Acne is a common skin condition that arises from pilosebaceous unit dysfunction, which consists of a hair follicle and its associated sebaceous gland.
Acne affects approximately 85% of individuals between the ages of 12 to 24 years. Typically, it first manifests at puberty, when increasing androgen levels activate the sebaceous glands, which begin producing sebum.
As androgen levels continue to rise, sebaceous glands become hypertrophic, and the amount of sebum greatly increases.
Sebum is a powerful inflammatory agent that leads to the more severe forms of acne and scarring when produced in excess. Sebum also disturbs the maturation of keratinocytes (dyskeratosis) by inducing epidermal inflammation. These two factors—increased sebum production and the dyskeratotic keratinocytes—cause occlusion of pores and the subsequent appearance of whiteheads. When the trapped material in the pores oxidizes and turns dark, whiteheads appear as blackheads. Blackheads are commonly seen in areas with enlarged pores, such as the nose.
The immune system’s response to the excessive sebum on the skin surface, together with the trapped sebum in the hair follicle and the bacterial flora (Propionibacterium acnes), leads to the appearance of inflammatory cystic lesions that involve the dermis and lead to acne scars. The severity of inflammation leads to the spread of acne lesions and the formation of pustules, inflammatory nodules, and more cysts.
Inflammation induced by the presence of increased sebum and P. acnes leads to variable degrees of scarring and postinflammatory hyperpigmentation (PIH) in certain patients. Over time, the chronic inflammation with its destructive effects damages skin texture, producing rolling, boxcar, and ice-pick scarring. Occasionally, hypertrophic scars and keloids can appear in predisposed individuals with severe acne.

Factors Contributing to Acne Development and Severity
■ Heredity: the size, number or density, sensitivity, and activity level of sebaceous glands
■ Disorders of keratinization, in which corneocytes are not shed at an adequate rate. This can cause occlusion of pores and microcomedone formation.
■ Lifestyle, including exposure to:
■ Practices that increase sebum production (e.g., hot showers or baths, saunas or steam rooms, and sweating from physical exertion or warm climates)
■ Dietary factors (nonorganic dairy products from cows that have been given hormones, a diet with a high glycemic index [which induces inflammation], and stimulants, such as caffeine)
■ Inappropriate skin care products (moisturizers, which weaken skin, and oil-based makeup)
■ Hormonal factors: systemic hormonal abnormalities (e.g., polycystic ovarian syndrome and other conditions associated with excessive androgens).
Additionally, hormonal changes before and during a woman’s monthly menses, as well as those that occur during pregnancy, may cause acne to develop or flare.
■ Patient manipulation of acne lesions: attempts to squeeze or extract whiteheads or cysts can increase lesion depth, inflammation, and the immune response, creating more aggravated acne flare and increasing the potential for postinflammatory hyperpigmentation


ACNE PREVENTION
Acne is preventable only if addressed at the initial stages, when whiteheads and blackheads begin to appear, but before sebum-induced inflammation can trigger the immune response. Every effort should be made to eliminate whiteheads and blackheads in the early, noninflammatory acne lesions stage.
In actuality, sebum and the resulting inflammation are the main problems in acne, and the control of sebum may be the key to acne prevention and treatment

ACNE TREATMENT STRATEGY
Acne treatment should represent only a portion of the broader approach that aims to restore general skin health. Healthy skin is less susceptible to acne. Accordingly, the treatment objective should be not only to temporarily slow down sebaceous gland activity and dry up the pimples but also to restore skin health while correcting all of the contributing factors responsible for causing acne at the same time.
f an underlying systemic hormonal abnormality is suspected as contributing to the patient’s acne, the patient should have appropriate blood tests ordered during the visit; a consult with an endocrinologist may also be appropriate in this setting. In female teenagers, it appears that certain birth control pills can help tremendously to regulate hormonal factors that play a major role in their acne condition. Such pills include drosperinone (Yaz), which counteracts the androgens that drive sebum production. Additionally, other agents such as spironolactone or insulin resistance agents (e.g., metformin) can be used. The physician must also determine whether a systemic antibiotic or isotretinoin is indicated. In short, the physician must determine the acne type (comedogenic [cystic and nonscarring] or severe [cystic and scarring]) and, based on the type, inform the patient (Box 6.3) and discuss treatment options. Patient compliance with a daily treatment regimen is essential, while at the same time improving overall skin health, includes the following: skin preparation, addition of disease-specific agents (if indicated), exfoliation and stimulation of epidermal renewal, barrier repair, stimulation of the dermis (for deep repair), hydration and calming (only if needed for skin dryness), and sun protection.
 Treatment should begin with appropriate topical agents; systemic agents can be added when needed.
Procedures such as exfoliative peels and photodynamic therapy (PDT), with blue or red light, can be used to assist treatment, but never as the first line of treatment. For example, if PDT is going to be used, one should start with all essential and supportive topical agents (see Chapter 3).
When the acne is somewhat controlled and the skin is more tolerant (e.g., after at least 6 weeks on a topical regimen containing essential topical agents), PDT sessions can be added to the overall treatment plan to accelerate and improve results. The topical photosensitizing agent applied before PDT treatment collects preferentially in sebaceous glands, and the subsequent exposure to light of the appropriate wavelength destroys those glands
Along with the discussion and planning that occurs at a patient’s first visit, the skin therapist can take certain steps to resolve some of the patient’s most pressing acne issues during that same visit.
These include extraction of comedones, intralesional steroid injection into inflammatory acneiform nodules, and initiation of a short course of oral steroids .
Furthermore, to help unclog pores and dry cystic lesions faster, skin therapists can use exfoliative procedures or products, including alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), or exfoliative chemical peels (Invisapeel, Non-irritating Ossential Exfoliating Polish once daily, Ossential Advanced Radical Night Repair, ZO 3-Step Peel) after the first maturation cycle of treatment (6 weeks) has been completed.


■ Extraction of individual comedones
■ Injection of active inflammatory acneiform nodules and cysts (to stop inflammation and prevent scarring)
■ Initiation of a 1-week course of oral systemic steroids (if not contraindicated) in patients with severe cystic acne that involves the face, back, or chest
■ Methylprednisolone in tapered doses (60-50-40-30-20-10-5 mg/day), which can be helpful in severe cases
■ If needed to arrest inflammation (while the patient is also starting on oral isotretinoin): repeated additional courses of oral systemic steroids (1 week per month for two to three courses) until isotretinoin benefits become apparent
■ If systemic steroids are contraindicated, an alternate anti-inflammatory agent, such as 200 mg ibuprofen daily for 10 days, repeated once a month during the first three keratin maturation cycles (18 weeks) of treatment Box 6.5 146


2. Addition of disease-specific agents
■ Examples include topical benzoyl peroxide, antibiotics, dapsone, adapalene, tazarotene
3. Epidermal renewal—alternate daily with the disease-specific agents
■ Exfoliation: all patients should use topical alpha-hydroxy acids
■ Postinflammatory hyperpigmentation, if present:  non-HQ agents can be added
4. Barrier repair agents (for epidermal stabilization), AM 5. Stimulation of the skin (for deep repair), PM
■ Tretinoin (retinoic acid)
6. Hydration and calming of the skin (as needed, to reduce reactions and improve compliance) (optional)
7. Protection of the skin—sunscreen daily, nonoily makeup

 
Treatment Duration and Phases in Acne Treatment
Treatment duration: three keratinocyte maturation cycles (KMCs), which are 6 weeks each (18 weeks total),
in which each cycle represents a treatment phase.
These include the following:
1. Repair phase: expected skin reaction to topical medications
2. Tolerance phase: reactions begin to subside; skin improvement starts to become noticeable
3. Completion phase: minimal to no skin reactions persist, and maximal improvements are seen
Every patient should follow a maintenance program after completion of active treatment to prevent recurrence
systemic treatment.
Similarly, patients presenting with cystic acne and subsequent active scarring may require concurrent systemic treatments such as oral antibiotics, isotretinoin, spironolactone, or other agents.


However, such an approach introduces concerns that likely outweigh these treatments’ merits. In particular, research shows that patients using topical or systemic antibiotics for acne should use them in pulsed fashion to reduce the potential for the development of antibiotic resistance. Specifically, after a patient has used one antibiotic agent for 2 or 3 months, he or she should be switched to another agent. Additionally, oral antibiotics have the potential for many side effects. These include, but are not limited to, bacterial resistance, gastrointestinal upset, photosensitivity, allergic reactions (including anaphylaxis), and, rarely, severe cutaneous immune system reactions, such as Stevens-Johnson syndrome.
For these reasons, the physician should limit acne treatment with systemic antibiotics to 2- to 3-month intervals and repeat only when necessary. Overall, the benefits of systemic antibiotics in acne are likely overstated.
Antibiotic Treatment of Acne
■ Systemic antibiotics are not essential in acne treatment.
■ If systemic antibiotics are used, they should be administered in 2- to 3-month “pulses,” followed by rest and subsequent treatment with a different antibiotic, if necessary.
■ This applies only in cases in which the acne is responding well to the systemic antibiotics and no postinflammatory scarring is appearing

Role of Oral Isotretinoin Isotretinoin is extremely effective in the treatment of acne because it addresses the role of sebum. Namely, isotretinoin reduces sebum production that then decreases inflammation, lowers P. acnes counts, and inhibits microcomedone formation. According to the U.S. Food and Drug Administration (FDA), it is indicated for patients who have severe, inflammatory, recalcitrant nodular or cystic acne. In 2006, the FDA implemented the iPLEDGE Program, which manages potential risks of isotretinoin use by educating patients in an attempt to eliminate fetal exposures to this highly teratogenic drug. Accordingly, it cannot be given to women who are breastfeeding, pregnant, or planning a pregnancy in the upcoming 6 months or so (assuming a 5-month treatment course with isotretinoin). Isotretinoin also has been associated with increased risk for developing or worsening depression (including suicidal ideation).
The association between isotretinoin use and an increased risk for inflammatory bowel disease has not been completely elucidated, but evidence for an association does not appear to be strong. Other potential contraindications include hepatic dysfunction (isotretinoin is metabolized in the liver), severe hyperlipidemia (isotretinoin can lead to a slight elevation in cholesterol), anorexia nervosa, and osteoporosis.

Guidelines Regarding Isotretinoin
During the past decade, the reputation of isotretinoin has been tarnished, particularly in the popular press, as lawsuits over potential and purported side effects have garnered headlines by targeting prescribers and manufacturers of isotretinoin. These developments have created a fear of isotretinoin that the public and many physicians now share. Many patients, even those with severe, recalcitrant, scarring acne, refuse to consider the drug because they have researched it online and have come across various sources claiming harmful effects from the medication.
Many of these concerns appear to be exaggerated. To date, isotretinoin has usually been prescribed for patients with severe nodulocystic acne that resists traditional treatments such as topical agents, as well as systemic antibiotics and hormonal therapies.

 
How We Treat Acne: A Comprehensive, Results-Driven Approach
Acne is not just a surface issue—it’s a multifactorial skin condition involving inflammation, excess sebum production, clogged pores, bacterial imbalance, and often hormonal influences. That’s why effective acne treatment requires more than a single product or facial.

At my office, we treat acne with a customized protocol—designed to reduce breakouts, heal active lesions, prevent future scarring, and restore the skin’s clarity and balance. Below are the key modalities we integrate depending on your skin’s needs.
🧪 1. Chemical Peels – Targeted Cellular Renewal
Chemical peels are a cornerstone in acne management. When applied correctly and professionally, they help to:

• Exfoliate dead skin cells that clog pores

• Minimize existing breakouts

• Brighten post-inflammatory pigmentation (PIH)

• Improve skin texture and reduce congestion over time

We use carefully selected acids such as:

• Salicylic acid – A beta hydroxy acid that deeply penetrates pores and dissolves oil

• Mandelic and lactic acid – For sensitive, inflamed acne-prone skin

• Azelaic acid or PHAs – For gentle anti-inflammatory action

Each peel is chosen based on your acne type (inflammatory vs. non-inflammatory) and skin tolerance, ensuring results without unnecessary irritation.
💧 2. Hydrofacials – Deep Pore Cleansing with Hydration
Hydrofacials are ideal for preparing the skin for more targeted treatments and clearing out congestion in a non-invasive way. This treatment offers:

• Thorough extraction of blackheads, whiteheads, and excess oil

• Deep hydration and antioxidant infusion

• Removal of dead skin and buildup

• Improved penetration of topical actives

Hydrofacials are especially useful for clients with clogged, bumpy skin, and for those transitioning off harsh home routines or medications.
✨ 3. IPL Skin Rejuvenation – Reducing Inflammation & Acne Scars
While IPL is best known for treating redness and pigmentation, it can be extremely beneficial for active acne and post-acne scarring. It works by:

• Killing acne-causing bacteria (P. acnes) in the skin

• Reducing redness and inflammation

• Stimulating collagen production to improve skin texture and acne scarring

• Lightening hyperpigmentation

IPL is best used as part of a larger acne protocol and in non-active or low-inflammatory phases. It’s also a powerful scar revision tool.
⚡ 4. Plasma Shower – Antibacterial & Healing Therapy
The plasma shower is a cutting-edge, non-invasive device that delivers ionized plasma to the skin’s surface. It is ideal for acne because it:

• Destroys bacteria on and beneath the skin

• Accelerates healing of inflamed lesions

• Reduces oil production

• Enhances product absorption post-treatment

• Helps prevent scarring and long-term pigmentation

Plasma is especially beneficial for active, sensitive, or cystic acne that cannot tolerate harsh topicals.
🧴 5. Topical Skincare – A Customized, Long-Term Strategy
We don’t believe in “one-size-fits-all” skincare—especially for acne. Your topical protocol is custom-created to:

• Regulate oil production

• Prevent clogged pores

• Reduce inflammation

• Restore the skin barrier

• Fade dark spots and acne marks over time

Common active ingredients we use include retinol, niacinamide, salicylic acid, zinc, and azelaic acid, balanced with hydration and barrier repair agents to prevent over-drying and rebound breakouts.
💊 6. Oral Nutritional Support – Skin Accumax® by Advanced Nutrition Programme
Acne often has internal triggers, and in many cases, topical treatment alone is not enough. Skin Accumax® is a clinically respected supplement that supports skin health from the inside out, especially in cases involving:

• Hormonal or cystic acne

• Jawline or cheek breakouts

• Poor skin healing or scarring tendencies

Key ingredients:

• DIM (Diindolylmethane) – Balances estrogen metabolism

• Vitamin A – Supports healthy skin cell turnover

• Antioxidants – Help manage oxidative stress and inflammation

This supplement is safe for long-term use and is often a game-changer when paired with professional skin treatments.
Every Acne Skin Is Different — And So Is Your Treatment Plan
Acne is a complex condition, and no two clients present the same. That’s why your protocol is:

• Tailored based on type, severity, and triggers (e.g., hormonal, bacterial, environmental)

• Adjusted with each treatment based on your skin’s progress

• Designed to target both the symptoms and the root causes of your breakouts

• Combined with at-home skincare and internal support for long-term results

💼 Pricing & Booking Information
Acne treatment pricing varies based on your skin’s unique needs, treatment choices, and the stage of acne you’re currently experiencing. A full consultation and assessment is required to build your protocol.
If you’re ready to start, I always recommend beginning with a Hydrofacial Deep Cleanse.
Why?
Clean, hydrated skin allows me to:

• Accurately assess your active acne type and skin condition

• Prepare your skin for more advanced treatments

• Start the clearing process gently and effectively
   

💛 A Commitment to Your Clear Skin Journey
I'm genuinely proud of every client who commits to their skin by following a full acne treatment plan at home and returning every 4 weeks for their Hydrofacial Deep Cleanse. Clear skin is a process, and consistency is key—and I want to honor that dedication with real support.
That’s why I offer complimentary follow-up appointments (5–10 minutes) in between your Hydrofacial visits—free of charge.
Why?
Because acne isn’t just an esthetic issue—it’s a clinical skin condition with inflammatory, bacterial, and hormonal components.
And I don’t believe in charging clients extra to do what’s medically and ethically right.
During your follow-up:

• I’ll assess your skin’s purging phase (which is normal in early treatment)

• Ensure that inflammation is controlled so that one breakout doesn’t spread or infect another area

• Apply active solutions or antibacterial treatments, such as plasma showers, if needed

These short check-ins help us stay on track, make quick adjustments to your protocol, and keep your progress moving forward—all without additional cost.
💬 Your progress is my priority, and so is doing things the right way—with care, science, and integrity.

✨ Book your Hydrofacial Deep Cleanse as the first step toward clearer, healthier skin—and we’ll take it from there with a plan built just for you.
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