Acne Has The Potential To Be Much More Than A Scourge Of  The Skin

By Nancy K. Crevier

It afflicts eight out of ten preteens and teenagers and is often viewed lightly by adults as a “rite of passage,” according to the Centers for Disease Control and Prevention. But acne is a rite that can result in permanent scarring to both the physique and the psyche.

Acne vulgaris is the result of oil and dead skin cells plugging pores, creating blackheads, blemishes, whiteheads, and pimples. If the pore is infected by germs, red, irritated swellings filled with pus result.

Mild acne, with just a few unsightly spots appearing occasionally, moderate acne, in which the acne afflicts larger areas but responds to over-the-counter solutions, or severe acne, when hundreds of pimples and cysts cover the face and other parts of the body, are the plight of the young and sometimes the not-so-young, and can involve years of social embarrassment, pain, and expensive treatment.

Hormonal changes make the skin oilier in adolescence, setting up an environment that is conducive to infection. Oily skin products that clog pores worsen the condition, and teens whose parents suffered from acne in their youth are more apt to get some form of acne.

Acne sufferers are willing to try nearly any new product that comes on the market, in hopes of finding a remedy that will clear skin once and for all. Some of the products are helpful, some are harmless, and a few may be downright dangerous. An obscure Hispanic folk treatment, capsules of dried rattlesnake meat powder, not only is questionable as to its efficacy against acne, but has been linked to cases of salmonella, according to a Reuters news agency report last spring. Yet for a person plagued by unrelenting skin eruptions, any product offering a cure appears worth exploring.

Those seeking natural alternatives to skin treatment are often steered toward tea tree oil, an antibacterial and antifungal agent derived from the leaves of the Australian Melaleuca Alterfolia tree. At natural-acne-treatment.com, however, it is noted that while tea tree oil may lessen acne symptoms, it is not a cure and that many people experience skin sensitivity when using it.

New products are constantly coming onto the market, said Dr Alicia Zalka of Dermatology Associates of Western Connecticut in Danbury, and natural products like tea tree oil have received press as an aid in combating the annoying and painful condition. “I believe that tea tree oil is considered to be a ‘natural’ antibiotic, but it is not really incorporated into any treatment of which I am aware. Its success rate is not documented, but I think it is safe to say that it is a fairly harmless product to try. Our experience is that a lot of these new products do not work successfully as more than spot treatments,” said Dr Zalka.

Phyto dynamic therapy is one new approach Dr Zalka has seen used with some measure of success. “A gel is applied by the doctor to the pimple and left on there for 20 minutes to one hour. It makes the skin sensitive to sun exposure. Then a laser is applied, targeting the sebaceous gland where acne begins. It shrinks the oil and sebaceous gland,” Dr Zalka explained. The drawbacks are the cost, which most insurance will not cover, and sun sensitivity that results. “Patients have to wear a load of sunscreen when they leave the office,” she said.

If a star like Jessica Simpson finds Proactiv Solution, one of several new three-step products available to consumers without a prescription and designed to heal blemishes and prevent new breakouts, worth going to bat for, does that mean that acne sufferers will soon be sporting skin as soft and smooth as the popular pop star? According to literature for Proactiv Solution, it can bring breakouts under control in 60 days.

Unfortunately, said Dr William Notaro, chief of the dermatology department at Danbury Hospital, only those with mild acne are likely to have a positive response to products like Proactiv, and those are also the people most likely to see an improvement with over-the-counter treatments in a two-month period. “[Proactiv-like treatments] are not quite the miracle they would like you to believe,” Dr Notaro said.

Time For Help

When acne does not respond within six to eight weeks to over-the-counter treatment, it is time to visit the dermatologist. Dr Notaro prefers a combination of Benzyl peroxide and a topical antibiotic and/or oral antibiotics to begin treatment. “Most dermatologists will start treatment with this sort of a combination,” he said. Individual response varies, however, so if within two months the patient is not seeing improvement, the patient will be reassessed. “It may be that a different antibiotic works better. Everyone is a little different,” said Dr Notaro.

A topical retinoid drug such as Differin or Tazorac cream often works for many of his patients, he said. “These vitamin A medications, the retinoids, help unclog the hair follicles where acne starts.” If the patient exhibits a lot of bumps and pustules, Dr Notaro may recommend an oral antibiotic such as tetracycline or minocycline to be used in combination with the topical ointment.

For severe acne, also referred to as cystic acne, isutretinoin, known by the market name Accutane, is still the best treatment, despite the drawbacks, said Dr Notaro. “The big problem with isutretinoin is that if a female takes it while pregnant, it will result in birth defects.”

For this reason, female isutretinoin patients must use two forms of birth control during treatment. Female isutretinoin users must also be tested regularly for liver levels, blood sugar levels, and triglycerides. Male patients are also required to have blood tests prior to going on the drug and one month into therapy, he said.

“But if someone has severe cystic acne, it is worth the risk. Acne can be pretty disfiguring,” said Dr Notaro.

Preventative care is essential when it comes to acne, according to Dr Notaro. “Try to get it under control as soon as possible.” And leave the poking and prodding to a trained dermatologist. “The trauma from manipulating a pimple can be worse than the actual acne,” he added.

Dr Zalka also prefers tried and true medications and treatments for acne, such as retinoid products that aid in skin cell turnover and prevent pore clogging; exfoliating products; topical antibiotics and antibacterials like Frevoxyl, Triaz, or Benzclin; oral antibiotics; or in some cases, hormone therapy like oral contraceptives or Spironolactone, a hormone compound capable of inhibiting the biologic effects of male sex hormones.

“They have a proven track record and are covered by insurance,” said Dr Zalka.

Lifelong Implication?

Acne is not something that is ever outgrown. “That’s a myth, nor is there any one food that causes acne,” said Dr Zalka. Individuals may find that they react to certain foods, but it does not mean that everyone with acne needs to adhere to the old taboos on chocolate, dairy products, fried foods, or sugary treats and drinks. Nor does weather directly cause acne, although Dr Zalka noted that the heat and sweat associated with summer months may make acne a bigger problem for some patients.

In August, Reuters News Agency issued a report that suggested acne sufferers could benefit by avoiding high glycemic load foods. High glycemic load foods, such as low-fiber carbohydrates, cause an increase in blood glucose, or sugar. The results of a new study, reported Reuters, showed that men with acne on a 12-week low glycemic load diet had a “significant reduction in pimples, whiteheads and other lesions compared with their peers who stuck to a conventional diet.”

A low glycemic load diet includes foods that are high in fiber and are complex carbohydrates. These foods cause a more gradual increase in glucose.

“I have heard by anecdote that a low glycemic diet can be successful,” said Dr Zalka. “It is possible that because of some people’s metabolism that a low glycemic diet might affect the acne condition.”

What does have a negative effect on acne, though, is stress, said Dr Zalka. That is why it is not uncommon for flare-ups to occur prior to big tests, social events, or situations that are disturbing. Spot treatment is available to knock out untimely skin eruptions, and can offer relief in just a couple of days.

Acne is very treatable, said Dr Zalka, but it may take a few attempts to find the treatment that works best for an individual. “Try to treat acne before any scarring occurs. I usually ask a patient to return in four to six weeks for reevaluation,” Dr Zalka said. “If one treatment isn’t working, we can try another.”