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Understanding and treating acne

Nov 19, 2007 | Staff | Baltimore Sun

Acne - the scourge of proms and first dates - is a skin disease that, while not considered a serious medical condition, can ruin a look, undermine self-confidence, and in severe cases, cause scarring, says Dr. David Strobel, chief of dermatology at St. Agnes Hospital and a clinical instructor at Johns Hopkins Hospital.

And, though acne is most common in teenagers and young adults, people in their 30s, 40s and even 50s still can suffer from it. Overall, nearly 17 million people in the United States have acne, according to the National Institutes of Health.

What is acne?

Acne is a common skin disease that occurs when the hair follicles under your skin get plugged. When this happens, the person affected can get blackheads or whiteheads, inflamed pimples and pustules and deeper lumps or nodules.

It usually occurs on sebaceous areas - or the areas with many oil glands - such as the face, neck, chest, shoulders and upper arms. What causes acne?

The causes are heredity and hormones - in particular, testosterone, which is present in both males and females. Testosterone increases in both males and females during puberty and stimulates the sebaceous glands and causes them to produce oil that plugs the pores. If hormones are part of the acne equation and we all have hormones, why do some people get acne and some do not?

Strictly heredity. Acne is often considered just a fact of teenage life. Can it have serious side effects?

Acne can certainly scar patients' faces, and that can be a lifelong effect. And I think in some cases, people can exhibit social withdrawal and isolation because of acne. They can become despondent and depressed, and it can have an impact on one's relationships with people of the opposite sex as well as co-workers.

When you treat it and clear it up, these patients often bloom, become more socially engaged and happier. What do you tell patients who come to you for acne treatment?

I do tell them most people get it at some time or another. Some get mild forms and others, severe - and it has nothing to do with washing your face.

I tell them there is a lot of good treatment out there. We treat it - not cure it. The cure is to grow up and out of it, though how fast is variable: Some people grow out of it in a year or two, and some take a decade.

The goal is to control inflammation and prevent new blemishes, and it takes at least six weeks to know if the treatment is working. How is acne treated?

We treat acne according to what type you have: the kind with whiteheads and blackheads, with papules or pustules or with cysts or nodules.

Patients in all three groups could benefit from the use of topical vitamin A, acid-like medications. These medications address the plugged oil glands by causing the skin cells to be less sticky so when the oil gland sheds its cells, they don't clump together. So it keeps the pores from getting blocked.

We also can use other topical medications such as benzoyl peroxide or topical antibiotics to reduce the bacteria count in the affected areas, which among other things can reduce inflammation.

And we can use oral antibiotics when the patient has more inflammatory, pustular or nodular acne. What about treating acne with birth control pills, does that work?

In women who may have a significant hormonal cause for acne, we sometimes do use birth control pills to treat the disease.

Any other treatments?

The ultimate treatment, particularly for nodular and cystic acne is Accutane, a derivative of vitamin A. This form of vitamin A really improves the oil glands so that they do not get plugged up, and it is an anti-inflammatory. It is the only medication that can cure acne, but it is only indicated for nodular cystic acne.

It is a 20-week course of treatment with strict guidelines that have to be followed. Why such strict guidelines?

The treatment is very controversial because of its side effects. It can cause serious birth defects if women get pregnant when they are on the drug - or for one month after they have stopped taking it. (The birth defects can include multiple skeleton abnormalities, enlarged heads and low-set ears.)

The federal requirement is that any woman taking the drug must be on two kinds of contraceptives, sign what's called the 'I Pledge,' which says that they are aware of the birth defects and pledge to abide by the guidelines of the program. ...

Having said all this, I would like to say that as a doctor I am a believer in the drug, but it should be respected.

Do you have any advice about preventing acne for those who wear makeup?

We do encourage women to wear as little cosmetics as possible and to use products that are noncomedogenic, or oil-fee and water-based.

By and large, the cosmetic industry has realized that most, if not all, women suffer from acne so they pretty much make all their products oil-free.

Stage productions - which often used oil-based products - are where we run into trouble.

Do you have any other skin-care advice?

Protect the skin from sun by using an SPF 30 full-spectrum sun block.

What about chocolate?

Acne is not caused by any diet. However, I sometimes hear patients say: 'If I take this food it seems to get worse.' Studies have shown that food isn't the cause, but if a food seems to make it worse, then I say: 'Avoid it.'

Are there any other acne-related myths you can dispel for us?

Acne isn't caused by not washing your face. In fact, too much washing can make it worse by irritating the skin.

And stress doesn't cause acne, but can be an aggravating factor. I tell my patients to use common sense: If you are stressed out and not eating right and burning the candle at both ends, it is going to be tougher for the medications to work. So I am a big believer in a healthy lifestyle.