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Paging Dr. Frischer - Acne
WRITTEN BY :   Dr. Alan Frischer

What do French fries and chocolate have in common?
They both do not cause acne! Whether you call them pimples, zits, blemishes, or acne, the condition is distressing. Although 85% of our kids encounter acne, grown-ups can also struggle with it into their 30′s and 40′s. So, what does cause acne, and how is it treated?
Let’s start with some classic acne myths. How many of them do you, or did you used to believe?
Myth #1: Acne is caused by dirt; therefore frequent washing will clear it up
Myth #2: Poor nutrition or specific foods cause acne
Myth #3: Popping pimples makes them go away faster
Myth #4: Acne is seen only in teens
Myth #5: Sun exposure helps to clear up acne
Myth #6: Masturbation or sexual activity causes acne
In reality, there are three main factors that contribute to the formation of acne: overproduction of oil (sebum), irregular shedding of dead skin cells resulting in the irritation of hair follicles, and bacteria buildup. Hormones certainly play a role, so it is indeed most common during the teen years. However, adults also get acne: women are susceptible due to hormonal changes of pregnancy, menstrual cycles, changes in birth control pills, and menopause; stress may be a factor; and bacteria, medications, and heredity very likely play a role as well.
Acne typically appears on the face, neck, chest, back, and shoulders, because these areas contain the most oil (sebaceous) glands. Each hair follicle is connected to these glands, which secrete sebum to lubricate the hair and skin. Sebum normally travels up the hair follicle onto the skin’s surface. When the body produces too much sebum and too many dead skin cells, they can build up in the hair follicles and form a soft plug, which can then cause acne. It takes two to three weeks before acne actually becomes apparent on the surface of the skin.
Acne treatments work by reducing oil production, promoting the sloughing of dead skin cells, killing bacteria, reducing inflammation, or by doing all of these. Typically, treatments take four to eight weeks to be effective, and there may actually be a worsening of symptoms before improvement. Treatment for mild acne normally begins with topical creams purchased without a prescription. They are generally mild medications and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid.
For more serious acne, when the over-the-counter treatments have failed, your doctor can prescribe other treatments. Some topical prescription products derived from vitamin A are tretinoin (Avita, Retin-A, Renova), adapalene (Differin), and tazarotene (Tazorac, Avage). These medications promote cell turnover and prevent the plugging of the hair follicles. Also prescribed are topical antibiotic creams, which kill off excess skin bacteria. Oral antibiotics can be effective for moderate to severe acne, by reducing bacteria and fighting inflammation. Unfortunately, antibiotic resistance has increased through the years due to overuse, and consequently, oral antibiotics are now given in shorter courses. Birth control pills, laser and light therapy, and cosmetic skin peels are also used for acne control.
One extremely controversial treatment is Acutance. This prescription product has been used successfully for scarring cystic acne or acne that has not responded to other treatments. However, it has been associated with severe birth defects; dry eyes, mouth, lips, nose and skin; itching; nosebleeds; muscle aches; sun sensitivity; and poor night vision. It can increase levels of triglycerides and cholesterol, and affect liver enzymes as well. Some studies associate use of Accutane with depression and even suicide.
Minor lifestyle changes and simple drug store products will usually have a big impact:
•Wash with a gentle cleanser and washcloth or hands no more than twice a day. Pores don’t get blocked from the top down; rather, acne starts deep within the skin. Facial scrubs, astringents and masks generally aren’t recommended because they, like excessive washing and scrubbing, tend to irritate the skin, which can make skin problems worse.
•Shower after exercise to clean off oil and sweat that can trap dirt and bacteria.
•Remove makeup before bed; it may cause further clogging of the pores.
•Avoid irritants, such as oily or greasy makeup, sunscreen, hairstyling products or concealer. When choosing these items, look for those that are water-based and that do not block pores.
•Keep hair clean and off of the face. Keep hands and other objects off of the face as well. Even telephone receivers, tight clothing, and hats can pose a problem.
•Use acne lotion sold over-the-counter to reduce excess oil and encourage peeling. Look for products that contain benzoyl peroxide or salicylic acid.
•Protect your skin, as sun exposure may worsen acne, and can worsen scarring as well.
•Resist picking or squeezing blemishes, as this may encourage infection or scarring.
•When all else fails, see your personal physician or a dermatologist. Good health and clear skin to you all!
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: June 23, 2011 – Volume 10 – Issue 10



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