FACE TO FACE WITH ACNE / or OUT: DAMNED SPOTS!!: Forget miracle cures.  If you have acne, get the facts and take affirmative action.

By Anna Magee

When it comes to spots, everyone’s got an opinion:  “You’ll grow out of it”, “Stop eating chocolates and your zits will go away”, “Careful not to catch his/her acne”. Truth is though, if you have acne and it really worries you, there is help at hand.  And it doesn’t involve giving up chocolate!

What is Acne?

In med-speak, acne is any pimple or blemish on the skin and everyone has the potential for it. The difference between mild, moderate and severe acne is really how you feel about your spots and how they respond to various treatments.

Causes

When we’re young, our body’s oil or sebaceous glands are very small, but during puberty more male sex hormones, known as androgens are produced by men and women - a process which often continues well past puberty’s expiry date.  These androgens lead the oil glands to enlarge, produce more oil and become blocked by a build up of skin cells that get stuck under the surface.  The result - the formation of blackheads, whiteheads, pimples and even cysts, often filled with pus on the surface of the skin.  Pus is what happens when white blood cells are summonsed to the area to fight infection.  Among the causes of acne, Consultant Dermatologist at Dublin’s Beaumont Clinic Dr. Gillian Murphy says that (perhaps unfortunately) the strongest is genetics.  If one or both of your parents have crossed swords with acne, it could be that you will too.  Other factors that might exacerbate spots include stress; after all, like any medical condition, acne will worsen under stressful conditions.  Here a B-Complex supplement can help.  Also, regular skin contact with industrial oils and greases (used in cars and machinery) can bring on a flare-up of blemishes.  Take care to gently and regularly wash the skin if you’re exposed to these in your workplace.

Not kid’s stuff

Although it often begins at puberty, acne shouldn’t be dismissed as merely a teenager’s problem as it often continues to or even begins later in life and can persist into old age.  (So careful when taunting your kid brother with Spotty Herbert gags.  You might just wake up one fine morning, twenty-something and a veritable Acker-Head-Annie!)  In fact, according to Alison Dudley, chief executive officer of the 6000 member Acne Support Group, the average age of subscribers is 26! Dr. Murphy believes the longer acne is left untreated, the higher the risk of scarring. So if you think you have a problem, throw out the myths and take control.

The Myths

You’ll Grow Out Of It - Perhaps, but not necessarily.  In fact, 20% - 50% of women seeking treatment are in their 20s and many have persistent acne into their 30s and 40s.  Even if you do grow out of your acne, it is still possible that it can leave lasting and permanent physical and psychological scars which you’ll be with for life.  The answer?  If your acne worries you, seek help.

Greasy, fatty foods, chocolate and junk give you acne - While a healthy diet is important to the general well-being of your whole body (and always reflected in the skin) there is no evidence suggesting that anything we eat - albeit a chocolate or a carrot - is responsible for pimples.

Acne is caused by dirt - Wrong.  The black in a blackhead is often mistaken for dirt, but is really just pigment in the skin cells blocked under the surface.  This myth has other dangers too, namely causing people to over-wash and over-scrub their skin, to get rid of surface oils.  This can actually make acne worse and sometimes lead to scarring.

The sun dries out your zits - It was once thought that UV light could benefit pimples and people still continue to believe it.  However, a tan can only temporarily mask acne.  More importantly, it can age the skin and lead to skin cancer.

Acne is catchy - Wrong again.  Acne cannot be spread or caught from one person to the next.

Action On Acne

Step 1:

Your chemist should be your first port of call. You may only need topical over-the-counter treatments - a mild facial cleanser like Neutrogena, Dove or Cetaphil and a topical cream or lotion which should be applied to the whole area affected by the acne, not just the individual spot or blemish.   Key ingredients to look for are Salicylic acid and Benzoyl Peroxide (careful, this can bleach clothing!).  Ask your chemist, but be wary of anything promising miracle cures.  Generally, dermatologists recommend giving any treatment a two month period to show signs of working - if none appear, get something stronger.  The Acne Support Group call this “The Two-Month Rule.”

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The BIG Don’ts:

Step 2: 

If you notice no improvement in your acne, head for your local GP who can prescribe topical antibiotics like tretinoin, isotretinoin and adapalene (they will be sold under brand names like Retin-A or Differin).  At the same time he may prescribe a course of oral antibiotics to help fight the infection.  Listen carefully to the doctor’s advice on dosage as when and how you take these can make or break their effectiveness.  Alternatively, and particularly helpful in cases of adult acne in women are hormonal treatments that re-balance the shift in hormones that has caused the acne in the first place.  This, in effect means a certain type of contraceptive pill can also control your spots - alright!  “The two-month rule,” says Dr Murphy “applies to your doctor’s treatment too, if you’ve seen no change - get a second opinion, ask to see a dermatologist.

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“The two-month rule applies to your doctor’s treatment too, if you’ve seen no change - get a second opinion, ask to see a dermatologist.”

When all else fails

All is still not lost! - For severe acne that won’t respond to any other treatment ask your doctor to refer you to a good dermatologist.  He may then prescribe a strong anti-acne drug called Roaccutane; these are powerful tablets based on vitamin A.  Although very effective in clearing severe acne, this drug can cause very dry skin, hair and scalp as it works by virtually “switching off” oil glands’ output by up to 90%.   There are other serious side effects too, that you need to be well aware of - so ask questions.  Dr Murphy warns that to get the most out of a course of this drug, “patients need to have a resilient character, as side effects are not pleasant.”  Most importantly though, make sure you tell your doctor whether you are taking other medications at the same time or if you are pregnant or planning to become so.  As Roaccutane can cause severe birth defects you must be using reliable contraception while taking them.  Keep in touch with your doctor and stick strictly to his/her advice.

If you’re on the net:

The Acne Support Group - the only one of it’s kind in the world is based in the UK and offers support and membership internationally and loads of great info: www.stopspots.org.uk or email: asg@the-asg.demon.co.uk

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Lara’s* Story:

“I started to get acne, along with all my other school friends at around 12 and 13 and thought ‘Well, a few spots what’s the big problem’ but within a couple of years I ended up with loads more than my friends and had them on my back as well.  I remember being so terribly embarrassed; even giving up swimming, which I loved because I didn’t want people to see my back, which I thought was just horrible.

“I had very greasy hair and skin and I’d sweat all the time…the whole thing was cringe factor 10!  So in my way I chose to deal with it by being the joker or the clown.  Being funny was my way of dealing with something that for me was extremely embarrassing.

“I’d constantly encounter people with very well-meaning advice that they thought was their God-given right to hand out to me.  Things like ‘Well if you’re going to eat that chocolate bar Lara, it’s no wonder you’ve got spots’ and ‘ have you tried washing a bit more?’

“The inevitable result for me was overwhelming guilt.  So I tried all sorts of faddy diets, paid out loads of money for expensive creams, lotions and soaps and nothing happened. 

“So I went to the doctor who prescribed ointments and antibiotics.  But in trying to get the ointment onto the spots on my back - which by that time had really worsened - I was feeling like a contortionist, and far too proud to ask anyone to do it for me.  And  I’d take my antibiotic pills after meals and was supposed to take them before, on an empty stomach.  I just didn’t take it seriously enough to find out more and listen to the doctor’s instructions.  I guess I always thought it would just go away somehow.

“Every fad and miracle cure I tried would give me an initial burst of hope and then, when it didn’t work I’d go through massive feelings of failure and abandonment.  That became a cycle which eventually turned into 12 years of pure misery.

 “By the time I reached my twenties, my acne had got progressively worse and my back was scarring, so I finally decided to go and see a dermatologist.

After agreeing to treat me, he proceeded to warn me of the side effects of Roaccutane, the drug he intended to prescribe.  Well, this actually frightened me off!  So I spent the next eighteen months trying to find some form of complementary or alternative therapy to get rid of my spots, once again to no avail.  So finally I became convinced that my type of acne needed something more aggressive.  So I was put on a course of Roaccutane for six months, which is longer than usual.  To begin with, my spots got worse and I remember a nasty flare-up four to five weeks into the treatment, that was my lowest ebb ever.  And I had to keep going back to the dermatologist for liver function and other routine tests.  Then I experienced dryness of the eyes, nose and particularly the lips.  But after that six month period, it completely went!  My life changed.  I started to receive compliments on my skin and my acne had gone.  That was at 24 and now nine years later, though I get the odd spot like everybody else, I would describe my skin as perfectly normal.”

*name has been changed

[shots 1,2 & 3 - optional - captions as follows]

Neutrogena (containing salicylic acid) is recommended by four out of five UK dermatologists:

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Clear Pore Treatment £3.99

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Clear Pore Medicated Wash £3.99

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Left to right:

Clear Pore Facial Bar £1.99

Skin Clearing Treatment £4.49

Clear Pore Medicated Wash £3.99

Spot Control Moisturiser £4.69

Clear Pore Treatment £3.99

Invisible Treatment Stick £3.99

[A word on illustration:

I have Roche looking for a PR shot of Roaccutane and I’ve provided pics 1, 2 & 3 - optional shots of  the Neutrogena range, one of the only ones dermatologists recommend.  As most dermos don’t have a lot of faith in beauty therapy’s effectiveness in fighting acne, I have not made this a product based story.  Instead it concentrates on facts, medical opinion and treatment - I suggest an illustration of a girl looking into a mirror, distressed about her face, but  very graphic photographs wouldn’t be suitable, in my opinion, as the degree of what is considered an ‘acne condition’ is so broad]

COPYRIGHT  ANNA MAGEE 1999

LINK TO EXAMPLES 2