Acne agony

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On The Teen Scene
Tonight's your first date with the person of your dreams. You're standing in front of the mirror, coaxing your hair into a more sophisticated style when there it is right on the tip of your chin--a big fat zit! You look at your face more closely and see another smaller pimple on your cheek. Lifting your hair, you spot several on your forehead, too.

Why did this have to happen just when you want to look your best? And, while we're at it, why you?

No one knows for sure exactly what causes acne vulgaris, the technical name for the zit attack. But researchers do know that it usually starts in adolescence and that heredity plays a big role. If one of your parents had acne, there's a good chance you'll develop it. If both of them had serious pimple problems, then your chances are even higher.

If you have acne, you have lots of company-about 80 percent of all teenagers develop some form of the skin condition. Most teens who get acne have the milder form, called noninflammatory acne, and get just a few blackheads or whiteheads every now and then. But some people suffer from the more severe form, called inflammatory acne, and have a constant outbreak covering the face, and sometimes also the neck, back, chest, and groin. These pus-filled pimples and cysts can cause deep pitting and scarring.

Acne develops when glands that produce an oily substance called sebum begin to work overtime, possibly due to hormone changes that are at their peak in the teen years. One of the jobs of the sebum is to carry cells shed by the glands to the surface of the skin. But because the excess sebum is blocking the openings of the glands, called ducts, both cells and sebum accumulate, forming a plug called a comedo. If the plug stays below the surface of the skin, it is light in color and called a whitehead. If the plug enlarges and pops out, the tip looks dark and it's called a blackhead. This isn't dirt and it won't wash away. The darkness is due to a buildup of melanin, the dark pigment in the skin. If the process continues, a pimple forms (see diagram).

What Causes Acne?
Acne most often starts at around age 11 for girls and 13 for boys. Scientists think a hormone called androgen plays a role in acne. Among other things, androgen stimulates the sebum-producing glands. After puberty, boys produce 10 times as much androgen as girls, and so it's not surprising that more boys than girls develop severe cases of acne. Also, bacteria called Cot nebacterium acnes, which cause skin fats to break down into irritating chemicals, can directly contribute to an outbreak.

Other things that can cause acne, or make it worse, are certain drugs, such as those used to treat epilepsy or tuberculosis; exposure to industrial oils, grease, and chemicals; and stress and strong emotions (which may account for the big date breakout). Some oily cosmetics and shampoos can, on rare occasions, trigger acne in people who are prone to get it.

Many young women notice that they get more pimples around the time of their menstrual periods. In fact, some studies have shown that up to 70 percent of women notice their acne worsening the week before their periods.

You may have heard that certain foods, such as chocolate, nuts, cola drinks, potato chips, french fries, and other "junk food" cause acne or make it worse. But there's no scientific evidence to back up these claims. Still, if you notice that outbreaks increase after you eat certain foods, it makes sense to eat as little of them as possible.

Oily skin and hair don't actually cause acne, experts say. Although there is an association between the severity of acne and the amount of oil a person's skin produces, not all people with oily skin have acne. And some people with dry skin do!

Does Anything Help?
In one Swedish study, most people's acne improved after exposure to the sun. But not all doctors agree that sunlight is helpful. Some say it may just be relaxing in the sun that makes the pimples vanish. At any rate, the idea that the sun improves acne by drying out greasy skin doesn't hold water; sun and heat increase oil production.

Mild acne can often be cleared up simply by washing your face once or twice daily and avoiding any food or drink you think triggers an outbreak. If these measures alone don't work, you may want to try one of the acne medicines that you apply directly to the skin and that are sold without a prescription. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid, all of which the Food and Drug Administration has found effective for treating mild acne. (The agency is reviewing some safety questions that have been raised about benzoyl peroxide.)

What won't work is picking at pimples. This can injure skin and underlying tissues. If you have acne that won't clear up with home treatment, see a dermatologist, a doctor who specializes in treating skin problems.

Sometimes dermatologists use instruments called comedo extractors to remove blackheads. They may also surgically drain large pustules or abscesses.

There are also drugs that can be prescribed for more severe cases. These include both topical and oral antibiotics such as tetracycline and erythromycin, and Retin-A (tretinoin), a derivative of vitamin A that comes in cream, gel or liquid. Another acne drug, Accutane (isotretinoin), is also derived from vitamin A. But this medication, taken by mouth, has serious side effects and isn't for everybody. (See accompanying article.)

In very rare instances, where these measures don't work or haven't been used before the acne causes permanent skin damage, plastic surgery can be used to smoothe over deeply pitted and scarred skin.

Acne may be an inevitable companion of the teen years. But today, with proper measures, it can usually be controlled before it becomes totally unsightly. And if pimples pop up for that big evening, don't let it get you down-your date will probably have a few, too.

ILLUSTRATIONS (4)

DIAGRAM: How Pimples Pop Up

Sebum, an oily substance produced by the sebaceous gland, mixes with cells from the hair follicle. Cells and sebum work their way to the skin surface, where they are washed away.

DIAGRAM: How Pimples Pop Up

Working overtime, the sebaceus gland makes too much sebum. Cells stick together and cannot be shed. Sebum and cells block the gland opening, forming a plug. The follcile can become so clogged that it bursts and the plug content leaks into the surrounding skin and tissue, forming a pimple.

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By Judith Levine Willis

Judith Levine Willis is editor of FDA Consumer. Sharon Snider, an FDA press officer, also contributed to this article.

ONE ACNE DRUG CAUSES BIRTH DEFECTS
There is one medication for acne that teenage girls should be particularly cautious of. The name of the drug is Accutane (isotretinoin). It's a capsule taken by mouth and it's derived from vitamin A, which has for some time been known to cause birth defects.

Accutane is approved by FDA for treating severe cystic acne for people whose skin condition does not sufficiently improve with other treatments, including antibiotics taken by mouth. Accutane completely clears acne in many people, but there continues to be concern about its use in young women who may become pregnant.

The instructions that doctors receive for prescribing the drug warn:

There is an extremely high risk that a deformed infant will result if pregnancy occurs while taking Accutane, even for short periods.
Accutane is not to be given to a woman of childbearing age (any menstruating female) unless she has "severe disfiguring cystic acne" that does not improve with standard therapies and unless certain precautions are taken.
Before prescribing Accutane to women of childbearing age, the doctor should give the patient an information sheet that includes statements about the drug's ability to cause birth defects. The patient is asked to initial these statements and to sign an authorization for treatment. If the patient is a minor, a parent or guardian's initials and signature are required.
Another acne medication, Retin-A (tretinoin), is also derived from vitamin A, but it is applied to the skin, not taken by mouth, and there have been no reports of birth defects related to its use.

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