You guys have been asking, so here’s what I found to be the most interesting new information on scars and scar treatments:

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Subcision plus suction.  Subcision is where a needle is placed sideways underneath a depressed scar and moved around, thereby disconnecting the scar from the skin below and allowing it to float up to the surface. The hope is that a hemorrhage will appear under the scar, leading to new connective tissue and a permanent raising of the scar toward the skin surface. For those of you who have tried this, you may have noticed that it seems to work, but that a large portion of these areas tend to recede again. However, a new common sense treatment is now being added to some subcision treatments. After the initial subcision of the scar an initial hemorrhage forms. Then, 3 days later, a suction machine, normally the same one used in microdermabrasion, is placed over the scar area and “vacuums” the skin up, ultimately reintroducing another hemorrhage under the treatment area.  This suctioning is repeated at least every other day for 2 weeks afterward in an attempt to produce more tissue under the scar. The Journal of the European Academy of Dermatology and Venereology concluded, “Frequent suctioning at the recurrence period of subcision increases subcision efficacy remarkably and causes significant and persistent improvement in short time, without considerable complication, in depressed scars of the face.” Pretty cool.

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Need to wait until 6-12 months after Accutane (isotretinoin) to get aggressive scar treatment? This is a commonly held belief since isotretinoin has been linked to keloids and raised scarring, perhaps because of collagen accumulation. It remains a prudent stance. However, in one very small study, doctors dermabraded one square centimeter on 7 participants faces using a diamond fraise while they were on isotretinoin. After 6 months, the scar revision appeared successful and there were no signs of keloid or raised scarring. Although this is interesting, patients and doctors must continue to proceed with caution in this area until we get more evidence.

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Why do we scar in the first place? Scars are the result of wound healing, which is one of the most complex biological processes, and includes the following 3 phases.  Some new info below:

(1) Inflammation: Upon closer investigation through biopsy specimens, researchers found that the initial inflammatory reaction was stronger and had a longer duration in patients who scarred.

(2) Granulation tissue formation:  Next, damaged tissues are repaired, new capillaries are formed, and new collagen begins forming. Researchers are noting, “The balance of collagen types shifts in mature scars to be similar to that of ounwounded skin, with approximately 80% of type I collagen.”  This one is a bit above my head. If anyone knows why this might be interesting, please comment.

(3) Matrix remodeling: As the healing process moves on, extracellular matrix metalloproteinases (MMPs) take on the job of deciding how much tissue will be built.  Too much MMPs and you may see a raised scar.  Too little and you may see a depressed scar.  However, why some people have too much or too little MMPs remains a mystery.

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I’ve read all the other scar related research that has been published as well. Basically it’s mostly the same stuff we have known before. The bulk of the evidence continues to show (1) significant improvement with ablative lasers (CO2 and Erbium;YAG) with pretty severe down time afterward, (2) somewhat less improvement with fractional lasers and needling but with less down time, and (3) the never-ending search for the perfect filler. If anything remarkable comes out in the near future I will let you know.

In case you just can’t wait to get back to your computer to see what’s aflutter on the messageboards, you’re in luck. Now you can check out the messageboards using your mobile device. Just type in acne.org/messageboard into your mobile browser and surf away.

 

 

 

 

 

Hey Everybody. Just a heads up to keep you all in the loop…we have been working on an upgrade to the messageboards for a few months now. It’s a huge job but we’re almost done. The new messageboard is now online and should be accessible for you, but keep in mind that it doesn’t have the look or feel that it ultimately will.  We will be working on sprucing everything up this week.  The new boards will have better navigation, search, members area…pretty much everything.  Plus it should be more integrated with social media and help everybody on here get to know each other better with upgraded tools.

Thanks for your patience, and please give me your feedback.  I know you will

A while back we switched to new pumps–pictured below on the right. You guys let me know they were kinda annoying and I agreed, so I switched back to the old pumps–pictured below on the left. From now on, if you order any Acne.org product with a pump, you will get the old, good pumps.

After a thorough review of the literature up until today…

This is what scientists know:

Hormones: Milk contains hormones such as IGF-1 (insulin-like growth factor) and androgen (male hormone) precursors.

Iodine: Milk often contains iodine, largely due to farmers dipping the teats of cows in an iodine solution before milking in order to sterilize. At large doses, iodine can cause what are called acneiform eruptions. Acneiform eruptions look similar to run-of-the-mill acne vulgaris but are different in important ways.

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This is what scientists postulate, but don’t know:

Hormones: IGF-1 and androgen precursors in milk could theoretically lead to increased skin cell production, causing pores to become clogged. IGF-1 and androgen precursors could also theoretically lead to increased skin oil production. Since we know that acne does not flourish in low oil environments, perhaps the hormones in milk might help provide an oily fertile ground for acne.

Iodine: The link between iodine and acne is even more theoretical than with dairy. However, some select scientists put out the possibility that if iodine does in fact aggravate acne, since milk contains iodine, milk could lead to more acne.

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The bottom line:

What stands out strongly now that I have read all of the evidence is that the design limitations in dairy and acne studies thus far leave us without any concrete answers. After performing a thorough review of existing evidence, authors in the Journal of Clinics in Dermatology agree: “Our conclusion, on the basis of the existing evidence, is that the association between dietary dairy intake and the pathogenesis of acne is slim.”

My common sense takeaway:

Northern Europeans were the first to domesticate animals and drink milk past childhood. In fact, the last genetic adaptation we see in humans is the gene which allows people of Northern European ancestry to digest lactose. If you can drink milk and eat dairy products without stomach aches, excess gas, or discomfort, perhaps ingesting dairy is part of a healthy lifestyle for you. However, for the rest of us, me included, if you do not have the gene, and dairy gives you issues, that’s a pretty clear sign that your body isn’t crazy about dairy. It might be a good idea to steer clear of it for overall health. As far as acne in particular is concerned, we just don’t know yet. I personally love pizza more than breathing and I’m not going to give up dairy completely until I see more concrete evidence linking it directly with acne or other serious negative health consequences.

Thanks for voting everybody. We will go ahead and move forward with a larger 16oz. AHA+. We’re also looking into whether we can make a 3.4oz. one as well, but this may take a bit longer. I can’t quote any exact launch dates at this point, but we are ordering the necessary raw materials and we will get the new size(s) of AHA+ up on the site soon. Thanks for your input on this.

I am pretty much always trying a new SPF. However, no matter how many I try, I seem to come up empty. In fact, up until now I could really only put my support behind Olay Complete All Day UV, despite its flaws.

Acne.org members and people around the office frequently ask me to trial products. A couple of weeks ago, Kent asked me to try Philosophy brand oil-free SPF30 and gave me a tube of it.

Quite suprisingly, I like it quite a bit. I actually prefer it to Olay. However, upon finding out how expensive it is, I was a bit sticker shocked. I don’t like recommending expensive products because I want the Regimen and all its components to remain accessible. The Philosophy SPF is $38 for only 2oz. However, since good SPFs come along very infrequently, I wanted to pass this along regardless of its high price. Click to read my review. If you have tried it, please add your review as well.

EDIT: We no longer have a physical pick up location in San Francisco. Sorry you guys!

Recently an Acne.org member wrote to me asking if I could look into niacinamide, an ingredient which may be beneficial for acne prone skin and which is included in some over-the-counter products, especially moisturizers due to its water loss prevention properties. Knowing that over-treatment of the skin can lead to irritation and the perpetuation of acne, he asked if I could explain whether niacinamide could potentially interfere with the effectiveness of the Regimen.

What is it: Niacinamide (a.k.a. Nicotinamide or Nicotinic Acid Amide) is a close chemical compound to Vitamin B3 (niacin) which can be taken orally or applied topically. Based on the published research I have uncovered, this ingredient may be a welcome addition to a skin care product ingredient deck and will most likely not prove to be an unwelcome variable.

Evidence: For the purposes of this post, I am speaking of topically applied niacinamide. Topical niacinamide may have measurable anti-inflammatory, anti-irritation, and skin turnover properties. In one study testing topically applied 4% niacinamide (brand name Nicomide), it was shown to reduce acne symptoms as much as 1% clindamycin, a widely prescribed topical antibiotic. Keep in mind that clindamycin produces unimpressive results, even if significant over placebo. In another study, in order to test for niacinamide’s effect on skin oil production, researchers applied 2% niacinamide to Japanese and Caucasian subjects. At least some of the Japanese subjects experienced somewhat reduced skin oil production.

Mixing it with other meds: Normally, it is wise to keep the amount of active ingredients one uses to a minimum to prevent over-treatment of the skin, and resulting irritation. However, since the skin reacts very minimally to niacinamide and it tends to cause so few side effects, it may prove a welcome passenger alongside other ingredients.

Beware of “label claim”: It is a general practice in the cosmetics industry to include ingredients in products at tiny amounts for what is referred to as “label claim.” Manufacturers will very often add one or two drops of an ingredient into huge hundred gallon batches so they can write on their label that the desired ingredient is in the product. If you see niacinamide in a product, check its placement within the product’s ingredient list. As an example, it is the fourth ingredient in Olay Complete All Day Moisturizer – Normal. The higher an ingredient is listed, the more of that ingredient is included, so its fourth place showing is promising. If you see it listed toward the end of an ingredient list, chances are it may be in the product only for label claim.

A final note: In my years of researching promising acne fighting ingredients, I have come across hundreds of ingredients which show promise in fighting acne. Studies of these ingredients are often small, and results, while scientifically significant, are often unimpressive. In other words, it is not time to lobby skin care manufacturers to be certain to include niacinamide in their products. Rather, be sure you have the basics in place–a non-overdrying cleanser, a 2.5% benzoyl peroxide, and a moisturizer which does the trick of bringing the skin back into balance. When used within the Regimen, these products alone should get you 100% clear. However, if you do see niacinamide on the label, I don’t see any reason at this point to worry that you will be over-treating your skin.

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As we move forward here at Acne.org, I will keep niacinamide in mind when formulating, along with all of the other promising ingredients available to us. I’ll also keep checking research as it emerges regarding this ingredient.

An explanation on my decision not to continue producing the old moisturizer, as well as tips to get the New Moisturizer to become your new bestie: