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smoothbeam/acne

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medstudent2005

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howdie folks

just a quick question: you guys ever heard of something called Smoothbeam for acne? how effective is it when compared to accutane? is it done by a medical doctor or can anyone do it? does insurance cover it?

thanks

NT
 

Kalel

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I assume that smooth-beam is some type of laser? Anyways, I looked it up in pub med and it looks like it is really new technology. I'm always hesitant to reccomend many of the newest tech stuff that just hit the market because of unforseen long-term side effects, and improvements are always just around the corner. I'd try the regular stuff before trying either one of your treatment options (benzoyl peroxide/antibiotic cream, topical retinoids, etc) for at least several months or so. I doubt if any insurance would cover this laser stuff since it's so new, and is an "elective" procedure.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=14756641&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=14677157&dopt=Abstract
 

Kalel

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Just spoke with a dermatologist about using laser therapy for acne and this is what he told me. Generally, he doesn't reccomend anybody pursue this route. It is an elective procedure and therefore it's not covered by insurance. Many of the people pushing to do this procedure are kind of shady people and don't have a lot of experience in treating acne. The laser therapy hasn't been shown to be much more efficacious then oral abx therapy (tetracycline or doxycline) as well. Generally, acne can be managed medically by a dermatologist. Accutane is a very effective medication at managing accutane for many patients (it dries up sebaceous glands), and the risk of it causing depression is pretty low (having severe acne is a counfounder in these studies, since severe acne is associated with depression). The suicide risk is mainly a political designation, it's not given a lot of credence by the derm board, but apparently, there was a Michigan legislator whose son committed suicide while on accutane and this legislator blamed the drug and got a big black box label on it. The other big black box label is very real and a pretty high risk, and that is the risk of teratogenicity, which is why it's very important for females who take this drug to be on at least 2 proven methods of birth control prior, during, and after taking the drugm (with a 1 month span of before and after). Anyways, other reccomended treatments for acne depend on the type of acne we are talking about, but doxycline sometimes works where tetracycline doesn't, and remember that topical stuff has to be used for at least 3-4 weeks before any real benefit can be seen. Other methods include spirnolactone, ketocanzole, and OCP's. If you are stressed and in a rush to get rid of you acne, you can actually see a dermatologist to get some sort of anti-inflammatory shot (I think ketorolac) directly injected into your face as acne is largely an inflammatory process.
 

jayski2030

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The cortisone injections are triamcinolone acetonide. I think the brand name is Kenalog or Kenacort. They work well on inflamed cysts.
 

alimarie81

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I heard that Smoothbeam is used for treating acne scars. I think it only has FDA approval for use on back acne, not facial acne; although derms who have the Smoothbeam are probably using it on facial acne too. Like Kalel said, it isn't covered on insurance and I am sure patients are paying big bucks for each treatment session. Going rates in Chicago per session are probably $300+, and it requires more than one session to see significant results. The use of the Smoothbeam laser on "Extreme Makeover" may have peaked interest in this subject recently. Any thoughts?
 

dj phin

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There are an increasing number of acne lasers being made available at the moment. These range from lasers to light sources to radiofrequency sources. They have varied results in individuals and do not always result in a dramatic change. Studies show that there is a decrease in lesion counts however with most of these technologies as they kill p acnes.
 

medstudent2005

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hmm, i'd never heard of the shots before. man, i had a VERY bad case of acne (i think combo of stress, skin susceptibility, and freaking Isoniazid...i hate that drug, wish i had never taken it...took it for no good reason...anyway) well, i was treated with doryx and tazorac, which sorta helped (but i made the mistake of combining benzoyl peroxide with tazorac, and boy did my life get REALLY messed up when half my face turned a brownish color and i looked like i had developed a weird case of herpes zoster)...i have been continuing the doryx, but i still get occasional breakouts and the damn macules have not gone away, so that i have all these tiny red dots all over my face, it's pretty annoying...i have now been using fineacia or whatever that is, but like i said, i still get breakouts even with the fineacia and doryx. i had always thought that steroids INCREASED the acne,as they are an immune suppressant...never heard of ketorolac being used though and no one ever mentioned it to me, even though i had the darn acne REAL bad and it ruined my self esteem, mental well being, all that good stuff you need in medical school to overcome every other ****ty thing coming your way :) anywho, i know that diet has never been proven to be a cofactor in development of acne, but it seems to me that everytime i have a seafood meal, i get breakouts...am i just nuts? i wish there was a cure for this damn thing..haven't yet tried accutane though.

thanks
NT
 

jrl4a

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Originally Posted by medstudent2005
anywho, i know that diet has never been proven to be a cofactor in development of acne, but it seems to me that everytime i have a seafood meal, i get breakouts...am i just nuts?

I know that although there is no conclusive link between diet and acne, there is a known link between excessive amounts of iodine and acne. Seafood is high in iodine and the excess is secreted through the sebaceous glands, irritating the skin and causing breakouts. Make sure any dietary supplements you are taking have no more than the DV for iodine and watch out for too much salt, seaweed, soy sauce, etc.

Hope that helps : ) I know how frustrating it can be, i've been there...and occassionally I'm there myself : )
 

medstudent2005

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hey, thanks for the post...so the culprit may be iodine, ey? makes sense then concerning the seafood and salt stuff. well, i guess that means sainora to sushi :)

Nt
 

Andy Jacobs

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Don,t know if any one can give me some advice,not a med student.Had acne over 20 years not bad, but enough to have an impact on my life.It mainly affects my back.Tried low dose antibiotics and then Roaccutane some years ago which suppressed it,but hasn,t cured it.It,s flared up recently and i,ve been on Oxytetracyclene for the last month.Can,t help feeling I,m wasting my time on this, but a little worried about the pontential side effects of Roaccutane,if I end up going that route.Also any suggestions for reducing scarring a sun tan would help is that such a big no no.
 

MeganRose

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Andy Jacobs said:
Don,t know if any one can give me some advice,not a med student.Had acne over 20 years not bad, but enough to have an impact on my life.It mainly affects my back.Tried low dose antibiotics and then Roaccutane some years ago which suppressed it,but hasn,t cured it.It,s flared up recently and i,ve been on Oxytetracyclene for the last month.Can,t help feeling I,m wasting my time on this, but a little worried about the pontential side effects of Roaccutane,if I end up going that route.Also any suggestions for reducing scarring a sun tan would help is that such a big no no.
Hey Andy,
I've struggled with acne for 15 years (bad, scar-causing cystic acne for much of that time) I'm only a 2nd year so I'm definitely not giving this advice as a professional. But from personal experience, my back acne was best treated by washing my back with a acne face product with salacylic acid (like neutrogena acne wash) and bc pills. (which I guess aren't really an option for you) My back hasn't had a blemish for 5 years now. My face is almost entirely clear now and I use tazorac with an at home glycolic peel (Obagi exofoderm) Also, I used to have a problem with redness and azaelic acid (Phonecia?) helped with that. Best of luck,
M
 

dermpa02

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Andy Jacobs said:
Don,t know if any one can give me some advice,not a med student.Had acne over 20 years not bad, but enough to have an impact on my life.It mainly affects my back.Tried low dose antibiotics and then Roaccutane some years ago which suppressed it,but hasn,t cured it.It,s flared up recently and i,ve been on Oxytetracyclene for the last month.Can,t help feeling I,m wasting my time on this, but a little worried about the pontential side effects of Roaccutane,if I end up going that route.Also any suggestions for reducing scarring a sun tan would help is that such a big no no.

Hello Andy,

Were you put on some kind of maintenance regimen after the Roaccutane (or Accutane, as it's known in the US)? There is no cure for acne, and what Accutane does is only temporary. The processes that give you your acne don't go away, and that is why you should have been on some kind of maintenance therapy. If you weren't on maintenance therapy, it would be no surprise that you flared again.

It is possible that you are wasting your time with the oxyTCN. If you've been on it a while and aren't seeing results, then you should ask your provider to consider changing to a different class of oral antibiotic. There are indeed several other very good choices that you could change to.

If your acne is bad enough to need Accutane, then I think you should talk it over w/ your provider. Many thousands of former Accutane patients have needed additional courses in order to achieve a long-term remission, so your case would not be out of the ordinary. As for your worry about long-term effects -- again, talk it over with your derm provider. They can tell you about the ways to monitor for the onset of these effects, and you can always stop treatment if it looks like effects might be appearing. And also consider that if you are reasonably young and healthy, that the odds of long-term side effects is actually quite low.

As for scarring... if your scarring is minor, then you can look into microdermabrasion or mild chemical peels. I personally don't recommend these, but there are lots of derm providers who do so. I find that once a person's acne is well controlled and the deep inflammation that brings out the scarring is gone, that people tend to look at their minor scarring with much less criticism. I do believe, along with many other derm providers, that long-term retinoid therapy for acne can also help with minor scarring, but it certainly won't make drastic changes.

On the other hand, heavy scarring can be treated quite effectively with the deep chemical peels, dermabrasion, or laser ablation. All of these work by stripping off your outer layer of skin (and the scarring along with it), forcing you to grow new, unscarred skin. Please keep in mind however that these procedures can produce great unwanted side effects, and that you must decide if the risk is worth the potential benefits. If you do ever decide to do one of these procedures, make sure you find someone that has done a lot of them.

Lastly -- you didn't mention if you were seeing a derm provider, or someone else. If you have been seeing a non-derm provider for your presumed back acne, then you should definitely consider seeing someone trained in derm. This is because there are other things that your problem could be, instead of acne. I've seen cases where things like dermoid cysts or pityrosprorum folliculitis were treated as acne, with the expected poor results.

hth,
Phil R.
 

dermpa02

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medstudent2005 said:
howdie folks

just a quick question: you guys ever heard of something called Smoothbeam for acne? how effective is it when compared to accutane? is it done by a medical doctor or can anyone do it? does insurance cover it?

thanks

NT

Hello MS2005

Just to add a few comments to the above -- I believe that one cannot compare Smoothbeam (SB) to Accutane. When you look at the laser trial pictures in the derm journals, you will see that the patients pictured usually don't have acne bad enough to warrant Accutane. IOW, I've yet to see any kind of direct comparison between SB and Accutane, in a patient that had true grade IV (cystic) acne.

Just who does the actual SB procedure depends on state laws. Some states will allow only the docs to perform laser, some states will let docs and mid-level providers do it, and other states will let the doc decide who can do it (which means that anyone with most of their fingers intact can run the machine).

As previously stated, insurance won't cover SB. In fact, some insurance companies have started to deny any kind of coverage for anything acne related, presumably because they think acne is a cosmetic issue only. At this point I would agree with them not covering SB, as you can decrease bacteria with oral and/or topical antibiotics quite effectively. On the other hand, given the fact that you won't encounter Stevens-Johnson syndrome with SB, I might change my mind in the future, if SB proves itself....

hth,
Phil R.
 
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