ACNE
Acne vulgaris (pimples, zits, whatever) is the most common human skin disease. 80% or more of teenagers and young adults have at least some acne, and acne can persist well into the thirties and forties (especially in women). Fortunately, there are many excellent treatments for acne now that did not exist when your parents (and even your doctors) were teens. So if your folks tell you that nothing can be done to help your acne, don´t believe them!
Acne is a disease of the hair and oil apparatus (pilosebaceous unit) of the skin and has several causes. Hormones (especially testosterone, the "male" hormone that is produced by both men and women) cause oil ( sebum) production. When oil glands get plugged with skin cells (keratin), inflammation and infection occur, and the result is acne.
When acne gets severe, it can cause painful nodules and cysts in the skin and can lead to lifelong pitting and scarring. The key is to start treatment before the damage is done.
Treatment of acne involves targeting the causes: plugging, inflammation and infection. Many different medications are available at the SHS:
Benzoyl peroxide 2.5%, 5% and 10% creams, lotions, washes and gels: Applied once to twice a day, benzoyl peroxide inhibits bacteria and causes a (usually mild) peeling of the face. Some patients are sensitive or even allergic to it, however. Some versions are available over-the-counter (OTC).
Retin-A (tretinion) creams, gels and liquids: Retin-A also unclogs pores by a peeling of the face, and can be very effective against acne. Retin-A must be applied only at night and washed off in the morning, since it sensitizes the skin to the sun. Often a sunscreen (SPF 15 or higher) is advisable during the day. Although some patients can´t tolerate Retin-A either, many show a significant improvement at 4 to 6 weeks, with optimal benefits at 3 months.
Topical antibiotics: Topical erythromycin (Ery-derm and others), and clindamycin (Cleocin-T and others) are dabbed onto acne lesions once or twice a day and fight the local infection. An excellent combination often used here is Retin-A at bed and Cleocin-T or Ery-derm in the morning.
Oral antibiotics: Tetracycline, doxycycline or erythromycin are often used orally for acne. While often effective, they kill bacteria everywhere in the body (not just the skin) and can upset the stomach. Tetracycline can make the birth control pill less effective, as well as cause birth defects. In addition, tetracycline can make some patients sensitive to increased sunburn. However, oral antibiotics are easy to use and inexpensive (here at the SHS), so many patients like them.
Differin (adapalene) gel: Differin gel is similar to Retin A and is alsoaoolied at bedtime. It acts by unclogging pores and gently peeling the face (a keratoltic agent). Precautions similar to Retin A are also advised (sunscreens, etc.).
Oral Contraceptives: Some, but not all, birth control pills improve acne by suppressing ovarian over-secretion of androgenic (male) hormones. If you aren't sure whether your birth control pill will make your acne better or worse, ask your healthcare provider.
Accutane (isotretinion) orally: This magnificent medication is reserved for the most severe, scarring, nodular and cystic acne and can lead to profound improvements. But like the little girl with the curl, when it is bad, it is horrid. Accutane can cause severe birth defects, severe liver inflammation, depression, bone mineral density problems and has led to deaths. It can only be prescribed by board-certified dermatologists on special prescription pads and requires lengthy consent forms and monthly blood tests.
A few final notes about acne: There is little to no evidence that greasy foods or chocolate make acne worse, but certain birth control pills (and other medicines) can. Likewise, some birth control pills can actually make acne better. So, remember that while there is no cure for acne, it can be made better–all you have to do is ask.
CSUB Student Health Services: (661)654-2394 mjh 1992, revised 2006