The Best Way To Treat Post-inflammatory Erythema

Summary

Highlights

• Dr. Dray emphasizes the frustration of dealing with post-acne erythema, a common but often overlooked skin issue 🔍
• Insurance often covers acne but not post-inflammatory marks, leaving patients without coverage for holistic treatments 💔
• Laser therapies like pulse dye laser target hemoglobin to reduce redness, but the skill of the provider is essential 🎯
• Innovative approaches like radiofrequency microneedling stimulate healing and improve skin texture 🌟
• Topical treatments such as tranexamic acid are available but require patience and consistent use for effective results ⏳
• Alternative treatments like oxymetazoline nasal spray provide affordable solutions by reducing redness through vasoconstriction 🌿
• Sun protection remains an essential step in reducing post-acne redness by preventing further inflammation from UV exposure ☀️

Key Takeaways

• Post-acne redness is not just a cosmetic issue—it's a persistent and frustrating skin condition that affects well-being 🌟
• There is no gold standard for treating post-acne redness due to a lack of insurance coverage and research 📚
• Consistent acne treatment is crucial in managing post-acne redness and preventing further inflammation 🚫
• Pulse dye laser and ND:YAG laser are effective, but results depend on the provider's skill ⚡️
• Topical treatments like tranexamic acid, azelaic acid, and niacinamide can improve redness over time ⏳
• Sun protection is critical to manage and reduce skin redness caused by inflammation and UV exposure ☀️
• Accessibly priced solutions like oxymetazoline nasal spray can be unexpectedly effective 🎉

Overview

Chapters

• 00:00 - 01:00: Introduction and Overview This chapter discusses the persistent issue of post-acne redness, a common frustration for many people. The speaker promises to share the latest and most effective treatments for this condition and hints at a surprisingly accessible and affordable treatment. They also mention acne's prevalence, affecting about 80% of adolescents and young adults.
• 01:00 - 03:30: Understanding Post-Acne Redness Many people, even after their acne has cleared, are left with persistent redness and dilated blood vessels, a condition that can persist for more than six months. This post-acne redness, commonly frustrating, is not exclusive to those with paler skin types but can affect individuals of all skin tones. Acne induces inflammation which attracts numerous inflammatory mediators leading to dilation.
• 03:30 - 05:00: Insurance and Research Challenges The chapter titled 'Insurance and Research Challenges' discusses the dermatological aspects of acne, specifically how it affects blood vessels and the epidermis. Acne can lead to the dilation of blood vessels and thinning of the epidermis, making the redness more apparent on the skin surface. This redness can appear differently depending on skin tones. Additionally, there is a critique on the policies of insurance providers, highlighting that while they cover the cost of treating acne, there are frustrations related to this coverage that are hinted but not fully detailed in the transcript.
• 05:00 - 13:00: Treatment Options for Post-Acne Redness The chapter discusses the distinction between post-acne marks that are considered cosmetic and those classified as skin conditions requiring medical treatment. As a dermatologist, the speaker views post-acne hyperpigmentation and erythema as conditions impacting patient well-being and thus deserving appropriate treatment. The chapter critiques the insurance industry's arbitrary decisions to cover some skin issues while deeming similar problems merely cosmetic.
• 13:00 - 17:00: Topical Treatments and Skincare Advice The chapter addresses the issue of post-acne redness, emphasizing the lack of comprehensive studies on effective treatments. It highlights the difficulty in finding insurance coverage for such treatments, which contributes to the absence of a standardized approach or 'gold standard' for managing post-acne erythema. The chapter suggests that more research is necessary and notes the scarcity of robust clinical trials on the subject in medical literature.
• 17:00 - 21:00: Skincare Routine and Prevention Tips The chapter discusses various treatments for skincare, particularly focusing on post-acne redness. It highlights that there isn’t a standard treatment approach for these skin conditions, as different dermatologists have different methods based on their available tools and expertise. The chapter emphasizes the importance of personalized care and acknowledges that what works in one case might not work in another.
• 21:00 - 25:30: Conclusion and Additional Resources The chapter emphasizes the importance of consistency in acne treatments as prescribed by a dermatologist. It highlights the need for regular follow-ups to ensure treatments are optimized and effective. The chapter warns that if acne continues to flare up, it can lead to increased inflammation, redness, and thinning of the skin, thereby making the condition more persistent and challenging to treat.

The Best Way To Treat Post-inflammatory Erythema Transcription

• 00:00 - 00:30 well hey guys we are long overdue for chit chat about what the heck to do about post acne redness this is something I know affects a lot of you guys it's very frustrating it can be quite stubborn to clear up and keep watching this video because I'm going to share with you the latest greatest treatments for post acne redness of course but I'm also going to talk about a treatment that you might be surprised to find out is pretty accessible and very affordable you know Acme is super common it affects about 80 percent of adolescents and young adults but a lot
• 00:30 - 01:00 of people once the acne is cleared up are left behind with persistent redness and dilated blood vessels that for some people clears up but for many people sticks around for greater than six months very frustrating post acne redness you might think of as something that is predominantly impacting paler skin types however it can affect all skin types you see when you have acne it's an inflammatory skin conditioner it brings in all these inflammatory mediators and that causes is dilation of
• 01:00 - 01:30 the blood vessels and also with acne you get a thinning of the epidermis that's that top part of the skin so the dilated blood vessels and the thin overlying epidermis makes it so that at the skin surface those blood vessels are more obvious and you see redness again redness looks different on all different skin tones now I just have to come on here and rant for a moment because one thing I find super duper frustrating insurance providers will cover the cost of treating acne great but then they
• 01:30 - 02:00 view the post acne marks as cosmetic and I don't know where they draw the line you know as a dermatologist I view acne post-inflammatory hyperpigmentation post acne erythema I view these as all skin conditions that can impact a patient's overall well-being and that need to be addressed and treated appropriately but why Insurance decides that one subset of these problems is worthy of being covered and the others are cosmetic the other thing saying that is super
• 02:00 - 02:30 frustrating about post acne redness is that we don't have great studies on treatments for post acne redness probably because again insurance doesn't cover a lot of the treatments we're going to talk about because of this there's not really a gold standard for treating post acne redness we need a lot more research so if you go online if you go into PubMed and you comb the literature looking for the most evidence-based post acne erythema treatments you're not going to come across robust clinical trials you will
• 02:30 - 03:00 find case reports case series outlining success with various treatments which we're going to talk about in this video but all that to say and contrast to many other skin conditions there's not really a gold standard approach so keep that in mind you know what we're talking about in this video it may not necessarily reproduce every single dermatologist's approach to treating post acne redness everyone has a different approach they have different Tools in their toolbox one of the most important things for you to focus on on is to make sure that the
• 03:00 - 03:30 acne is under good control and that means staying consistent with your acne treatments as prescribed by your dermatologist and following up with them accordingly to make sure that your acne treatments are optimized because you see if the acne is still flaring and you're still breaking out a lot that's going to bring in more inflammation into the skin it's going to drive more redness more dilation further thinning that overlying epidermis making all of this a lot more stubborn and that's very important to
• 03:30 - 04:00 keep in mind because you might be at a point in your journey where you are still breaking out maybe not as much but it's still happening but the redness is the thing that catches your eye and is bothering you the most so don't lose sight of the fact that you still need to stay super consistent with the acne treatments in order to get ahead of the redness now what can be offered in terms of addressing post acne redness there are laser and light based treatments that definitely can help one of the go O2 laser treatment options the one that
• 04:00 - 04:30 you know definitely is is most frequently utilized is pulse Dye Laser pulse Dye Laser works by targeting hemoglobin so it targets the hemoglobin so it can selectively destroy those dilated blood vessels and that background redness pulse Dye Laser is generally pretty well tolerated and it has very few side effects when it comes to any laser-based device though it's all in the skill set of the the treating provider and in the settings and
• 04:30 - 05:00 everything it's not a matter of just point and shoot with any one laser absolutely not they have to assess your Skin's response and you know as it relates to your background skin type there are a lot of factors in terms of you know setting the laser etc etc and if the laser settings are not quite right you can get something called purpura which is essentially a bruise and in some conditions we want a little bit of bruising but in the case of post acne redness if the settings are such that it triggers purpura well that can
• 05:00 - 05:30 obviously make the redness worse more problematic so that would be something that would need to be avoided but all that to say pull style laser is a go-to laser-based treatment for redness in general and has got a track record of success for post acne redness the second most common laser-based treatment is probably an indie yag laser now this targets oxyhemoglobin as well as melanin so here the settings are definitely really important to get it right but it certainly can be an effective tool for
• 05:30 - 06:00 treating post acne redness there's a 595 Pico domain in the yag laser and you're like what the heck is that don't worry about it but this laser is a little bit more sophisticated in terms of more selectively targeting oxyhemoglobin and not the melanin so it may be even a better option but the thing about lasers and light based devices is that you know different providers have different lasers at their disposal they develop a comfort level with a certain laser and so it's not to say that at you couldn't
• 06:00 - 06:30 get results from any of these or that one is better than the other but all that to say you know pole style laser is probably the the one that has the the most track record for efficacy for those you've probably heard of broadband light treatment or intense pulse light treatment these are different than than lasers but depending on the settings utilized the parameters they certainly can also be effective for improving facial redness and facial redness as it relates to Healing acne fractional radio
• 06:30 - 07:00 frequency micro needling what the heck is radio frequency micro needling I actually have a video talking about this basically these tiny little needles uh create injury zones without disrupting the epidermis and they introduce into the deeper layers of the skin a type of energy known as radio frequency and what this does is it uh heats up that part of the dermis leading to a stimulation of healing Pathways that all ultimately
• 07:00 - 07:30 improve collagen production and this study actually showed an improvement in post acne redness and they actually had some biopsies taken and showing that there was a reduction in inflammation and a reduction in blood vessel you know abnormal blood vessel formation those are lasers light based energy-based devices and tools treatment options as you guys know though these treatments that can be cost prohibitive for a lot of people and you know you've got
• 07:30 - 08:00 there's a bit more involved going in having the treatment done people want something they can put on the skin maybe at home to try out so what topicals are there that are available for post acne redness tranexamic acid actually can be somewhat effective for post acne redness what the heck is tranexamic acid I have a video all about this it's a synthetic form of a lysine that actually you know the science of it is a little
• 08:00 - 08:30 bit you know beyond the scope of this video but it was discovered to be an effective treatment when given by mouth for melasma melasma is a hyperpigmentation condition but it also has a vascular component to it but people of course were interested in well can you put it on the skin and get similar benefits for melasma more research is needed but some of the preliminary research is definitely suggesting that topical tranexamic acid Can Be an Effective modality for improving redness however you know
• 08:30 - 09:00 formulation is key due to the nature of how you know tranexamic acid is something that's referred to as a polar substance so that can make skin penetration challenging in formulations if you go to Ulta or you know the drugstore you're going to find a lot of topical tranexamic acid it's a cosmetic ingredient or it can be a cosmetic ingredient again there's going to be a lot of heterogeneity out there in terms of quality of tranexamic acid and because it's a cosmetic that you might
• 09:00 - 09:30 buy there's no way for anyone to tell you what's you know a good topical tranexamic acid the nice thing about transamic acid is even though there's a lot of heterogeneity out there in terms of what you might buy from the store it's generally pretty well tolerated like people don't seem to have issue with it uh and it but the thing is it it takes like everything in the skin it takes time to start working applied nightly you might start seeing some improvement around six to eight weeks
• 09:30 - 10:00 which you know in the in the lifespan of skin isn't too too bad but for some people you know we're really bothered by it just you know if you're going to try it out realize it's not gonna it's not going to change things drastically overnight you're going to have to stay consistent with it and be patient with it oxymetazoline and bromonidine what the heck are these These are medications that are referred to as Alpha receptor agonists and the way they work is by binding on receptors and and causing
• 10:00 - 10:30 blood vessels to constrict to clamp down so the end result of that is going to be an improvement in redness these these compounds have a decent track record both clinically as well as in in clinical studies of improving uh post acne redness of these two compounds oxymetazoline is the most desirable in my opinion because one thing that can happen with these compounds is that they can actually trigger a rebound worsening of redness but that actually has only
• 10:30 - 11:00 been shown with bromonidine not with oxymetazoline to clarify bromonidine is what is in lumify eye drops and then oxymetazoline is what is an Afrin nasal spray now of these two bromonidine you have to be careful of because it can cause rebound worsening of redness whereas the oxymetazoline which is what is an Afrin seems to be okay in that regard and not causing rebound worsening redness and so yes you can actually
• 11:00 - 11:30 apply Afrin nasal spray to the skin and derive that potential benefit of reducing redness from oxymetazoline just by getting a nasal spray but I do not suggest doing that with the lumify eye drops which have bromonidine in it because the bromonidine can lead to rebound worsening redness the oxymetazoline 0.05 percent uh it has been you know it's it's got a good clinical track record of efficacy for post acne redness uh and it's it's
• 11:30 - 12:00 what's an Afrin nasal spray that you can buy Afrin is just a brand name for oxymetazoline nasal spray uh you can even go in the Dollar Tree and they have an oxymetazoline nasal spray so it can minimize the redness by vasoconstriction and may ultimately help in in clearing things up now when it comes to your skin care routine there are some other ingredients that I've shared with you guys before that are beneficial for redness in pursuing the skin niacinamide these are generally well tolerated mild
• 12:00 - 12:30 and they're commonly found in a lot of moisturizers and moisturizing products but uh the other ingredient that I really like for post acne redness is acetylic acid acetylic acid is great because it's it's an acne treatment so it potentially can impart some ongoing acne control and IT addresses hyperpigmentation and it also addresses redness so I'm rather
• 12:30 - 13:00 fond of azolic acid as a side note YouTube has this new shop feature and if you tap on the little bag you're going to see one of my favorite azelic acid products from Paula's Choice the azelic acid booster I've talked about this on here before so if you want to learn more about that product you can you can read more about it by tapping on the icons you've heard me rave about that one that product before it's it's very good one another product that I think is a great option for post acne redness post acne hyperpigmentation it's just a great
• 13:00 - 13:30 lightweight moisturizer overall it's the procure rosicare it has licorice root and it has niacinamide in it both of which can help calm down redness and irritation when it comes to your skincare routine though keep it really simple anything that might irritate the skin or if you find illicit symptoms of sensitivity like burning stinging redness back away anything that you're is irritating to the skin can potentially worsen that background redness and make it more stubborn to to treat so pay attention to your skin how
• 13:30 - 14:00 it's responding to things you know while niacinamide and a licorice root azelic acid while those are generally very well tolerated there's always going to be a subset of people that don't get along with those ingredients listen to your skin if it burns it stings it makes you flush don't use it it's gonna you know it's not going to it's not going to be helpful to you the other thing which should come as no surprise coming from me but I cannot emphasize how important this is and that is you've got to be protecting your skin from the Sun UV
• 14:00 - 14:30 rays are going to drive more vasodilation into the skin because your skin you know tries to respond to the UV rays by bringing in more inflammation to to hopefully take care of the of the dead and dying cells and that onslaught of inflammation releases vasodilatory compounds you get more vasodilation that coupled with the fact that UV rays from the the sun slow down healing it's just going to make this process a lot more slow and stubborn for you the other
• 14:30 - 15:00 thing to bear in mind with your skincare routine is don't go out chasing after a lot of exfoliants things that can be harsh irritating the skin whatever you don't pick or try and manipulate your skin including if you're still breaking out picking squeezing that definitely can make for persistent facial redness persistent red bumps dilated blood vessels known as teal injectasia so don't squeeze pop or otherwise manipulate the skin and importantly like
• 15:00 - 15:30 I said at the beginning of the video stay consistent with your acne treatments one reason that acne treatments fail is that people stop them prematurely like the skin will clear and they'll be like oh great and then they'll stop the treatments and then the acne will come right back a lot of acne treatments need to be continued so make sure you are you know checking in with your dermatologist making sure like do I need to continue using what you prescribed because oftentimes you do and stopping premature really can not only make the acne come back but drives more inflammation into the skin that ultimately could worsen this problem for
• 15:30 - 16:00 you our right guys so let me know in the comments have you ever heard of oxymetazoline otherwise known as like Afrin nasal spray for redness for persistent facial redness drop a comment below but I hope this video was informative to you guys and you enjoyed it on the insulate I'm going to link up my video All About acne in your 40s if you are an adult breaking out for the first time or you're still breaking out you've been breaking out your whole life definitely check that out because we
• 16:00 - 16:30 talk all things hormones and how our hormones change with age and causes to break out so watch that one next if you missed it but if you guys like this video give it a thumbs up share it with your friends and as always don't forget sunscreen And subscribe I'll talk to you guys tomorrow bye [Music]
• 16:30 - 17:00 thank you