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Ask the Medical Expert Archives 2000-2004

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Acne
June 2000

Q. I am a 20-year-old female who has been experiencing frequent breakouts in the recent months. Previously I have not had trouble with acne. I am in a profession in which I rely heavily on my appearance, and these frequent breakouts are affecting my work. I need information on the latest treatments. I am looking for something that REALLY works, no matter what the cost. Any suggestions?

A. Thanks for your question regarding acne. I'm sure it is a concern for many of our readers. Of course it is a common condition, affecting males and females, and does not always go away after adolescence. Let's review some general concepts about acne, then address some specific concerns raised by your question.

The current ideas concerning acne are that it is an inflammatory condition that begins when the secretions of normal oil glands get clogged. The oils and other elements get trapped under the skin resulting in plugged pores which can become inflamed causing the characteristic papules (red bumps), pustules (mini-infections), and cysts (larger, deeper lesions). If not treated successfully, scarring can result. Acne is somewhat more common and more severe in males. There is often a genetic factor, and several generations can be prone to this condition. In addition to the genetic factors that can't be changed, certain prescription medications can cause or worsen acne, and women should avoid oil-based cosmetics that can plug the pores.

As you have described, your acne clearly has a relationship to the menstrual cycle. Your doctor may well want to order some lab tests to see if some of the endocrine glands are playing a role in your particular case. DHEA, testosterone, LH, and FSH levels may clarify this possibility.

Treatment is aimed at unblocking the pores and reducing the inflammation. Several effective medications are available and the particular treatment depends on severity, location, and the types of acne lesions that are present. If plugged pores are common, tretinoin products are often helpful. Inflammation can be treated topically with products such as benzoyl peroxide and antibiotics. If topical treatment is not sufficient, the use of oral antibiotics is often helpful. In severe cases not responding to these measures, oral use of isotretinoin can be used. It is often highly effective, but has significant side effects, and cannot be given at all in pregnant women. This compound is usually given under close supervision by a dermatologist. Your doctor or a specialist can help determine which treatment seems best for you!

HELPFUL WEBSITES:

  1. http://www.aad.org/
  2. http://www.derm-infonet.com/acnenet/
  3. http://acnesite.www.publishing.com/
RECENTLY PUBLISHED MEDICAL ARTICLES:
  1. Pearls in the Management of Acne: An Advanced Approach.
    Prim Care. 2000 Jun;27(2):289-308.
  2. The science and art of treating acne in adolescence.
    West J Med. 2000 Mar;172(3):155-6.
  3. New treatments and therapeutic strategies for acne.
    Arch Fam Med. 2000 Feb;9(2):179-87. Review.
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