You may already know one fact about acne: It doesn’t always go away when you get older. Those unsightly, confidence-sapping breakouts can last–or even start–well past the age of consent. But there have been medical advances in treating even the most severe and persistent forms.
Accutane (isotretinoin) has proved 90 percent effective in clearing up cystic acne–the most disfiguring form, which affects about 400,000 U.S. adults and may not respond to any other treatments, including antibiotics and retinoic acid (Retin-A).
“In many cases, there’s no alternative [to Accutane],” says Dr. Robert Stern, a dermatologist at Harvard Medical School. “For some, it really substantially improves their appearance, self-image, and quality of life.”
But the drug, a synthetic derivative of vitamin A that is taken orally, can cause severe birth defects if women take it while pregnant. For that reason, the American Academy of Dermatology recommends that doctors have female patients sign consent forms explaining the dangers and that patients take pregnancy tests before and during therapy.
There’s less concern about using Retin-A, in the news because it combats wrinkles as well as acne. Because Retin-A is applied to the skin, the body absorbs “an almost undetectable amount,” says Stern.
The medical news about acne scars is less controversial but equally dramatic. Collagen injections, an office procedure, can plump up soft, shallow scars, with “touch-ups” recommended at intervals of six months to two years. Treatment costs from $200 to $500, and patients must be tested to determine if they are allergic to collagen.
Dermatologists are using lasers to remove raised acne scars (as well as birthmarks and injury scars). The treatments work even on scars that have been around for a while, says Dr. Philip Bailin, dermatology chairman at the Cleveland Clinic, and healing appears to be permanent. Often, multiple lesions can be treated in one office visit, under a local anesthetic.
Doctors are watching to see if this technique is an improvement over dermabrasion (surgical skin-planning). It may also replace chemical peeling, which is difficult to control, and punch grafts, done with a “cookie-cutter” instrument that replaces the scar with new skin.
Accutane, collagen, and lasers are usually reserved for the most serious cases of acne. For the most part, treatment of pimples and comedones (whiteheads and blackheads) is the same for adults as for teenagers: medications to keep them under control and proper hygiene to prevent them.
Retin-A, for example, peels both the skin’s surface and the pore linings, banishing the buildup of oil and dead skin cells that clogs pores and causes breakouts. But it’s a potent drug and should be used with caution.
Benzoyl peroxide creams, sold without prescription, attack acne much as Retin-A does, with few side effects other than drying, and in addition they knock out bacteria within the clogged pores. For persistent case, doctors often prescribe antibiotic lotions tetracycline or erythromycin). Oral antibiotics are prescribed for very inflamed acne.
The location of breakouts can be a clue to their cause. Bumps on forehead, nose, and chin point to hormones (male and female), while cheekbones dotted with tiny pimples can mean that makeup or grooming products are at fault. You should switch to oil-free or medicated soaps, shampoos, and cosmetics to avoid triggering acne; and avoid products containing alcohol and lanolin, which may cause rashes and plug pores.
Red spots and streaks on the face (rosacea) occur when tiny blood vessels under the skin become enlarged. Sometimes cysts appear and the nose reddens. The cause of this type of acne is unknown, but alcohol and spicy foods are suspected. Treatment is almost always with antibiotics, although a topical gel was recently approved by the Food and Drug Administration.
One way to avoid acne is to reduce stress.
“Under stress, many people literally give themselves acne,” says Dr. Peter Pochi, professor of dermatology at Boston University School of Medicine. The skin is a sensitive transmitter of feelings, and emotional changes–including becoming tense or upset–will produce changes in the body’s hormones, and thus in the skin, no matter what ointment or cream you use.
To ease the strain on your skin, you can reduce stress through exercise and relaxation techniques; if you need help, videotapes and cassettes are available.
Pamper your skin, too, by showering after working out, and drying thoroughly. Follow a sensible diet and avoid those foods thought to cause acne, including lobster (for the iodides) and such hormone-rich meats as liver and kidneys. Outdoors, use sun blockers that contain no oils or lubricants.