What Is Acne ?

The Institute Introduces Its New Acne Clinic!

The Philadelphia Institute for Advanced Skincare is proud to announce its new Acne Clinic, helping put your best face forward!

The Institute offers an exceptionally comprehensive program to address and treat both adult and teen acne concerns.Please fill out the Acne Questionaire and you will receive individualized recommendations within 24 hours.

At The Institute, you will meet with board-certified physician, Dr Seema Patel and her expert nursing staff. As a patient, you will be given a personalized treatment plan directed to treat your specific skin care requirements. We utilize standard medical treatment, such as antibiotics and topical medicines. In some cases we recommend laser treatments and peels targeted to treat the scarring effects of acne. At the Institute, we believe in treating acne in its earliest stages, as this is the optimal method to prevent long-term scarring.

The Institute is offering this extraordinary service as a walk-in clinic. You do not need an appointment, nor do you have to wait weeks or months to see a dermatologist!

Acne clinics are available on Mondays, Tuesdays 3-6 p.m. and Saturdays from 9 a.m.-1 p.m. Center City 2031 Locust St at The Carlyle Building *63 West Lancaster Ave., Ardmore, PA

The Institute is accessible by the R5 train from 30th Street Station, Suburban Square or Market East

Most insurance plans are accepted Including but not limited to Aetna, Personal Choice, Independence Blue Cross/Blue Shield, Keystone, Medicare. If you have questions regarding your provider, Please contact us.

Read more about acne scar treatment options at
The Institute for Advanced Skincare

What Causes Acne? | See Our Acne Quesionaire

Who Gets Acne?

People of all races and ages get acne. It is most common in adolescents and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.

Contact ShantiMedspa to schedule an acne consultation at one of our convenient locations in Center City or at our Ardmore location on the Mainline (convenient to King of Prussia) by phone 610.642.2644 or by email info@shantimedspa.com.

How Is Acne Treated?

	AM Regimen		PM Regimen
Step 1	Antibacterial cleanser		Antibacterial cleanser
Step 2	Acne gel or acne pads		Acne gel or pads if needed
Step 3	Ultrasmoothing SPF		Ultrasmoothing cream
Step 4			AHA 15

Click here to visit our online store to conveniently and securely purchase quality Neostrata products. Call 1.877.642.2644 or email info@shantimedspa.com now to order your Physician grade Neostrata Acne regimen. Clinically proven to be more effective than over the counter regimens including Proactive. Remember: Maintenance is the cornerstone of effective acne management"

Cleansers: Antibacterial Cleanser (8321), Facial Cleanser PHA 4 (8406), Foaming Glycolic wash (8205)

Acne Tx: Acne Tx Pads (8322), Spot Tx Gel (8320)

Discoloration: Skin Lightening AHA 10 (8007), Bionic Skin Lightening SPF 15 (8411)

Brightening: Skin Brightening Gel (8009), Bionic Skin Brightening (8413)

Prevention: Bionic Face Serum PHA 10 (8410), Renewal Cream PHA 10 (8319), High Potency Cream AHA 20(8206)

Moisturizers/SPF: Oil free lotion SPF 15 PHA 4 (8318), Daytime Protection Cream SPF15 PHA 10 (8414), Ultra Smoothing Cream SPF 15 AHA 10 (8006)

Acne is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment1 is aimed at reducing several problems that play a part in causing acne:

abnormal clumping of cells in the follicles increased oil production bacteria inflammation.

All medicines can have side effects. Some medicines and side effects are mentioned in this booklet. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.

Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne

Doctors usually recommend an OTC or prescription topical medicine for people with mild signs of acne. Topical medicine is applied directly to the acne lesions or to the entire area of affected skin. There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common ones:

Benzoyl peroxide – destroys P. acnes, and may also reduce oil production
Resorcinol – can help break down blackheads and whiteheads
Salicylic acid – helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles
Sulfur – helps break down blackheads and whiteheads.

Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use of the medicine. If you experience severe or prolonged side effects, you should report them to your doctor.

OTC topical medicines are somewhat effective in treating acne when used regularly; however, it may take up to 8 weeks before you see noticeable improvement.

Treatment for Moderate to Severe Inflammatory Acne

People with moderate to severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Several types of prescription topical medicines are used to treat acne. They include:

• Antibiotics – help stop or slow the growth of bacteria and reduce inflammation
• Vitamin A derivatives (retinoids) – unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples are tretinoin (Retin-A2), adapalene (Differin), and tazarotene (Tazorac)
• Others – may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid (Azelex).

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Your doctor will consider your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based gel or solution, which tends to dry the skin. Your doctor will tell you how to apply the medicine and how often to use it.

For some people, prescription topical medicines cause minor side effects, including stinging, burning, redness, peeling, scaling, or discoloration of the skin. See more info....With some medicines, such as tretinoin, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away, notify your doctor.

As with OTC medicines, the benefits of prescription topical medicines are not immediate. Your skin may seem worse before it gets better. It may take from 4 to 8 weeks to notice improvement.

For patients with moderate to severe acne, doctors often prescribe oral antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Prescription oral and topical medicines may be combined. Common antibiotics used to treat acne are tetracycline (Achromycin V), minocycline (Dynacin, Minocin), and doxycycline (Adoxa, Doryx, and Monodox).

Other oral medicines less commonly used are clindamycin (Cleocin), erythromycin, or sulfonamides (Bactrim). Some people taking these antibiotics have side effects, such as an upset stomach, dizziness or lightheadedness, changes in skin color, and increased tendency to sunburn. Because tetracyclines may affect tooth and bone formation in fetuses and young children, these drugs are not given to pregnant women or children under age 14. There is some concern, although it has not been proven, that tetracycline and minocycline may decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be necessary to achieve the desired results.

People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin (Accutane), a retinoid (vitamin A derivative). Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Isotretinoin can cause birth defects in the developing fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin.

Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin; however, the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels unusually sad or has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, it's important to consult your doctor.

Other possible side effects of isotretinoin include:

dry eyes, mouth, lips, nose, or skin (very common)
itching
nosebleeds
muscle aches
sensitivity to the sun
poor night vision
changes in the blood, such as an increase in fats in the blood (triglycerides and cholesterol)
change in liver function.

To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.

See Before/After Treatment Images

Treatments for Hormonally Influenced Acne in Women

In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.

The doctor may prescribe one of several drugs to treat women with this type of acne:

• Birth control pills – to help suppress the androgen produced by the ovaries
• Low-dose corticosteroid drugs, such as prednisone (Deltasone) or dexamethasone (Decadron, Hexadrol) – to help suppress the androgen produced by the adrenal glands
• Antiandrogen drugs such as spironolactone (Aldactone) – to reduce the excessive oil production.

Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.

Early treatment is the best way to prevent acne scars. Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding down" scars, is sometimes used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.

How Should People With Acne Care for Their Skin?

If you have acne, you should gently wash your face with a mild cleanser, once in the morning and once in the evening, as well as after heavy exercise. Wash your face from under the jaw to the hairline and be sure to thoroughly rinse your skin.

Ask your doctor or another health professional for advice on the best type of cleanser to use.

Using strong soaps or rough scrub pads is not helpful and can actually make the problem worse. Astringents are not recommended unless the skin is very oily, and then they should be used only on oily spots.

It is also important to shampoo your hair regularly. If you have oily hair, you may want to wash it every day.

Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes can lead to the development of scars or dark blotches.

Men who shave and who have acne should test both electric and safety razors to see which is more comfortable. When using a safety razor, make sure the blade is sharp and soften your beard thoroughly with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the risk of nicking blemishes.

Many of the medicines used to treat acne can make you more prone to sunburn. A sunburn that reddens the skin or suntan that darkens the skin may make blemishes less visible and make the skin feel drier. However, these benefits are only temporary, and there are known risks of excessive sun exposure, such as more rapid skin aging and a risk of developing skin cancer.

While undergoing acne treatment, you may need to change some of the cosmetics you use. All cosmetics, such as foundation, blush, eye shadow, moisturizers, and hair-care products should be oil free. Choose products labeled noncomedogenic (meaning they don't promote the formation of closed pores). In some people, however, even these products may make acne worse.

For the first few weeks of treatment, applying foundation evenly may be difficult because the skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide.

Medical researchers are working on new drugs to treat acne, particularly topical antibiotics to replace some of those in current use. As with many other types of bacterial infections, doctors are finding that, over time, the bacteria that are associated with acne are becoming resistant to treatment with certain antibiotics, though it is not clear how significant a problem this resistance represents.

Scientists are also trying to better understand the mechanisms involved in acne so that they can develop new treatments that work on those mechanisms. For example, one group of NIAMS-supported researchers is studying the mechanisms that regulate sebum production in order to identify ways to effectively reduce its production without the side effects of current medicines. Another group is trying to understand how P. acnes activates the immune system in order to identify possible immunologic interventions. Other areas of research involve examining the effects of isotretinoin on an area of the brain that might lead to depression and developing a laser system to treat acne and acne-related scars without damaging the outer layers of the skin.

Learn more about ALA or Photodynamic Therapy (PDT) for Cystic (scarring acne)

For cystic acne we will use specialized lasers to target the overactive sebaceous glands that are the root cause of cystic acne, shutting down their hyper-activity and returning your skin to its normal and beautifully calm state. In these treatments we often use an extraordinarily effective combination of specialized blue frequency light energy with ALA (Aminolevulinic acid) in a process called Photo-Dynamic Therapy (PDT). Typically PTD treatment is further customized by the precision of 1 or 2 specialized lasers Amazingly, even the most severe cystic acne cases that may have persisted for years are eliminated, healing and rejuvenating the skin and returning it to its naturally beautifully calm and clear state.

Though severe cases acne and cystic acne are routinely resolved for extended periods of time, depending on other factors such as the patient’s diet, hygiene and hormonal imbalances, regular treatments may be needed from time to time. Please read below and the Acne Treatment handout for additional details.

CYSTIC ACNE TREATMENTS
A new skincare procedure is now available that treats active cystic acne as well as older acne scars leaving your skin smoother, more radiant and vibrant. The procedure is called Photodynamic Therapy for Acne Treatment (PDT) using Levulan. Levulan is a 20% solution of Aminolevulinic Acid (ALA), which is a natural substance found throughout your body. Photodynamic Acne Treatment is skincare procedure by which a photosensitizing agent (ALA) is applied to your skin. The ALA is then activated with a specific wavelength of light, which “turns it on.” ALA has been used extensively for the treatment of a variety of different skin conditions, and is approved by the FDA for a number of treatments including sun damage, Rosacea, actinic keratosis and some precancerous skin lesions.

Acne results from the obstruction and inflammation of sebaceous glands, affecting 80% of the human population. Acne typically begins in adolescence with hormonal changes. However, there are many older individuals who suffer from “adult acne”. There are several different presentations of acne ranging from comedonal (blackheads and whiteheads), papular, pustular, and cystic acne. In many cases, a patient may be afflicted with all of these simultaneously.

Prior to Photodynamic Acne Treatment, the best available skincare treatment option for cystic acne was the pharmaceutical prescription drug called Accutane. However, Accutane is complicated by many systemic side effects including birth defects, liver abnormalities, mood depression, very dry skin and night vision changes. PDT Acne treatment provides a viable alternative for all types of acne conditions.

How PDT skincare treatment works:
The Levulan (ALA) is applied to your skin and left on for 30-45 minutes (“Incubation). Levulan is a clear solution and painless. Once absorbed into your skin the ALA is activated with a specific wavelength of light in the blue spectrum. This takes about 10 minutes. Active cells such as Acne sebaceous glands preferentially absorb ALA, and consequently when the ALA is activated by the blue light, a patient’s overactive sebaceous glands will be dramatically impacted, shutting them down; hence the term “Photodynamic” therapy. The ALA will also target sebaceous hyperplasia (which are those small 1-3 mm bumps on your skin) and the papules of acne Rosacea. Skin oiliness is decreased, and the appearance of pores is minimized. The entire skin texture improves following a Photodynamic Acne skincare Treatment.

After Photodynamic Therapy (PDT) the typical patient will be red and have skin peeling and crusting for several days after the treatment. (Please note pictures of actual patients). Usually, the first 2-3 days are the most intense. Complete resolution typically requires 2-3 weeks. Pressed mineral base foundation will hide most of the redness. We advise remaining indoors the day following your treatment to avoid sun exposure, as you are photosensitive for up to 48-hours after PDT.

The advantages of PDT skincare are rapid treatment of acne lesions without scarring or surgical excision. The skin appears refreshed and younger following treatments. We advise 2-5 treatments at 3-4 week intervals between each treatment to obtain optimal results. There are no known systemic side effects.

In order to enhance the absorption of the ALA into the skin it is recommended that a portion of the outermost dead layer of skin be removed (Stratum Corneum) before applying the ALA in order to maximize penetration of the ALA. Typical methods include various scrubs or dermabrasion techniques. At AMA Corp a mild Erbium laser peel is used, which is much more effective, extremely precise and safe, while greatly enhancing the results of the ALA PDT treatment. (The laser peel is included in the treatment price)

The procedure, step-by-step:

In cases where the patient also suffers from existing acne scarring, sun damage, age spots and wrinkles, PDT treatments can be customized along with other specialized protocols.