From occasional breakouts in the teenage years to chronic, ongoing battles
that last clear into adulthood, acne is one of the most common -- if not the
most frustrating -- of all skin conditions.
And while there have always been a variety of treatment options available,
more recently some have been a cause for concern.
Indeed, the popular treatment Accutane was always linked to an increased
risk of birth defects. And it has also received media attention when
researchers began debating whether it might also increase the risk of suicide
in young users.
Long-term oral antibiotic treatments -- once a mainstay of acne care -- also
hit the headlines, implicated in everything from encouraging drug resistance to
escalating the risk of breast cancer to increasing respiratory infections in
Topicals had their share of problems, as patients continued to report that
otherwise effective treatments like Retin A (retinoic acid) were causing skin
inflammation, in many instances as bad or worse than the acne itself. And while
certain oral contraceptives helped many women clear their skin, some became
concerned about side effects, including an increased risk of blood clots,
particularly in smokers.
"The treatments that we had, worked. And most worked well. But many patients
began looking for options that were either safer or more convenient to use,"
says David Goldberg, MD, director of Skin and Laser Surgery Specialists of New
York and New Jersey. He is also director of the Laser Research and Mohs Surgery
Center at The Mount Sinai School of Medicine in New York City.
Fortunately, some new options have come on board. But are they any better --
or any safer -- than what we had in the past? WebMD asked experts to help us
What Causes Acne
According to the American Academy of Dermatology, acne develops when
hormonal shifts (like the kind that occur during puberty, and in women, before
a menstrual cycle and sometimes prior to menopause) cause an overproduction of
oil and cells inside a skin follicle. Together, they form a kind of biological
traffic jam that plugs the opening of the pore and causes the follicle beneath
This allows for the overgrowth of bacteria found normally on skin --
Propionibacterium acnes (P. acnes) -- producing irritating
chemical substances, which further fuel the inflammation. The end result is
"It can be characterized by anything from whiteheads and blackheads, to tiny
hard pimples you barely see, to pus-filled nodules, even fluid-filled cysts
with roots deep in the skin," says Sumayah Jamal, MD, PhD, an assistant
professor of dermatology and microbiology at the NYU Medical Center in New York
'Gold Standard' vs. New Treatments
For decades, doctors have said the "gold standard" for treating mild to
moderate acne has been a combination of a deep pore cleanser like benzoyl
peroxide (it attacks excess oil) and a topical antibiotic or sulphur drug to
combat the bacteria. For some patients, treatment also included the topical
prescription medication Retin A to help speed clearing. And it's a combination
that is still in use today.