Remember how awful it could be–the self-consciousness, the mood swings, the longings, the embarrassment of acne flare-ups? Puberty and the teen years are hard enough under the best of circumstances. Add an even moderately bad case of acne into this volatile emotional mix, and, for some children, you have serious problems.
“It’s important that treatment be sought at a relatively early age, because acne can be a very serious and important disease,” says Alan Shalita, MD, professor and chairman of the Department of Dermatology at SUNY Brooklyn in New York City and an expert in treating severe cases of acne. “It can lead to very visible scarring of the skin as well as the invisible scarring of the child’s self-confidence and self-image.”
More than 84% of the population between the ages of 12 and 25 has some form of acne, according to Dr. Shalita. “There’s a large number of people with acne that do not seek out treatment because they are not aware of it or feel they can’t afford it,” he says. “We need to raise awareness out there that very effective and affordable treatments are available.”
Parents Do Something
“The enduring myth about acne says that it is a condition that will clear spontaneously, but that couldn’t be more false,” says John Strauss, MD, professor emeritus of dermatology at the University of Iowa. “Acne is something that is real. It needs the attention of a dermatologist.”
Parents concerned about a child’s acne should offer to make treatment available. “You need to determine whether the child is bothered by the acne,” says Dr. Shalita. “Ask the child if it is causing problems at school. It is important to convey to the child that any time they want help, it’s available.”
Far more common, says Dr. Strauss, is the situation in which the parent can’t pay for treatment. “There really is very little excuse in our day for cases progressing to where there is significant scarring, either emotional or physical,” says Dr. Strauss. “There are lots of acne cases that are minor, but what one person sees as minor, another may see as a serious problem. We need to make allowances for individuals and get treatment to everyone who needs it before damage starts.”
“In real life, what you see as the emotional damage brought on by acne is impaired self-image, social withdrawal, anger, anxiety, and most notably, depression,” says Dr. Shalita. “Some children are even driven to the point of suicidal ideation.”
“I’m the first to admit that many milder cases of acne can be effectively treated with over-the-counter medications,” says Dr. Strauss. “But the person who has more inflammatory acne is more in need of therapy, especially when you’re dealing with nodular acne–the big inflamed sores. But I see patients who have just a mild case but want the help of a medical professional.”
Dr. Shalita agrees. “There is a wide variety of over-the-counter acne products in drug stores, and we’re not saying there is anything wrong with those for mild acne,” he says. “But if people don’t respond to them, they should seek out real help before scarring starts.”
Dr. Shalita says he typically recommends that if a person uses over-the-counter products sold in drugstores–like preparations of antibacterials such as benzoyl peroxide, or vitamin A containing creams–for 3 months and doesn’t see any improvement, then it’s time to see a dermatologist.
“The earlier someone comes in for treatment, the better, because we have a broad array of therapeutics that help virtually every patient,” says Dr. Strauss.
Acne treatments fall into two broad categories: topical agents and oral medications.
Topical agents include the usual products seen in drug stores. These work by unblocking the pores or killing bacteria on the skin.
Oral medications include antibiotic pills like tetracycline. Generally, most cases that don’t respond to topical agents will respond fairly quickly to a combination of topical agents and oral antibiotics. For severe cases that do not respond to oral antibiotics, there are other drugs that can even lower oil gland activity.
“Accutane [generic name isotretinoin] is a very powerful drug,” says Dr. Shalita, whose practice specializes in these very severe cases. “It is effective in the most severe cases, but its use must be tempered with good judgment because it can damage a developing fetus. Women who are fertile cannot take this drug unless they agree to use two types of contraceptives during treatment. Despite these serious restrictions on Accutane’s use in women of childbearing age, it is the most valuable drug we have.”
The good news for women is that other groups of medications are available. One brand of oral contraceptives has been shown in studies to help clear acne. Only one such product so far has been approved by the FDA for this use–Orthotricyclin–but, Dr. Strauss says, it is likely that other oral contraceptives have a similar effect; several are in the process of winning approval from the FDA to make such claims.
“In families where the parents have not gone through acne themselves, the children who have acne are in a difficult situation,” says Dr. Strauss. “These parents may not have a good feel for the kind of physical and emotional scarring that results, and they may not feel like acne is a problem that needs medical attention, but they’re wrong.”
Article By: John Casey, Medical Writer