Big Girl Blemishes - Toronto Fashion - April 2003
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Big Girl Blemishes. An adult guide to zapping acne.

By Rachel Rafelman

Irony plays with our lives, but who knew it would also play with our skin? An acne sufferer in my teens, I enjoyed a few blissful clear-complexioned years before the dreaded “visible signs of aging” coincided with the return of my youthful eruptions. Wrinkles and zits together, what a curse. My fruitless search for a beauty potion that smartly combined an anti-aging powerhouse with an acne remedy has me considering pumping Clearasil into a bottle of Second Debut. 

It is small consolation that I am not alone. “Adult acne is more common than most people think,” says Dr. Martie Gidon, a Toronto dermatologist, adding that until recently, adult acne was largely unreported. But statistics indicate that over 50 per cent of women (25 to 58) have some type of adult acne and that the median age for treatment has increased from about 20.5 to 26.5 years of age. “It is difficult to say why, exactly,” says Gidon, “since adult breakouts are often a combination of factors”. Hormones (even the ones in our food), heredity (genetics), stress and environmental pollution all play a role. 

Dr. Lisa Kellett, director of cosmetic laser dermatology at SpaMedica, who sees about three cases of adult acne a day, cites widespread use of anti-aging products as another cause. “They’re heavy, oily, and can cause problems on their own.” Such as oily skin. Due to collagen loss, older skin is less able to repair damaged tissue, resulting in a scar. But the question remains: What will help? 

Louise, a Toronto editor, has tried many over-the-counter remedies that “didn’t work.” The birth control pill stopped breakouts but produce a blotchy, brown hormone-related “mask.” She went off the pill; the acne returned. A topical tretinoin gel “took care of the acne, but chewed up my face. I looked dry and red all the time.” Next was a strict no-meat or dairy anti-acne diet, but Louise kept “falling of the wagon.” Like me, she’s willing to try most anything and has become mildly obsessed with finding a cure. 

But let’s go back to where it all starts. A zit begins two to three weeks before it is evident on the surface. Hormones cause the sebaceous gland to pump out excess oil (sebum) which clogs up the follicles resulting in a sebum plug. Special bacteria (called P-acnes) move in, the immune system becomes involved, inflammation ensues and a couple of weeks later, a red, swollen pimple erupts. The worst are the “cystic” zits – hard, painful knots that typically pop up along the jaw line, or around the mouth. Prevention is the key.

Traditionally, there are three approaches to acne management, none of which are permanent and all of which have a downside. The first, topical applications, ranging from over-the-counter products to prescribed preparations (antibiotic ointments, tretinoin creams, glycolic acids), can irritate the skin. Next contraceptive pills including Diane-35, have well-documented side effects. Lastly, there are antibiotics, to which about 40 per cent of acne bacteria are resistant. 

Accutane, a retinoid that inhibits the production of sebum, but can cause birth defects (women taking it must use two different forms of birth control), also causes dryness of the mucus membranes, bone and muscle ache and in extremely rare cases, mental-health disorders. According to Dr. Stephen Mulholland, surgical director of SpaMedica, there is new artillery in the war again acne: ultrasonic peels, which use ultrasonic energy to liquefy plugged oil glands; a blue light source (whether passive, like ClearLight, for mild acne, or pulsed, like Aurora, for more severe acne) that kills acne-causing bacteria; and radio frequency energy, which destroys the home where the bacteria live. SpaMedica is the only place in Canada where this three-pronged treatment (with pulsed blue light) is currently available. 

“Accutane or antibiotics take 12 weeks for a 60 per cent improvement,” says Mulholland. “The Acne Program takes six weeks for a 70 per cent improvement – twice as fast and no side effects.” Six weeks of the Acne Program is $1,000, (about the same as Accutane). Follow-up treatments (about $85 each) are likely needed, but it depends on the person. So far, no one has needed a second round of the whole treatment. Both Mulholland and Kellett admit that it helps to control acne. 

Linda, a fashion industry professional, underwent a six week ClearLight program a year ago and is uncharacteristically enthusiastic. Her problem arose after her second pregnancy, and in the course of undergoing various treatments, ended up with “seriously overprocessed skin” prone to “horrible breakouts”. “ClearLight zapped my zits and smoothed out the texture of my skin. I glow!” 

Gidon admits ClearLight “sounds great,” but says it’s new and hasn’t had experience with it. “It doesn’t affect hormones. But I can see it being used with out established treatments.” 

Acne still cannot be cured. “It doesn’t last forever in adults,” says Mulholland encouragingly. “You can control it and avoid scarring until the hormone profile levels out.”

Most of us can’t wait. Louise has tried ClearLight and after one visit can already see results. I’m considering it as well. It’s got to be more palatable than my homemade concoction.

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