Beyond acne struggles

As the aesthetic medicine market evolves, leading dermatologists explore effective treatment approaches for diverse acne challenges.

T he market of aesthetic medicine is expanding and is predicted to advance up to US$ 212 billion by 2032 in contrast to US$ 75 billion in 2023. This impressive growth at a CAGR of 12.17 per cent reflects the increasing demand for aesthetic procedures worldwide. The Indian medical aesthetic devices market is also set to witness significant expansion, with estimates suggesting it will grow from US$ 1.62 billion in 2024 to US$ 3.2 billion by 2029, a CAGR of 13.28 per cent. This growth is a result of the increasing health consciousness, and the introduction of new technological products in the aesthetic, and beauty enhancement industry.

Skin-related concerns, such as acne, remain significant issues across various age groups. Social networks have raised awareness, leading many patients to seek treatment for even mild cases of acne.

Understanding acne variations

Patients from all age groups have been seen to seek medical attention for their acne.

“This acne may be caused by stress, gym routines or different kinds of lifestyles,” says Dr Madhuri Agarwal, Celebrity Dermatologist and Founder, Yavana Aesthetic Clinics. She adds, “Other patients will seek further medical attention if they used a product and it failed to work on them. Some patients will come as a result of being driven there by a spouse or a friend.” Aesthetic medicine practitioners will therefore categorise acne based on its severity to administer the right treatment. Dr Madhuri goes on to point out the three grades of acne: mild, moderate, and severe.

Dr Shefali Trasi Nerurkar, Consultant Dermatologist, Dr Trasi Clinic and La Piel Skin Clinic, says, “Gen Z patients often experience significant psychological distress from even a single pimple, they seek attention from grade one. Millennial patients are often seen to come during grade two, with some individuals presenting more severe acne, having tried multiple treatments without success.”

When addressing acne management, Dr Rinky Kapoor, Founder &Director &Consultant Dermatologist, at The Esthetic Clinics emphasises the importance of a thorough patient history: ”We always ensure that we take a detailed history of any patient who comes in for the first consultation, because nowadays, a lot of people look for products online and go in for DIYs.”

Understanding past treatments, lifestyle, diet, stress levels, and hormonal factors is crucial for tailoring effective treatment plans. Dr Madhuri insists that, “As dermatologists, we should not lose sight of the fact that we have to do a proper procedure.” A detailed patient history helps in classifying the severity of acne and identifying specific concerns, be it for facial or body acne.

Treatment approaches

Treating acne in preteens and teenagers presents unique challenges. Dr Manu S Walia, Head Dermatologist, Myra, points out that parents are often more concerned about their children’s acne than the children themselves. Effective counselling is crucial in these cases, helping parents understand that a few lesions are not usually a major concern. However, appropriate treatment, including face washes and topical therapies, is essential for more severe cases.

Dr Rinky shares an example of a young patient with comedonal acne. In such cases, “simple lifestyle modifications, like regular face washing and managing dandruff, can be effective.” It is also important to educate both parents and patients about the longterm nature of the acne treatment and need for maintenance.

For moderate acne, Dr Sejal Shah, Aesthetic Dermatologist, Visage Skin Clinic, recommends topical retinoids like tretinoin and adapalene as first-line treatments: “Topical retinoids is my first line of treatment usually.” Benzoyl peroxide is also a staple in her practice due to its effectiveness.

In agreement, Dr Shefali suggests that “combining older modalities, such as clindamycin with benzoyl peroxide or retinoids, often yields better results than using any single product alone.”

On her part, Dr Manu supports the use of benzoyl peroxide, stating: “Studies show that adding benzoyl peroxide prevents bacterial resistance, which is important these days.”

Dr Rinky mentions niacinamide being beneficial for its antiinflammatory properties and suggests that botanical alternatives can be effective for mild acne.

And Dr Madhuri states, “Sunscreen is essential for all acne patients, particularly those on treatments that increase photosensitivity, such as isotretinoin or doxycycline.”

Convincing a patient to use sunscreen can be a daunting task, Dr Shefali adds that you need to “talk to your patients like you are talking to your friends and explaining to them the importance

of sunscreen.” Dr Madhuri highlights, “If they have PIH, I tell them to use a tinted sunscreen which gives light coverage to the skin as well.” Even though sunscreens should be applied frequently, using them with moisturisers can solve both dryness and protect the skin from the sun.

Lasers or chemical peels are among the interventional treatments and are prescribed once the patient’s reaction to the medical line has been assessed. Dr Shefali recommends that most such treatments should be introduced in the subsequent interactions rather than at the initial session. This approach ensures that the patient’s adherence and response to initial treatments are assessed before proceeding with more invasive procedures.

Various treatment modalities are used for managing comedones and other acne-related issues, depending on the severity and nature of the condition. Dr Sejal highlights that for patients with numerous comedones, an extraction approach is essential. She combines this with topical benzoyl peroxide and adapalene to address both existing and new comedones. This method accelerates resolution compared to topical treatments alone.

Dr Rinky also agrees with the extraction but further says that “the kind of treatment may further depend on the age of the acne patient as well as the severity of the acne.” In cases with extensive involvement, she suggests considering “oral retinoids, especially when topical retinoids are insufficient.” Oral retinoids can offer a more systemic approach to managing severe cases.

On the other hand, Dr Madhuri prefers initiating treatment with oral isotretinoin, particularly for severe cases: “But in the long term, it helps to give a resolution because sometimes extraction itself leads to a lot of scarring.”

Steroid-induced acne presents its own set of challenges. Dr Sejal recounts a case involving a patient who developed acne after using steroids prescribed during the lockdown. “The patient’s initial treatment involved antibiotics and isotretinoin, but severe headaches led to discontinuation.” She then incorporated carbon dioxide laser treatments and spironolactone to manage hormonal flares. Despite a lengthy treatment period of nearly a year, the patient eventually showed significant improvement.

Dr Shefali emphasises the importance of addressing steroid dependence by gradually reducing steroid use rather than abrupt cessation. She also starts acne treatments early, including antibiotics and chemical peels, to combat inflammation and acne: “I would start using chemical peels because you are constantly in a race against that steroid, and you need to win that race for the patient.” She advises additional counselling to help patients manage their expectations and stay motivated throughout the treatment process.

In cases where patients exhibit excoriation of acne lesions, Dr Rinky presents a unique case of unilateral acne affecting a 40-year-old woman. Despite extensive investigations, the cause of the one-sided flare remained unclear. Her approach involved: “Giving her oral antibiotics, and then putting her on oral retinoids.”

Dr Shefali says that unilateral acne can be perplexing, often associated with environmental or behavioural factors. Psychological counselling and detailed patient education are crucial for managing expectations and ensuring such as young individuals with psychological stress, Dr Manu advocates for a holistic approach. This includes: “Counselling and involving parents in the treatment process, alongside starting with topical treatments.”

Dr Sejal adds that referring such patients to a psychologist or psychiatrist can be beneficial, although it can be challenging to convince them or their families. She suggests: “I then advise them to start with means to reduce stress - yoga or meditation.

Strategies for complex acne

Dr Shefali shares a case involving a 21-year-old female engineering student suffering from severe nodular and cystic acne. The patient, also diagnosed with PCOS, faced additional challenges, including high testosterone and prolactin levels. Her approach was: “We referred her to an endocrinologist, and together, as a team, we improved because the testosterone levels were high.” Shefali also implemented a combination of oral antibiotics, isotretinoin, and topical treatments. Additionally, fractional lasers were introduced after initial infections were controlled, “and then in the fourth or the fifth session, I started around fractional lasers,” resulting in significant improvement in both acne and scars. effective treatment. .

Advanced acne solutions

With the ongoing advancements in aesthetic medicine, dermatologists are adopting more patient-centric and developmental approaches to acne treatment across different age groups and severity. Thus, acne control is not only about medications but also about patient counselling, improving their lifestyle, and proper encouragement. Through complementing traditional acne treatments with modern approaches and technologies, dermatologists are focusing on both the medical and psycho-social aspects of acne management emphasising trust and overall positive results. Due to this trend, the market for aesthetic procedures will continue to grow and provide even more sophisticated treatments for acne-related issues.

Through collaboration, patient-centric care, and continuous research, the journey toward flawless skin is becoming more achievable for all.

The above article has been extracted with excerpts from the panel discussion on ‘New modalities and strategic management in acne in different age groups’ that was held at the Aesthetic Medicine India Conference 2024.