Acne Treatments Take Care Of Mind, Body

Published by Contra Costa Times

Posted on Sat, Jan. 10, 2004

By Dr. Thomas Paige

Acne can scar the psyche as well as the face. A typical patient might be a 15-year-old named Allison who comes in early in the morning so she won't miss much school: looking down at her hands, her hair styled to cover much of her face, heavy pancake makeup to hide blemishes, a shy, somewhat fearful expression.

After a brief discussion, she might even cry when relating how last year's "peaches and cream" complexion had broken into red and purple eruptions on her forehead, cheeks and chin. After weeks of scrubbing, and many medicines from the drug store, she'd finally persuaded her parents to bring her to the doctor. For most teenagers, reassurance about "inner beauty" is little consolation.

Since acne tends to run in families, her parents had had pimples, but eventually outgrew them. They thought Allison just had to wait. The same teenage hormones that cause such dramatic emotional changes, and painful self-consciousness, also can cause acne. Allison wasn't really interested in my brief lecture that her hormones caused her skin oil glands to produce more oil and in some way cause the pores to plug up with dead skin cells. On the face, this appears as a blackhead or whitehead and is called a comedone. If comedones rupture, an inflammatory pimple results.

She had tried many diets; avoiding fats, chocolate, milk and fruits at different times. But diet usually doesn't play an important role in acne. Luckily, there are many treatments for acne that work:

For girls and women, use lighter makeup that is free of acne-causing ingredients. Water-based cosmetics are generally better than oil-based products.
Wash the face gently twice a day with a benzoyl peroxide soap. Don't try to scrub acne away.
Retin-A (tretinoin), a topical cream, can help by loosening up the plugged pores. This cream can itself redden the face, so it must be used with caution. Initially, the skin may get redder, but after a few weeks, there may be significant improvement.
Acne may need oral and/or topical antibiotics. The topical antibiotics come as an invisible solution applied directly to the acne areas. The oral antibiotics are capsules often taken at lower doses and for longer periods than for other infections. These can be very effective and are sometimes taken for years, until the patient outgrows acne.
And finally, for patients with acne that forms large painful bumps, there is a pill called Accutane. In my experience, this medicine is both safe and very effective. It can be disastrous to a fetus, however, if a woman taking it is or becomes pregnant. Furthermore, there have been news reports associating Accutane with serious depression and even suicide. However, the current scientific data is unclear as to whether this linkage exits.
There is recent data that exposure to a certain type of light may benefit acne. This is still experimental, however, and not available except at certain research centers.

The net effect of my lecture about acne to patients like Allison is that there is hope for their acne and the embarrassment it causes them. Consult your doctor. Don't wait until acne scars both your face and your self-image.

Dr. Paige is chief of dermatology at the Contra Costa Regional Medical Center. He practices at the Martinez, Pittsburg and Richmond Health Centers.