December 15, 2006

The Best Wealth is Your Health

Acne – treatment and control

By Dr. Meena Sathappan
Special to the Times

Acne affects a large percentage of humans at some stage in life. Almost all teenagers get acne at one time or another. The term acne comes from a Greek term that means “skin eruption.”

Though there are many forms of Acne, the two most common are Acne vulgaris and Acne rosacea.

Acne vulgaris is most commonly experienced around puberty, typically of the face and shoulders/chest. Acne rosacea is a red rash predominantly on the face

What causes acne?
You haven’t done anything to cause your acne. As such, it’s not your fault if you have it. Pimples are caused when oil ducts in the skin get plugged up and then burst, causing redness and swelling. Although there are many myths about acne, the following are three main factors that cause it.

Hormones: When you begin puberty, certain hormones, called androgens, increase in both males and females. These hormones trigger oil ducts on the face, back and upper chest to begin producing oil. This can cause acne in some people.

Heredity: If other members of your family had acne as teenagers, there may be a chance that you have inherited a tendency toward getting acne as well.

Plugged oil ducts: If you are prone to acne, the cells that line the oil ducts in your skin tend to get larger and produce more oil, and the ducts get plugged. This traps the oil and leads to the formation of blackheads or whiteheads. The plugged ducts allow germs in the skin to multiply and produce chemicals that cause redness and swelling. This is why simple blackheads and whiteheads may turn red and bumpy and turn in to the pimples of acne.

While there isn’t much you can do about heredity, there is a lot you can do to keep your oil ducts from getting plugged.

What makes acne worse?
- Pinching (or “popping”) pimples, which forces oil from the ducts into the surrounding normal skin, causing redness and swelling.

- Harsh scrubbing, which irritates the skin

- Irritation caused by things that rub on the skin, including headbands, hats, hair, and chin straps

- Certain cosmetics (makeup), such as creams and oily hair products, which can block oil ducts and aggravate acne.

- Some medications

- For young women, changes in hormone levels brought on by menstrual periods

- Emotional stress and nervous tension

How can acne be treated?
It’s important to know that there is no true cure for acne. If untreated, it can last for many years, though it usually goes away as you get older. The following treatments, however, generally can keep acne under control.

Topical use of benzoyl peroxide lotion or gel
Benzoyl peroxide helps kill skin bacteria, unplug the oil ducts, and heal acne pimples. It is the most effective acne treatment one can get without doctor’s prescription. Many brands are available in different levels of strength (2.5 percent, 5 percent or 10 percent).

Start slowly with a 2.5 percent or 5 percent lotion or gel once a day. After a week, increase to twice a day (morning and night) if your skin isn’t too red or isn’t peeling.

Apply a thin film to the entire area where pimples may occur. Don’t just dab it on current blemishes. Avoid the delicate skin around the eyes, mouth, and corner of the nose. If your acne isn’t better after 4 to 6 weeks, you may increase to a 10 percent strength lotion or gel. Start with one application each day and increase to two daily applications if your skin tolerates it.

2. Stronger medications prescribed by your doctor
If you don’t see results, consult your pediatrician. Your doctor can prescribe stronger treatments, if needed, and will teach you how to use them properly. Three kinds of medications may be recommended:

Tretinoin (Retin-A) cream or gel helps unplug oil ducts but must be used exactly as directed. Be aware that exposure to the sun or tanning parlors can cause increased redness in some people who are using the medication
Topical antibiotic solutions may be used in addition to other medications for a type of acne called pustular acne.

Oral antibiotic pills may be used in addition to creams, lotions, or gels if your acne doesn’t respond to topical treatments alone.

3. Use of Accutane
Isotretinonin (Accutane) is a very strong chemical taken in pill form. It is used only for severe cystic acne that hasn’t responded to any other treatment. Accutane must never be taken just before or during pregnancy. There is a danger of severe or even fatal deformities to unborn babies whose mothers have taken Accutane while pregnant or who become pregnant soon after taking Accutane. Patients who take Accutane must be carefully supervised by a doctor knowledgeable about its usage, such as a pediatric dermatologist or other experts on treating acne. Your pediatrician may require a negative pregnancy test and a signed consent form before prescribing Accutane to females.

Important things to remember
- Be patient. It takes 3 to 6 weeks to see any improvement. Give each treatment enough time to work.

- Be faithful. Follow your program every day. Don’t stop and start each time your skin changes. Remember sometimes your skin may appear to worsen early in the program before you begin to see improvement.

- Follow directions. Not using the treatment as directed is the most common reason the treatment fails.

- Don’t use medication prescribed for someone else. This holds true for all medications, especially Accutane. Doctors prescribe medication specifically for particular patients. What’s good for a friend may be harmful for you. Never take Accutane that’s prescribed for another person.

- Don’t overdo it. Too much scrubbing makes skin worse. Too much benzoyl peroxide or Retin-A cream makes your face red and scaly. Too much oral antibiotic may cause side effects.

Finally, many people don’t understand acne and may say hurtful things about it. Although acne may bother you, keep in mind it’s only temporary. With present-day treatment, it usually can be controlled.

Additional information can be found at:

- AcneNet, is a comprehensive online information resource from the American Academy of Dermatology: http://www.skincarephysicians.com/acnenet/

- Information on acne, medications and treatment of scars: www.acne.org

Source: American Academy of Pediatrics

Dr. Meena Sathappan is a board-certified Pediatrician who lives and practices in Evergreen. She is available for questions and consultation at Aasha Pediatrics, 2060 Aborn Road, # 230, San Jose, CA 95121 (corner of Aborn Road and Capitol Expressway). You can call her at 408-274-9099, or e-mail her at msathappan@gmail.com . Website: www.aashapediatrics.com