Acne is a chronic inflammatory disease of the sweat glands and hair follicles. It affects patients of all ages. It results from multiple factors, but the abnormal degree of keratinization or epidermal cell stickiness is one of the most important factors. This leads to a high degree of clogging of the pores, which, in turn, leads to the sequence of redness, inflammation, infection, pustule, rupture and scarring. This should be viewed as a sequence, and acne may be present at any stage. It may end at any stage or progress from inflammation all the way to unsightly scars. Open or closed comedones (whiteheads and blackheads), papules, pustules, hyperpigmentation, spots, and nodular or cystic lesions can all be present. Hormones and some drugs can stimulate the condition or make it worse.

The goals of treatment are to reduce the degree of stickiness and clumping of the exfoliated, oily epidermal skin cells and to decrease inflammation and bacteria. This is an ongoing process. All treatments work mostly by preventing new acne. The existing blemishes heal on their own. The improvement process takes time, and you must be patient. There are often initial “flare-up” periods when you start a program or new product, and your acne will often get worse before it gets better. This process can be frustrating. You may need to change and modify products or usage several times before the “right combination” is obtained. This is why you need a professional to evaluate, initiate, and regularly follow up your program. This way the least amount of time is wasted and you don’t lose time “experimenting” on this or that product.


Your examination will range from full-on red, raised, inflamed pustules to mild blemishes and occasional breakouts to pigmented areas of former breakouts to no pustules and just irregularity and scars. As you can see, there is a broad spectrum of acne conditions. It is important for us to identify where you are at present, evaluate your history of acne, review your previous treatments, and formulate a plan.

Program Basics and Overview

This is the basic outline for treating acne. It will be modified according to your expectations, history, anatomy, and lifestyle.

To start:

  • Deep-Cleansing Acne Facial. This is mostly to exfoliate the upper skin layers and especially those cells that stick and clog the pores. It is also to remove the plugs and congestion from the pores, and then prepare the skin for better penetration of products. It also smoothes fine lines, tightens the skin, and removes some of the superficial pigmentation.
  • Topical and/or oral antibiotics, according to your condition.
  • Begin the Obagi CLENZIderm System. This is the combination of a topical antibiotic with cleansing and glycolic products to remove the cells that clog pores and lead to acne breakouts. It decreases the inflammation in congested pores and is very effective in clearing your skin.

2 weeks:

  • Second Deep-Cleansing Acne Facial to increase the effects noted above. It allows us to do even deeper extractions of stubborn clogged pores and clear the skin to the next level.
  • Intensify and adjust the CLENZIderm home program, as determined by how you are clearing.

4 weeks:

  • Begin a Microdermabrasion Facial program. This is to allow for even deeper exfoliation and clear any remaining pustules, which should be very few by this point. It is also now time to start the smoothing process to your skin and start working on any pigmented spots left over from the healed pustules.
  • Begin Retin-A and a program to continue exfoliation and prevent sticky skin cells from blocking pores ever again.

8 weeks:

  • Second Microdermabrasion Facial. By now most pustules are gone, and this facial is to provide smoother skin, reduce pigmentation, and improve texture.
  • Review and adjust the Retin-A and Nu-Derm home program, as indicated. Usually it is reduced at this point.
  • Maintenance phase:
  • Continue the Nu-Derm products, but on a much less intense level—just enough to maintain your results
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