Ultraviolet Light Treatment.

If ultraviolet-induced peeling of the skin is of value in acne vulgaris, it is when comedones are profuse and when there are superficial acutely inflamed papules and nodules. In ultraviolet therapy pronounced local effects are desirable. Each exposure should produce marked erythema, which will be followed by a fine dry exfoliation of the epidermis. Before any treatment is given, the patient should be informed of the inevitable erythema and carefully acquainted with its duration and the subsequent peeling. The dose given is governed somewhat by the patient's acquiescence to the concomitant discomforts. At the time of treatment the eyes are shielded with goggles or, better yet, watermoistened pledgets of cotton. Ultraviolet is usually given at a fixed distance such as 30 inches, and the treatment time is gradually increased in successive treatments. Each exposure should be long enough to produce erythema of the skin. X-ray Therapy. Because of the efficacy of oral antibiotics, retinoids, and intralesional triamcinolone acetonide, x-ray treatment of acne is only rarely used. Because of the general disrepute into which x-ray therapy has fallen, x-ray therapy is now given only in extremely severe cases of cystic acne in men and women in their twenties or older in whom all other methods, including oral prednisone or triamcinolone acetonide intramuscularly, and Accutane orally, have failed. The patient should be completely aware of the alleged hazards of xray therapy that are being publicized today. For the technique of x-ray therapy for acne, reference should be made to the seventh edition of this book (p. 259). Scar Removal. After acne vulgaris has cleared, particularly the indurated and cystic types, profuse pitted scarring may be an unfortunate disfigurement. Although there is no method by which all scars may be removed, several means are used to relieve scarring. Derrnabrasion. Also known as skin planing, this is a useful and effective method for removing or improving postacne scars. It is done with rotating motor-driven steel wire brushes or diamond fraises. The eyes are protected with gauze pads during the spraying of the refrigerant. An area of about 13 sq cm is frozen with an aerosol spray of fluorethyl or dichlorotetrafluoroethane such as Frigiderm. Immediately after the freezing, the eye pads and other gauze pads are removed from around the treatment site to avoid entanglement with the high-speed rotating brush. The frozen skin is then removed with long even strokes of the brush. As soon as thawing occurs, the area is refrozen if more dermabrasion is intended at the site. Moderate bleeding is mopped with sponges, and the next area is treated similarly. When the treatment is completed, the bleeding is stopped by pads in about 15 minutes. Nonadherent dressing pads (TeIfa pads) are placed on the wound and then bandaged.