Acne is a common skin condition caused by inflammation of the hair follicles and oil-producing (sebaceous) glands of the skin. It is most common on the face, but can also occur on the back, chest, shoulders and neck.
Moderate to severe acne can cause embarrassment, self-esteem problems, and sometimes depression.
Acne is caused by a combination of many factors, including genetics, hormones, friction, cosmetics, stress and skin contactants. Most important is the genetic factor. Most people inherit the tendency to develop dysfunctional oil glands at a time in life when certain normal hormones affect the oil glands. Changing hormone levels cause production of abnormal oil from genetically predisposed dysfunctional oil glands. This abnormal, thick oil clogs the pores allowing the backup of oil and increasing pressure, which then causes the gland and oil ducts to leak or rupture under the skin. Once ruptured, inflammation and then infection can occur. When acne is severe, it can lead to serious and permanent scarring.
Treatment for acne depends upon its severity. It consists of using medications which chemically unclog pores, reduce infection and inflammation, and normalize abnormal oil gland production. Topical preparations (creams, gels or lotions) may be prescribed to help unclog the pores and reduce the amount of harmful bacteria.
In mild cases, I prescribe a tretinoin gel which unplugs clogged pores and prevents future breakouts. Tretinoins may be used alone or in combination with erythromycin, Cleocin, or benzoyl peroxide. These medicines may require weeks or months of use and work best when adjusted carefully by a dermatologist. Many patients give up too soon. Antibiotics taken by mouth are often prescribed for moderate or severe cases. Most acne requires 4-8 months of treatment for a complete cure. Special formulated medical facial peels can speed the healing of acne lesions in most cases.
Accutane(isotretinoin) will be considered for severe, resistant, and/or difficult cases which have not improved satisfactorily during other treatments. Accutane is the only drug that “shuts off” and shrinks oil glands that cause acne. Accutane actually normalizes abnormal, dysfunctional oil glands. It will decrease overactive oil gland production, diminish scars and completely clear acne. Treatment with Accutane takes an average of 6-8 months. New methods of dosage adjustment diminish the unwanted side effects to a minimum. The recent concerns of side effects are greatly exaggerated by those who do not understand Accutane and its proper use. All side effects can be completely avoided by proper dosing. This must be explained to patients and parents before treatment begins.
I prescribe Accutane in much lower doses to completely avoid all side effects. Lower doses, properly adjusted, make Accutane the best acne medication available when used in this manner. Remember, your neighbor or friend who experienced side effects from Accutane could have avoided those side effects by decreasing the dose.
Most importantly, all acne is curable with proper treatment and adjustment of medications under the supervision of a dermatologist. Untreated acne can leave lifelong scars that can affect your self-image. There is no need to wait months or years for your acne to clear. It is best to initiate treatment early, before scarring occurs.
John J. Jones, Jr. M.D.
