Acne Treatments: A Q&A with Stanford dermatologist Justin Ko

Most of us suffer through at least minor acne as a teenager, but many battle severe acne into adulthood. It affects up to 50 million people annually and can cause permanent scarring, poor self-image, depression and anxiety.

The American Academy of Dermatology recently published new guidelines for acne treatment in the Journal of the American Academy of Dermatology. The new guidelines recommend using several therapies at once. I spoke about them with Justin Ko, MD, MBA, clinical assistant professor of dermatology.

What is your advise for people that suffer from mild to severe acne?

There are great treatments out there! Find a physician with whom you feel comfortable; someone who is willing to talk through the reasons behind acne and formulates with you a personalized treatment approach based on your type of acne, skin type, other health issues, preferences, etc. A therapeutic partnership between a provider and patient is essential. I think that being able to treat acne successfully and effectively is the mark of a good dermatologist. It is and remains immensely satisfying for me to go through this journey with my patients and see them come out the other side with a newfound comfort in their skin. 

What do you think of the new American Academy of Dermatology guidelines?

The AAD’s acne treatment recommendations represent the current standard of care. Our core treatment arsenal is comprised of topical treatments, oral antibiotics, hormonally-based treatments and isotrenoin (accutane), as well as other less-commonly used treatments that can have their place for the appropriate patent or situation. I agree with the guidelines that it is especially important for a topical regimen to form the foundation of any approach to acne treatment and not to rely on a single modality.

How has acne treatment changed in the past two decades?

We now have an appreciation for the fact that different types of acne require different approaches. I myself am using oral antibiotics less and more hormonally-based treatments and isotrenoin (accutane) when I think a patient will benefit. Here at Stanford, we also see acne-like eruptions in different forms due to underlying medical conditions and treatments, including new targeted-cancer treatments.

How do laser treatments and photodynamic light therapy work?

In the right settings these treatments can be good, as a companion to “traditional” treatments or situations when a patient is unable to use “traditional” treatments. They work in a couple ways. Some light-based treatments take advantage of a property of selected wavelengths of light that reduce the skin’s immune activity. Acne is fundamentally inflammation around hair follicles, so these light-based treatments can help.

Photodynamic therapy and intensive treatment protocols for PDT actually aim to shrink the oil glands, which play a role in acne formation in unlucky people. This intensive treatment can be quite painful, but it can be effective.

As with any of this, it’s essential to find a provider who is trained in the appropriate, safe and effective use of laser therapy.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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