Saving Face - Canadian Living - November 2002
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Saving Face

By Lindsay Robertson

Thousands of Canadian adults have found to their dismay - that acne isn’t a condition everyone outgrows. But with help from science and technology, they can put their best faces forward.

Brenda Mason was 13 and living in a small Ontario town when she went to a dermatologist for the first time to get help for her acne. Throughout her adolescence, Brenda had tried one treatment after another but with little success. For the most part, she had to contend with pustules, pockmarks, redness and blackheads – a condition that she considered embarrassing and hoped would eventually disappear.

It didn’t. When she was in her 20s, Brenda developed an even more sever case of acne: hard, cyst-like pimples that covered her face. She tried various topical ointments and creams, antibiotics and even the gold-star standard: the vitamin A derivative known as Accutane. Some products provided partial improvement, and, with Accutane, she even enjoyed clear skin for several years, but the acne always returned.

Today Brenda, 49, is a nurse living in Toronto and the mother of a teen and preteen – and she is still battling acne. Having adult acne, she says with exasperation, “just makes you feel like you’ve never grown up.” Like many people, she had always thought acne was an adolescent condition. Even doctors at one time believed that acne was a disorder endured almost exclusively by young people. Dr. Eileen Murray, a dermatologist and an associate professor of dermatology at the University of Manitoba in Winnipeg, remembers being told in medical school that acne was a teenage disease. “But then I opened the doors of my medical practice and had all these women walk in with acne,” says Murray, who had been treating the condition for 26 years.

In 1999, research out of the United Kingdom reinforced her observations. On examining a random sample of 749 adults, the researchers found that 54 per cent of woman and 40 percent of men had some acne and 12 per cent of women and three per cent of men had serious acne.

What is Adult Acne?
Adult acne is similar to adolescent acne, but it appears more often on the chin and lower cheeks rather than extensively covering areas that include the forehead, chest and back. While the condition has probably always affected adults, many dermatologists agree that there seems to be an increase in the incidence of adult acne, especially in women, says Dr. Lisa Kellett, a dermatologist and director of laser and cosmetic dermatology at SpaMedica in Toronto. Why? “Dermatologists don’t really know the cause,” she says. “We think it may be related to a combination of increased stress, hormonal changes and the use of anti-aging cosmetics, which tend to be oilier than other cosmetics,” says Kellett.

The ClearLight program causes no discomfort, no reddening and no down time – patients return to activities immediately after treatment.

All acne is a chronic inflammatory disease of the hair follicles on the face, chest and back, says Murray. She explains that male sex hormones, which we all have, stimulate the sebaceous glands in the follicles to secrete oil. In people with acne, cells that line the pores reproduce too fast and plug up the pores, so the oil is trapped. Once the oil accumulates, bacteria that is normally present in small amounts on the skin begins to flourish, causing redness and inflammation.

Why does this happen only to some people? It has nothing to do with diet or hygiene. “Acne is primarily genetically determined,” says Dr. Jay Taradash, a dermatologist at Sunnybrook & Women’s College Health Sciences Centre in Toronto. If one or both of your parents had acne, you are a likely candidate. “One inherits a tendency for the sebaceous glands to overproduce oil and for the pores to get plugged,” he says. If acne is one of your inheritances, read on.

TREATMENTS: All treatments for acne involve a three-step approach: unplugging the pores, preventing the pores from becoming clogged again and eliminating bacteria, says Murray. Here are the treatments most doctors recommend.

BENZOYL PEROXIDE: This ingredient is commonly found in over-the-counter medications and is also the active ingredient in some prescriptions, where it is found in higher concentrations. Pros: Benzoyl peroxide has been used for several decades to treat mild forms of acne and is readily available as a cleansing bar, cream, gel or lotion. Cons: It can irritate skin and cause excessive dryness. It may bleach fabrics. Tips: Follow the directions on the package. Check with your doctor before using any other acne product with it.

RETINOIDS: Your oil glands might be sensitive to normal amounts of male hormones or you may produce more male hormones than is normal. Either way, the cells in your oil glands could be overstimulated or become sticky and plug up your pores. The class of medicines known as retinoids- derivatives of vitam A- slows down the growth of new cells, thereby preventing new pimples from forming. There are several types of retinoids, which are available as topical creams or gels or as oral medications.

Topical Retinoids: These are used to treat mild to moderately sever acne. Retinol and retinaldehyde- topical medications you can buy over-the-counter – are not effective at slowing down the growth of cells; creams containing retinoids, such as Retin-A, Adapalene and Tazarotene, are effective, but they require a prescription. Also, this medication is more effective in oral form. Pros: Retinoid creams have also been shown to reverse some of the effects of sun damage and may reduce fine wrinkles and freckles. Cons: They can cause dry skin, increase the risk of sunburn and cause redness and peeling. Retinoids may cause birth defects, so pregnant women should not use them. Tips: Retinoids can take up to three months to be effective. If retinoid creams cause dry skin or redness, reduce use to every other day or use less cream per application. Your skin should gradually get used to it and then you can apply it more often. Always apply a sunscreen to expose skin.

If your skin is dry, Taradash recommends using moisturizers that are oilfree and noncomedogenic, or won’t clog pores. He also recommends oil-free makeup.

If, despite careful application of retinoid creams, your skin becomes red and peels dramatically, discontinue use.

Oral Retinoids: Isotretinoin is also available as an oral medication commonly known as Accutane. It’s recommended for nodular cystic acne- the most severe type of acne- and acne that doesn’t respond to other treatments. Despite reports that Accutane causes depression in some users, Murray says case studies suggest that suicide rates are actually considerably lower among Accutane users than in the same age groups in the general population. The reason? Doctors think that people with bad acne tend to be more depressed than the general population, but once the acne clears, the depression clears. Nonetheless, Accutane may cause mood changes, and patients are urged to report changes to their doctors. Pros: It can be very effective for severe acne. It may require five months of treatment, but remission can last from several months to many years. Cons: The most serious side-effect is its potential to cause birth defects to a developing fetus; women who are pregnant, breast-feeding or planning pregnancy should not take isotretinoin. To avoid birth defects, women must sign a form stating that they’ll use two types of contraception to prevent pregnancy. The most common side-effects are dry skin, lips, eyes and nasal passages.

Oral Antibiotics: These are available by prescription for moderate to sever acne. The most commonly used oral antibiotics are tetracycline, erythromycin, minocycline and doxycycline. Pros: Oral antibiotics decrease inflammation and reduce bacteria. Cons: Bacterial resistance to oral antibiotics is becoming a problem, says Taradash, who adds that this has become a growing concern in the past year or two. To combat this, doctors are prescribing lower doses for shorter periods of time.

Topical Antibiotics: To minimize resistance to topical antibiotics- which can occur from six months to a year after starting antibiotic treatments- doctors recommend topical products that combine antibiotics with benzoyl peroxide. Pros: Like oral antibiotics, topical antibiotics decrease inflammation and reduce bacteria. Cons: They can cause antibiotic resistance and dry skin.

HORMONE THERAPY: This prescription acne treatment targets hormones. Current hormonal acne therapies come in the form of oral contraceptives, which lower the amount of male hormones in the body. Women with premenstrual acnes flare-ups tend to respond very well to these contraceptives.

NEW TECHNIQUES

Lasers: Some dermatologists are taking a high-tech approach to acne treatment. Kellett uses a new technology called ClearLight. In this procedure, a UV-free light emits a high-intensity narrow- band blue light that is supposed to kill acne bacteria by targeting porphyrins, a substance made by bacteria. Treatment consists of a 15-minute session twice a week for one month. It includes a SonoPeel, an ultrasonic peel involving an ultrasound device with a small probe that strokes the skin and vibrates so quickly that it dissolves dead surface cells and liquefies plugs. The provincial health plans include eight ClearLight procedures and two SonoPeels at a cost of $999.

New Retinoids: Doctors are continually searching for better acne treatments. Dr. Charles Lynde, a professor at the University of Toronto who has his own dermatology clinic, conducts several new acne drug trials every year. His team has just completed work on a retinoid-like oral medication that is stronger than the current drug but has fewer side-effects; it is currently headed into a clinical-trail stage and, if it is deemed safe, it could be available within three to four years.

Acne-Fighting Moisturizers: Pharmaceutical and cosmetics companies are coming to the aid of baby boomers who are battling wrinkles as well as acne. For instance, look for the anti-aging treatments that combine ingredients used to reduce wrinkles (such as retinol, a pure form of vitamin A) with acne-fighting ingredients (such as salicylic acid).

New Hormone Therapies: Dr. Diane Thiboutot, an associate professor of dermatology at Penn State University College of Medicine in Hershey, Pa., is doing cutting-edge research on how hormones affect the skin. She has found that hormones are made in the skin as well as in the ovaries and adrenal glands. “In the future it might be possible to treat the skin locally with something to control the hormones,” she says, “rather than having to take a pill that affects the whole body.”

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