Acne Be Treated? Treating Acne:

¶ … Acne Be Treated? Treating Acne: the Methods, Advantages and Dangers Entailed What is acne, why does it appear on the skin, and can it be prevented? According to the National Health Service (NHS) Direct Online Health Encyclopaedia, acne affects a person's hair follicles and the sebaceous glands in the skin, "which secrete an oily substance called sebum" (a fatty lubricant material). The places on the body which most commonly are afflicted with acne are the face, arms, back and chest.

Acne usually begins to attack a person's skin about the time of puberty, the NHS explains, but acne can also begin around adulthood in other people. Only 20% of the people in the UK go through life acne-free, the NHS explains, but for those not so fortunate to avoid the plague of pimples, the onslaught can happen generally between the ages of 11 and 30.

Why does acne appear on the skin at around the time a person reaches puberty? The NHS Direct Online Health Encyclopaedia "Acne Introduction" section explains that changes to a person's "hormone levels" create a condition in the sebaceous glands that produces excess amounts of sebum; the sebum, together with dead skin cells, "blocks the hair follicles, which enables the formation of spots ranging from blackheads to painful red nodules," the NHS reports.

When going into the NHL Direct Online Health Encyclopaedia "Acne Causes" page, however, one learns that the increased "hormone level" is actually the presence of the hormone testosterone, which, some may not realize, is present in boys and girls. Testosterone triggers the rapid division of skin cells, the "Acne Causes" page explains, resulting in a blocking of the hair follicles. That is a little different explanation from the "Acne Introduction" page, which didn't mention the production of testosterone as a contributing factor to the blockage of the hair follicles.

The "Acne Causes" page continues, with the information that changes in skin acid levels during puberty also "encourages the growth of bacterium," which also becomes trapped in hair follicles. When the acid is trapped in hair follicles, the pimple is more severe, in fact it becomes a "deeper infection" in the form of pustules and nodules.

The "Acne Introduction" Web page explains that "acne usually corrects itself over time," so a person could technically not treat the acne - "in most cases it should get better without treatment" the NHS reports - however, for some individuals, letting the acne go on without treatment "may take years" and "can potentially cause permanent scarring." Hence, the NHS recommends treatment.

The "Acne Causes" page offers addition information on causes of acne: 1) it may be genetically passed on through family trees; 2) stress causes existing acne to become worse; 3) girls may have increased acne breakouts during menstruation; 4) some drugs (corticosteroids, anti-epileptic medicines, and oral contraceptives) may aggravate acne; 5) exposure to "dangerous chemicals called dioxins" may cause a rare kind of acne called chloracne.

Heavy intake of chocolate and greasy fried foods does not cause acne, the NHS states, but failure to wash one's face, especially during puberty and teen age years, can indeed aid acne blemishes to get their start on the face. In the NHS Web page "Acne Prevention," the only suggestions not previously offered is that acne "is not infectious" and is not caused "by poor hygiene," albeit, washing one's face and removing make-up prior to going to bed are helpful preventative measures.

Various traditional treatments for acne In the NHS Web site there is a link to "Wellingborough LHG Acne Treatment Advice," which gives treatment information for mild, moderate, and severe acne. In the case of "mild acne" ("open and closed comedones," several small papules and pustules), "Topical Adapalene (Differin) gel/cream or Isotrexin/Retin A gels and/or Benzoyl peroxide 2.5-5% gel" is recommended.

For "moderate acne" ("numerous comedones and small inflammatory papules; numerous pustules") oral and topical remedies are recommended: topical (Zineryt, Zindaclin, Benzamycin); antibiotics (Oxytetracycline; Lymecycline; Erythromycin; Minocycline; Doxycycline; Trimethoprim). In the case of "severe acne" ("numerous comedones, deeper papules and pustules; deep & large lesions; Nodules/cysts and abscesses"), the Wellingborough LHC advice is to use "systemic and topical treatment" similar to "moderate acne" treatment plus "immediate referral for Roaccutane" (blood test at the time of referral). The "severe acne" cases also require "systemic antibiotic therapy" for 3-36 months.

Meanwhile, the Acne-Rosacea.co.uk Web site takes acne severity to another level, "very severe acne": "requires urgent referral to a hospital specialist for mega dose antibiotics and possibly oral isotretinoin." When is acne treatment not a good idea? When is acne treatment deadly? On the subject of isotretinoin, an oral medication for severe acne sometimes prescribed by the brand name Accutane, it should never be prescribed for a pregnant woman: "istretinoin can cause severe birth defects in unborn fetuses," and has been linked to severe depression, behavioral changes and in some cases suicide" (Acne Resource Center, 2004).

Moreover, isotretinoin can cause "headaches...nausea, vomiting and blurred vision," the Acne Resource Center advises on their Web site: (http://www.acne-resource.org).Additional negative symptoms include a decrease in the production of tears (causing red, itchy eyes, and even "ulcerations of the cornea, especially with contact lens wearers"); a decrease in the ability to distinguish between shades of black and white (causing "night blindness"); and, also, liver enzymes "can be elevated causing jaundice, hepatitis, and abdominal pain." The deadly legacy of people with acne who used Accutane As an indication of just how far individuals will go to attempt to rid themselves of acne, the story of the drug Accutane is very revealing.

There could likely never be a more relevant instance in which a decision should be made against treatment of acne than that involving the drug Accutane. Indeed, the Acne Resource Center is either lagging behind on their Web site updates, or they have chosen to ignore the latest medical news regarding the suicide deaths of individuals who used Accutane (isotretinoin), and whose use allegedly resulted in first depression, then suicide.

According to the Web site www.the-accutane-lawyer.comWeb site (one of the sites where users get information about class actions suits being brought against the manufacturer), "there have been 142 suicides involving Accutane" since 1982. FDA scientist David Graham testified before Congress last year that Accutane was one of the five dangerous drugs that should be restricted or removed from the market" (Canada.com News, 2005), a news source reported.

On the Web site, which is sponsored by Ennis & Ennis, a Washington D.C.-based law firm, the attorneys claim that Accutane has the following side effects: "Inflammatory Bowel Disease"; "Crohn's Disease"; "Ulcerative Colitis"; "Kidney Transplant"; "Liver Transplant"; "Birth Defects"; "Suicide"; and "Intra cranial Hypertension." Hoffman-LaRoche, Inc., a subsidiary of Swiss drug-maker Roche, has been dispensing Accutane in the U.S. since 1982.

In October, 2001, Congressman Bart Stupak "expressed his concerns about Accutane following the suicide of his son," who was taking Accutane for an acute case of acne at the time. A more widely publicized case of suicide involving Accutane is that of the son of Liam Grant, who believes his son's suicide was caused by Accutane. Grant's son, also named Liam, was a 19-year-old engineering student at University College Dublin, who played guitar and drums, but was an acne sufferer. He was given a prescription for Accutane in February, 1997.

His father says he should have noticed the potential warning signs that ensued" (McCoy, 2005), according to an article in USA Today. The younger Liam, "previously outgoing and enthusiastic about his plans, increasingly spent time alone in his bedroom," the article pointed out. "When his friends called, he asked one of his brothers to tell them he was unavailable." And, tragically, Liam Junior was found dead in June 1997, "hanging from a tree outside Dublin.

A jury...ruled the death a suicide and called for more research on Accutane and its side effects." The father, Liam Senior, has spent "roughly $1 million of his retirement nest egg on scientific research examining the effects of Accutane." As to the manufacturer's response, according to McCoy's article: "Roche feels a great deal of sympathy for Liam Grant regarding the loss of his son, but according to a significant body of scientific evidence, there is no cause-and-effect relationship between Accutane and psychiatric events." That may be the company's position, but nonetheless: Roche changed the package insert four years after Accutane went on the market to say that "some users had reported depression"; in 1997 French regulators forced Roche to list suicide as a "potential side effect"; in February 1998, the U.S.

Food & Drug Administration required Accutane packaging to include the statement that adverse reactions, besides depression and psychosis, could include "suicidal ideation, suicide attempts and suicide." In March, 1998, England and Irish health officials required Accutane to post warnings on the drug's label regarding "risk of psychiatric disorders." And in June, 2002, Roche puts the following warning on all its Accutane labels: "[this drug may lead to] depression, psychosis and, rarely, suicidal ideation, suicide attempts, suicide, and aggressive and/or violent behaviors." The UK's Medical Control Agency (MCA) released data in February 2001 which indicated that "1,795 adverse reactions" had been reported on their database since Accutane's introduction in 1982 (pressbox.co.uk 2001).

Of those 1,795 reactions, "23 were fatal, 14 being actual suicides," the pressbox Web site reported.

More than 200 of the "adverse reactions were psychiatric with 20 reports of suicidal thoughts of suicide attempts." Additionally, 80 reports of "depression" were logged and 13 reports of "mood swings." The pressbox article stated that surprisingly, 74% of UK patients who had used Accutane "had mild or moderate acne according to a study among UK dermatologists." The MCA, through the article in pressbox, stated that Accutane "should only be used for severe recalcitrant cystic acne as a treatment of last resort." Not all Accutane patients wind up depressed, psychotic or dead from suicide, of course, and Brandi Jones is one example of an Accutane success story.

At least, she made it through six months of Accutane treatment, and now her skin is "mostly pimple-free" (Setoodeh, 2005), according to an article in Newsweek. At the age of 16, the cysts on her chin were so painful her face "throbbed like someone had punched me," she is quoted as saying in the article.

She spent her nights "tossing and turning" and her days she spend "popping Tylenol and Aleve." When all over-the-counter acne remedies failed to clear up her face, she got a prescription for Accutane from her dermatologist, knowing the drug could cause depression "and that it sometimes made acne worse before improving it." She said she "felt pretty suicidal at times," and "isn't sure she'd go through with the treatment again," but her face is not clear, and she sleeps all night.

Other problems to be aware of in treating acne When using topical antibiotics that contain erythromycin, clindamycin or tetracycline, one should be aware that these antibiotics may "fluoresce under ultraviolet light" - and therefore should not be used to fight acne when dancing at a disco, according to Acne-Rosacea.co.uk.

Also, the same Web site warns that there are serious side effects connected with the long-term use of antibiotics in the battle against acne; long-term use "affects bacterial balances in the intestinal tract and can lead to oral thrus, nausea, abdominal pain or diarrhoea." These symptoms may be serious in about 5% of the patients who are on long-term antibiotics for acne, the Acne-Rosacea.co.uk page asserts. Meanwhile, for acne sufferers with darker skin pigment, Dr. Pearl E.

Grimes (University of California, Los Angeles) warns that some acne treatments, such as benzoyl peroxide, tretinoin, glycolic and salicylic acids, Adapalene and tazarotene "can actually exacerbate post-inflammatory hyperpigmentation" (www.Acne-Rosacea.co.uk,2004). Dr. Lawrence Charles Parish, a clinical professor of Dermatology and Cutaneous Biology at Jefferson Medical College in Philadelphia, Pennsylvania, in his "Myths About Acne" report, explains to teenagers that scrubbing one's face can "worsen the condition." By using a scrub cloth, loufa, or "abrasive cleansers," one simply "aggravates the skin," he reports.

"It's best for teens to wash their faces with their hands," he continues, noting that the temperature of the water "has no affect on acne or pustule formation." Additionally, "drinking lots of water, taking numerous vitamins" will do "nothing" for the teen but "increase bathroom time" and "waste money." Adding lotions and moisturizers to the face "will just aggravate the condition and create more zits," Dr. Parish warns.

"The skin is not dry!" he emphasizes; "the skin is actually oily." Various alternative treatments for acne An up-and-coming treatment for acne, according to Dermatology Nursing journal (2004), is "nonablative laser technology." This laser treatment "can clear acne without producing a notable injury to the outer layer of the skin," the article reports.

"The laser emits a wavelength of light that is strongly absorbed by water within the skin." This then generates heat, "in and around the sebaceous glands," hence, the structure and function of the sebaceous glands are altered, "leading to prolonged acne clearance." About three to five treatments - which take between five and twenty minutes each - are prescribed at "monthly intervals" to help reduce or remove the acne from a face.

There is a "slight snapping or stinging sensation" associated with the treatment, but the article states that applying ice after the treatment, and pretreatment with "topical anesthetic" can reduce any irritation dramatically.

Meanwhile, the Acne Resource Center lists 87 "alternative therapy" links for the treatment of acne, ranging from "Thought Field Therapy 4 U," "Craniosacral therapy," "Hypnosis,' "Hair Replacement," "Inner solutions" to "Energy Psychology," "Spinaloptions," "Psychotherapy" and "The Anxiety and Depression Help Site." Some sound so bizarre the one wonders how an acne-challenged person would even be helped, but perhaps it speaks to the frustration that grows when pimples mar an otherwise attractive face.

An "Industry-independent, randomized" study of antibiotic therapy for acne carefully-controlled study of the effectiveness of antibiotic therapy on 649 community participants was conducted through Queen's Medical Centre, Nottingham, UK, and was reported in The Lancet (Ozolins, et al., 2004).

The study utilized the "efficacy and cost-effectiveness of five antimicrobial regimens for mild to moderate facial acne," and also looked into whether "propionibacterial antibiotic resistance affects treatment response." The article's "Introduction" asserts that, unlike earlier reports which indicated that around 80% of people between 11 and 30 will have acne to some degree, "Acne vulgaris [has] a point prevalence reaching 100% among adolescents." The article goes on to report that "antibiotic therapy has been an important part of acne management worldwide for the past 40 years"; however, acne is not an infection in the classic sense" because "direct anti-inflammatory activity could be as important as inhibition of propionibacteria growth, or even more important." Important points that the research set out to examine include: a) whether "Minocycline is more cost-effective than Oxytetracycline" (the former is far more costly than the latter); b) whether "a leading topical treatment (a combined formulation of erythromycin and benzoyl peroxide) is more effective than oral treatment"; c) whether topical erythromycin and benzoyl peroxide "prescribed separately are as effective as the combined formulation" (the combined formulation is more expensive); d) "how well a cheap over-the-counter treatment (5% benzoyl peroxide) compares with prescription antibiotics." Thirteen percent of the participants were recruited from UK colleges, all of whom had at least "15 inflamed and 15 non-inflamed lesions on the face." The outcomes - which were determined at 18 weeks - were gleaned through "patients' self-assessed improvement and reduction in inflamed lesions." In the final report, which is most pertinent to young people suffering from acne, the "cheapest treatment (benzoyl peroxide) was 12 times more cost-effective than Minocycline." Moreover, "topical benzoyl peroxide.