Today Acne Troubles Are More Than Skin-Deep

In today's fast culture of beauty and fashion, embarrassment and frustration over appearance is common among acne sufferers. Recent studies, however, show that the emotions don't end there.

Two Scandinavian studies published this fall link acne and depression - even suicide - in profound ways. A study of Norwegian teens suffering from severe acne showed that girls were twice as likely and boys three times as likely to report having suicidal thoughts as those with little or no acne. Another study, from Sweden, linked suicidal attempts with teens and adults who have severe acne.

"We see a lot of frustration among patients who are suffering from acne," says Dr. Joshua A. Fox, founder and director of New York-based Advanced Dermatology and the Center for Laser &, Cosmetic Surgery. "Unfortunately, in some patients this sometimes translates into a sense of hopelessness about their situation which leaves them depressed. At 16 or 36, being incredibly unhappy with your appearance can lead to feelings of despair. It's important to know that there are treatments - more than ever, thanks to science and new technologies - that can help."

Affecting nearly 50 million Americans, acne is the most common skin disorder in the United States according to the American Academy of Dermatology. Nearly 85 percent of all people have acne at some point in their lives, and by mid-teens, more than 40 percent of adolescents have acne or acne scarring.

"There is no one-size-fits-all approach to acne intervention, but there are ways to find the treatment that is right for you," says Dr. Fox. "Knowing when to seek help from a dermatologist, and then with that doctor finding the personalized appropriate treatment for your particular situation are key to giving yourself the best chance to get acne under control."

Dr. Fox recommends looking into treatment when acne begins to bother you, but stresses the importance of early intervention since it can prevent permanent scarring and psychological trauma. He also warns against buying into the myths that surround acne. "Worrying about the untruths that are told about what causes acne does nothing positive for one's self esteem nor for one's acne," says Dr. Fox. Acne is not caused by poor hygiene and diet.

The truth is that acne is promoted by three major factors: the overproduction of oil by enlarged oil glands in the skin; blockage of the hair follicles that release oil; and growth of bacteria within the hair follicles.

Other myths abound about what will cure acne, and desperate acne sufferers may wish they were true, says Dr. Fox. Still, getting a tan or putting toothpaste on them isn't likely to cure pimples. And, the most common potentially harmful myth about what can scare away a pimple is that you should pop or pinch it. "In fact, this might cause you to get an unsightly scar and possibly more acne," says Dr. Fox.

Today's treatment options
What does work varies by patient, and fortunate for acne sufferers there are more options today for treatment than ever before. In 2004, more than $2.2 billion was spent on acne treatment, including substantial costs for prescription and over-the-counter products.

Most acne patients begin with over-the-counter topical medications that contain benzoyl peroxide or salicylic acid. Prescription topical ointments can include these topical antibiotics, sulfer, or azelaic acid - a natural material that kills bacteria in the skin so will help clear and prevent acne caused by bacteria. Oral medications include antibiotics that now can be taken once a day, oral contraceptives and stronger medications like Accutane that can treat severe acne cysts. Retonoids including Retina A, Differin, and Tazarac all work by stopping pimples from forming under the surface of the skin.

New prescription topical drugs came out in 2009 and 2010 that combine ingredients proven to fight acne alone for better effectiveness. These include Epiduo® gel which combines benzoyl peroxide to clear up pimples and the retinoid adapalene to prevent new ones from forming. Acanya gel combines benzoyl peroxide with an antibiotic. CLENZIderm® M.D. gel has been on the market a few years and contains a patented, solubilized form of benzoyl peroxide said to help it penetrate deep into the follicle and treat acne where it starts.

In 2009, all patients in one preliminary study who received a combination of photodynamic therapy (PDT) with a photosensitizer known as topical 5-aminolevulinic acid (ALA) experienced complete clearance of their acne. PDT works by using laser or light energy - in this case a pulsed dye laser was used - to activate the ALA, which penetrates into the oil glands and is applied to the skin one hour prior to treatment. As it penetrates, ALA binds to the oil glands and sensitizes the cells to light.

Other laser and light therapies (like blue light and smooth beam laser) have become more common in the treatment of acne, as are chemical peels that destroy parts of the skin in a controlled way so that new skin can grow in its place.

"No matter the treatment, one of the most important things to remember is to stick with the medication or physical treatment long enough to allow them to take effect, which might be six to eight weeks," says Dr. Fox.

One acne therapy for which the jury is still out? Treatment by iPhone. This year saw the introduction of AcneApp, which purportedly zaps zits by light therapy that works by holding the phone to your skin. So far, no clinical trials prove that this works. Dr. Fox doubts that this will be effective.

About Dr. Fox: Joshua L. Fox, M.D., F.A.A.D., earned his medical degree from the Mt. Sinai School of Medicine in New York. He completed an internship at Maimonides Hospital in Brooklyn, followed by a three-year dermatology residency at the New York University School of Medicine. A Fellow of the American Academy of Dermatology, Dr. Fox is a leading authority in the field of dermatology, with an expertise in skin cancer, acne, cosmetic surgery and laser procedures and is the author of many dermatologic publications. He is the founder and director of Advanced Dermatology, P.C. of New York and New Jersey and the Center for Laser and Cosmetic Surgery and is a spokesman for both the American Academy of Dermatology and the American Society of Dermatologic Surgery. He is the director of a fellowship program in Laser & Cosmetic Surgery. http://www.advanceddermatologypc.com/index.html. Dr. Fox is also the founder and President of The New Age Research Foundation, a national, non-profit [501 (C) (3)] health organization committed to improving the quality of life of those with skin conditions through research and education.