Treatments for acne and its myths

September 23, 1997|By Judy Foreman | Judy Foreman,BOSTON GLOBE

Brian Dube was 14 when severe acne first struck.

"It was pretty bad," says Dube of his initiation into the blotchy hell that virtually all teen-agers experience to some degree just before and during puberty. But a five-month course of the potent drug Accutane worked miracles.

"My face was very, very clear" for years, says Dube, a college student who is working as a mental health counselor.

Then, this year, his acne flared again. For a young man of 24 who prides himself on being "pretty well-dressed," it's distressing, he says, to wind up again with "ugly things on your face."

In his case, the acne came back in late winter. But for many young people, acne flares up in the fall in a paroxysm of perversity -- just when classes, jobs, sports and romances begin anew and the urge to put one's best face forward is strongest.

Dermatologists don't know why this is, but they do have educated guesses -- and some increasingly good ways to treat it.

Some think that exposure to the sun's ultraviolet rays in the summer may make acne better -- an effect that would clearly lessen as the days get shorter.

But several large studies have shown that UV doesn't do much except camouflage blotches, says Dr. Robert Stern, vice chairman of the dermatology department at Beth Israel Deaconess Medical Center. A summer tan, in other words, may simply make red pimples and other signs of acne less noticeable.

Others suspect it's mostly stress -- the body's hormonal response to the onslaught of intellectual, physical and emotional demands that come with new beginnings.

Whatever the trigger -- and specific foods, including chocolate, have not been proven guilty, though a high-fat diet is suspect -- the underlying cause of acne is a combination of hormones, clogged pores and bacteria.

A couple of years before puberty, a hormone made in the adrenal glands called DHEA (dehydroepiandrosterone) begins signaling the sebaceous glands, at the base of hair follicles in the skin, to pump out oil.

DHEA is the same hormone that some people take as a dietary supplement to ward off aging and is tightly enough linked to acne that it's been dubbed the "acne androgen," says Dr. Donald Lookingbill, a dermatologist at the Mayo Clinic branch in Jacksonville, Fla.

Once puberty is in full swing, other androgens, or male hormones made in the ovaries and testicles, further stimulate the glands. Though both males and females get acne, boys often get it worse because they have more androgens.

As the oil glands go into overdrive, the ducts through which the oil travels to the skin surface tend to become clogged with a sticky combination of oil and cells shed from inside the duct, says Dr. Barbara Gilchrest, chairman of the dermatology department at Boston University School of Medicine.

The first sign of trouble is a tiny bump at the surface, a whitehead or "closed comedo," in medical jargon.

If the pore enlarges, the gunk in the duct may oxidize and turn black, creating a blackhead or "open comedo." (Contrary to widespread belief, blackheads are not caused by dirt or lack of good hygiene.)

Bacteria in the follicle may also start gorging on the oil, or sebum, turning it into a fatty acid that causes inflammation, says Dr. Bonnie Mackool, a Massachusetts General Hospital dermatologist.

The result is an all-too-familiar blotch that most people call a zit or a pimple. Luckily, there are lots of ways to banish zits, including washing your face -- no more than a couple of times a day and without harsh scrubbing -- with a non-irritating soap.

You can also minimize the use of "occlusive clothing" -- helmets with chin straps, shoulder pads, baseball caps worn backward with the strap on your forehead and tight Spandex garments.

If you spend all day on the phone, try cleaning the receiver. If you habitually rest your chin on your hand, stop.

You should also go easy on hair pomades, which can trigger acne along the hairline. That goes for makeup, too, some say, although many brands now are "noncomedogenic" -- less likely to cause acne.

"We are taught by department stores to put something on our skin constantly," says Gilchrest, but it's a bad idea. "If you can convince people to stop putting stuff on their face, acne gets better."

Over-the-counter remedies like Oxy-5, Oxy-10 or Clearasil that contain benzoyl peroxide often help by killing bacteria. Stridex pads, which contain salicylic acid, also help.

But steer clear of harsh scrubbers or cleansing grains -- these can actually aggravate acne, dermatologists warn.

And resist the temptation to pop your pimples -- you can make things worse.

If you try this stuff and nothing works, see a dermatologist, who may prescribe topical antibiotics such as erythromycin or clindamycin, or oral antibiotics, usually tetracycline or erythromycin.

Retin-A, or tretinoin, is another effective prescription medication -- it works by keeping follicles from clogging up.

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