of multiple macrocomedones. The topical anesthetic is applied for 60–90 min beneath an occlusive adhesive dressing, after which cautery is used to provide very low-grade thermal damage in order to stimulate the body's own defense mechanisms to induce resolution of the comedo. This takes seconds to perform and should be painless. There is very little associated scarring or postinflammatory hyperpigmentation and it is generally well tolerated.

3. Chemical Peels

Glycolic acid and salicylic acid peels are also beneficial in mild-to-moderate comedonal acne in women aged 13–40 years. They promote desquamation, which reduces corneocyte adhesion and follicular plugging, enabling the extrusion of inflammatory contents.

application of glycolic acid

4. Intralesional Steroid Injections

Larger inflammatory nodules and cysts respond well to intralesional injections with triamcinolone acetonide, with a rapid reduction in pain and swelling. A 30-gauge needle is used to inject 1–2 mg/ml triamcinolone acetonide into the center of the lesion until the erythema blanches. Injections can be repeated if necessary every 3 weeks.

injection directly into the lesion

5. Cryotherapy

If large inflammatory lesions persist beyond 2 weeks, cryotherapy is the preferred option. Superficial freezing with liquid nitrogen will hasten the resolution of such lesions and is relatively painless. Two 15–30-s freeze–thaw cycles are recommended.

6. Light therapy

Lasers are the most common light sources utilized in acne therapy, which produce a high-energy beam of light of a precise wavelength range. A range of treatments are currently being used, including broad-spectrum continuous wave visible light sources (blue light and blue–red light), specific narrow-band light, intense pulsed light (IPL), pulsed dye lasers (PDL), potassium titanyl phosphate lasers, infrared diode lasers and photodynamic therapy (PDT) with or without photosensitizing agents (aminolevulinic acid or methyl-aminolevulinic acid). Light therapy exerts a selective cytotoxic effect on the proprionibacteria, which appear to be more susceptible to short-term damage from light therapies than keratinocytes. Comedonal and proinflammatory cytokines are also suppressed.