My teen-age daughter has acne that has gotten worse despite various diets and the vigorous use of different soaps.
She is obviously troubled by the condition but has been reluctant to see a doctor.
Are there useful treatments that would make it worthwhile for her to go to a doctor?
Acne is the most common skin problem, occurring in about 80 percent of people at some time. Although most frequent between ages 11 and 30, acne can persist for many years. It should not be taken lightly because acne can cause permanent scarring and emotional problems.
Acne occurs when the follicles of sebaceous glands, widespread on the face, chest and back, get plugged up with sebum, the oily substance secreted by sebaceous glands, and sloughed-off cells from the sebaceous glands. The treatment options are aimed at correcting these two factors and preventing the overgrowth of bacteria within these plugs of sebum and cells.
Dietary restrictions do not reduce the production of sebum, and studies have shown they are of no benefit in the treatment of acne.
Washing with soaps and detergents can remove sebum from the skin but does not stop the overproduction of sebum that causes the obstructions. Aggressive scrubbing of the skin can even make the acne worse.
To slow the sloughing of skin cells, doctors suggest topical use of tretinoin, adapalene and salicylic acid. Tretinoin and adapalene are more effective than salicylic acid; adapalene is less irritating to the skin than tretinoin. It may take several months for maximal benefit, and the applications have to be continued until there are no new skin lesions.
The overgrowth of a common type of skin bacterium, P. acnes, can cause inflammation within the acne lesions. Growth of this organism can be controlled either by topical applications of various antibiotics, by benzoyl peroxide or by a combination of benzoyl peroxide and the antibiotic erythromycin.
A number of antibiotics are effective when taken by mouth. Because each can produce different side effects, the choice is partly dictated by which one is best tolerated. Antibiotics must generally be used for a prolonged period or in repeated courses.
Because sebum production is stimulated by male hormones, severe, intractable acne can be eased in women with estrogen or spironolactone.
Estrogen is taken in combination with a progestin as with oral contraceptives. These two measures to reduce sebum production take two to four months before improvement occurs, and they may have to be continued for a long time.
Both men and women also can reduce sebum production with oral isotretinoin, a vitamin A derivative.
More than half of the people who can tolerate high doses of this drug have a permanent cure after four to six months.
Unfortunately, the use of isotretinoin is limited by the high frequency of troublesome side effects.
Most dangerous is the development of serious defects in the fetus if isotretinoin is taken during the early stages of pregnancy. Consequently, women must be on birth control pills while taking zTC the drug and for at least a month after it is stopped.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.
Pub Date: 6/10/97