She's tried almost every drug on the market, from Retin-A to Cleocin T to tetracycline, not to mention all the drugstore lotions and potions she's lathered her skin with. But nothing can take back the feelings of unattractiveness and self-doubt, the devastating days when merely leaving the house was difficult.
Like Specter, many women are battling acne into their adult years -- and feeling frustrated about it. And increasingly, many of them are trying a new approach, one that goes beyond the traditional treatments such as retinoids, benzoyl peroxides, and antibiotics: They are using the birth control pill to control acne.
For Specter, hormone manipulation (which is how the pill works) became an option several years ago, when she got involved in a serious relationship and wanted both birth control and a new acne treatment. After talking with her doctor, she decided to start taking Ortho Tri-Cyclen, a birth control pill that's shown some success in treating adult acne. Ortho Tri-Cyclen reduces androgens (male hormones) and regulates a woman's hormones so their swings aren't as severe and don't throw a woman's body -- and complexion -- into flux. While all women have some level of androgens, an excessive amount can lead to acne.
Women and Acne: The Painful Truth
The number of women (and men) who struggle with acne well into their 20s and 30s is huge. In fact, a study published in the October 1999 issue of the Journal of the American Academy of Dermatologyfound that of 749 adults between the ages of 25 and 58, 54% of women and 40% of men suffered from some form of acne. What's more, the prevalence of adult acne in both sexes did not decrease substantially until after the age of 44.
That acne is a teenager's disease is just one of the misconceptions associated with the condition. Another is that dirt and oil on the skin cause acne.
Acne, in fact, is caused not by dirt or oil, but by bacteria called P. acnes that live on everyone's skin. During puberty, the body produces higher levels of androgens, which can overstimulate the skin's oil-producing (sebaceous) glands, resulting in a greater amount of the oily substance called sebum. The more sebum, the more likely it is that a hair follicle will become clogged, resulting in follicular plugs called comedones. These clogged follicles allow P. acnes to proliferate. Some people are hypersensitive to P. acnes, says Guy Webster, MD, PhD, vice chairman of the department of dermatology at Jefferson Medical College in Philadelphia. These people have excessive immune responses to the bacteria -- similar to an allergic reaction -- and this results in acne.
But hormones, too, can be the cause. According to Debra Jaliman, MD, clinical instructor of dermatology at Mount Sinai School of Medicine in New York City, some women are genetically prone to having more drastic hormone swings, higher levels of androgens, and oil glands that are more sensitive to hormones. "When hormone levels stay stable, it's easier on the skin. When they fluctuate a lot, that's when the skin breaks out." Hence, those pesky pre-period breakouts with which women are so familiar.
Studying the Pill
That's another reason some scientists believe the birth control pill and other hormone-controlling drugs can treat acne. The only birth control pill studied for this purpose is Ortho Tri-Cyclen, but according to Jaliman, any formulation that contains a low amount of androgen can be used to treat acne.
In a study published in the November 1997 issue of the Journal of the American Academy of Dermatology, researchers looked at the effectiveness of Ortho Tri-Cyclen in treating acne. Evaluating 247 women, scientists found that 93.7% of the Pill-taking group showed an improvement, while only 65.4% of the placebo group had such skin-clearing results.
Still, those results, while they sound promising, can be deceiving, says Jaliman. "Improvement does not mean total clearing. To a patient, if they're improved but not clear, they're still not happy," says Jaliman, who, in her practice, has seen mixed results with the Pill.
For Specter, the Pill did help, but not permanently. In her first year of taking Ortho Tri-Cyclen, she saw the most dramatic improvement. (She was also using two topical medications: Retin-A and Cleocin T.) She didn't become totally blemish-free, but there was noticeably less acne overall. After that initial year, however, her acne worsened, and she didn't like some of the side effects she experienced while on the Pill, especially the weight gain. (Other potentially serious side effects of the Pill include blood clots, heart attack, stroke, hypertension, and diabetes. These risks are higher in women who smoke and increase as women age.)
So when she broke up with her boyfriend, Specter decided to stop taking Ortho Tri-Cyclen. Now she's using doxycycline, an oral antibiotic, and Avita, a retinoid, and is pleased with how her skin looks. "I've struggled for a long time with my acne," says Specter. "When it comes to my self-esteem, I just feel so much prettier with a clear face. I mean, who doesn't?"