Oct. 25, 2000 -- Very few things can dampen the teen years the way that acne can, but new treatments may reduce the physical and emotional scars that teen acne often causes, according to experts speaking recently at a conference held by the American Academy of Dermatology (AAD).
The most common skin disorder in any age group, acne -- whether it occurs on the face, back, chest, or shoulder -- affects 85% of all teens, or more than 20 million teens, according to the AAD. And in about 30% of these individuals, the acne persists through adulthood. An AAD survey found that acne can be especially distressing for teens, causing both emotional and physical scars.
"It is important for teen-agers and their parents to realize that both acne and acne scarring are treatable medical conditions," Steven Mandy, MD, clinical professor of dermatology at the University of Miami in Florida, said at the AAD-sponsored meeting in New York. "Early and ongoing therapy may reduce, and even prevent, the physical and emotional toll of this common skin condition."
While there is still no cure for acne, there are a variety of effective treatments that can control the sequence of events that cause acne, he says. Acne occurs when hair follicles containing sebaceous glands trap the oily substance they produce (sebum). It can be caused by changes in hormone levels and certain environmental or genetic factors, he says, adding that "stress can influence acne but it is not a sole cause."
But despite some common misperceptions, diet has no effect on acne and neither does dirty skin. "Acne has nothing to do with dirt," Mandy says. And "sunlight does not improve acne."
Appropriate treatment starts with an evaluation by a dermatologist, he adds. "It's always wise to see a doctor if you have enough acne to be concerned so he or she can give you a proper assessment of your skin," Mandy says. "When it comes to home care, there are a lot of products out there and what is good for the goose is not good for the gander."
After doing an evaluation, the dermatologist can advise on what type of soap or drying lotion is best for your skin type and help you make informed decisions on appropriate water-based and oil-free makeup and concealer.
These days, a dermatologist's arsenal of effective acne treatments includes topical creams such as tretinoin, adapelene, azelic acid, and tazarotene to help unclog oil ducts. Antibacterial agents, including benzoyl peroxide, alone or in combination with antibiotics such as erythromycin or clindamycin, can be added to topical creams. For girls, certain low-dose birth control pills also may help clear up skin. For severe, disfiguring and cystic acne, there is a drug called Accutane (isotretinoin).
While extremely effective, this controversial drug is not without side effects. The FDA currently is considering placing this drug on a list of drugs that can only be obtained by registered doctors and patients.
Side effects of the drug include birth defects so women taking it must take precautions to prevent pregnancy. In addition, other possible side effects to Accutane may include depression and suicide, hair loss, muscle aches and pains, and vision loss. However, it does work, Mandy says. Within 20 weeks, Accutane completely clears up acne in 80% of people taking it, and in most cases, it is gone for good, he says.
Rep. Bart Stupak (D-Mich.) recently urged that Accutane's maker, Roche, should pay for independent studies of the medication's possible psychiatric side effects and called for additional FDA funds to study the drug. In May of this year, the congressman's son, B.J., committed suicide while on Accutane.
But "as dermatologists, we strongly believe that limiting access to Accutane is a disservice to patients," says Richard K. Scher, MD, president of the AAD and a professor of clinical dermatology at Columbia University and an attending dermatologist at Presbyterian Hospital in New York.
"Depression is a common problem in adolescents with or without acne. The links between suicide or depression and Accutane are unclear," Scher says. "To our knowledge, studies addressing the issue are yet to be completed and/or made available in medical literature."
Still, no matter what medication is chosen, acne treatment needs to begin as early as possible because when treatment begins too late, scarring can occur. The good news is that advances in dermatologic surgery are helping to make acne scars a thing of the past, Mandy says.
For example, certain lasers can help resculpt scars and elevate the scars that give skin a crater-type appearance. And dermatologists can now inject scars to elevate them by pumping them up with filling agents.
For more information on acne, visit the AAD web site at www.skincarephysicians.com/acnenet/index.html.