First, it is important to understand the cause of cystic acne. The designation of Grade IV acne is given after cysts have formed; these acne lesions are caused by the same factors as less serious acne lesions. There is an over production of sebaceous secretion and wax-like plugging of the hair follicle/ sebaceous duct that traps a mix of bacteria (including P. Acne, S. Aureus, S. Epidermitis, and other surface flora).

This anaerobic environment is favorable for bacteria to multiply and cause the inflammatory process to commence. Bacterial enzymes (predominantly from P. Acne) proceed to break down the triglyceride lipids in sebum into free fatty acids. The body's normal response to this inflammation is to congregate white blood cells to combat the bacteria overgrowth, leading to pustular/ liquid debris. At this point, cysts have not yet formed, but those individuals predisposed to cystic formation have a spreading to lateral and sub dermal areas outside the infected follicle.

In patients with existing cystic acne, Reversion works quite well to prevent new lesions prior to cyst formation. The Reversion Antimicrobial Wash contains Chloroxylenol, which has been proven to kill 99.9% of surface bacteria. It has also been proven to penetrate to the dermal layer if left on the skin for at least one minute. Thus, the Antimicrobial Wash is effective in preventing new cysts from forming; however, if cysts have already formed and developed walled-off spaces, surgical drainage is usually necessary along with systemic antibiotics to heal the bacterial infection and cyst/ sinus tracts.

Instruct your patient that the key things to remember are:

1. As soon as a new lesion begins, start to control its progression by administering acne medication; never pick or squeeze acne lesions or blackheads.
2. Use the Reversion Acne Control System twice daily.
3. Get plenty of rest and drink 8 glasses of water each day.
4. If a particularly inflamed lesion appears, apply a small drop of Reversion Antimicrobial Wash before going to bed and leave in place all night (for one night only).
5. Apply an ice pack for 5 minutes to very inflamed lesions; this will reduce swelling.

Accutane works internally to decrease secretion by the sebaceous glands in the skin, which can cause the skin to be extremely dry. It also causes the face to be very sensitive to topical applications of many skin care products, including the Reversion Antimicrobial Wash and Acne Medication. Because of this, we recommend that your patient stop using Accutane at least 3-4 weeks before using the Reversion Acne Control System.

Some people may experience a mild irritation or sensitivity to either of the products, although these occurrences are well within the normal expected population range for skin sensitivity to anything. An exception to this would be a person who is allergic to aspirin, which is acetyl salicylic acid; patients allergic to aspirin should not use the Acne Medication because it contains salicylic acid (the Theraderm Lactic Acid Exfoliant works well as a substitute exfoliating agent). The Antimicrobial Wash contains Chloroxylenol, which is approved by the Food and Drug Administration for use in surgical scrub soaps as well as for topical use in the conjunctiva of the eye for surgical prep. This is a very mild material to use on the skin itself and should not cause anything more than mild irritation, if that.

It is unusual for Reversion products to make skin itchy. The Acne Medication does contain salicylic acid, which is similar in chemical structure to aspirin.

Suggest that your patient stop using the Acne Medication for 5-7 days to see if the itching disappears. You may also try a spot test by using the Reversion products on a very small (1/2 inch) area of the upper arm for a few days to see if itching occurs there. Be specific to use the Acne Medication only on one arm, and the Antimicrobial Wash only on the other arm. If sensitivity is due to EITHER one, this simple test should tell if so and which product. If no itching occurs with the arm test, then it is very unlikely that there is any sort of allergy to Reversion, and the itching may disappear if the Reversion is used only once a day.

Patients with acne-prone skin should avoid oily moisturizers; after all, part of the acne problem is due to excess oiliness already in the skin. This fact was addressed as the Reversion Acne Control System evolved. There is a solution: the RS-OPC Reparative Gel is not only oil-free, but also contains three carefully balanced components that add three unique benefits to healing skin. The RS-OPC Reparative Gel contains 2.5% oligomeric proanthocyanadin (OPC), one of the most potent antioxidants known. It has 20 times the antioxidant capacity of vitamin C, and 50 times that of vitamin E. In addition, it acts to protect and enable vitamin C in its function of repairing damaged collagen in the skin. The RS-OPC Reparative Gel also contains Aloe vera to soothe injured tissue as it heals, and hyaluronic acid, a powerful humectant that attracts 1000 times its own weight in water to the surface of the skin, making it the perfect moisturizing agent for dry, irritated, or acne-prone skin. To learn more about the RS-OPC Reparative Gel, please see page 42 in this manual.

If the LA peel is done during an acute acne breakout with pustules, your patients should stop using the Reversion system until the entire skin surface is “dry skin,” with no open healing areas. Once the face has completely healed, the patient may resume using Reversion.