Healthbeat Report: Options for Treating Acne

February 8, 2010 8:51:48 AM PST
Whether you're 15 or 55, a rebellious complexion can be frustrating and embarrassing but getting rid of the problem is possible.Experts say, now more than ever, consumers need to know their options.

Recently updated guidelines for treating acne encourage doctors to approach it as a chronic disease. They should be proactive knowing that the effects can be not only physically but psychologically damaging. There is a dizzying array of products promising results. So what really works?

Seventeen-year-old Trace Hamilton plays in a band but says it's hard to be a serious performer when your complexion is a mess.

"You wake up one morning and you are like, 'what happened?'" said Hamilton.

The high school senior's acne was so bad he was immediately placed on a serious medication, isotretinoin, found in generic versions of Accutane.

Accutane is no longer an option. The brand was quietly discontinued this past summer. Many dermatologists such as Kelle Berggren with Central DuPage Hospital say isotretinoin is safe and effective despite possible serious side effects including depression and birth defects.

"After a course of it you have a 40 to 60 percent chance of cure, meaning you don't need to take any other drugs," said Dr. Kelle Berggren.

Hamilton is carefully monitored like other acne patients. The treatment typically lasts about 6 months. But it's an option some people still don't want to consider.

Acne is caused by four main culprits, according to experts: excess oil production, clogged pores, inflammation, and bacteria.

Most dermatologists believe sharp hormonal fluctuations, for example during puberty or even menopause, play a big role in outbreaks.

Antibiotics are effective at killing off bacteria but there's growing concern about their over use and resistance.

"I'm on antibiotics right now, I just started back up," said Elizabeth Taylor, 52.

Taylor wants other mature women with stubborn acne to know they're not alone. She's tried it all but says only antibiotics keep her skin free of the large cysts.

"If I want to be clear, this is what I have to do," said Taylor.

Other prescriptions choices include topicals such as retinoids like Retin-A and oral medications, including birth control pills for women, to help keep skin clear. But in reality, most people are going to head for over the counter medications.

"It's very reasonable to start on a cleanser and a leave-on that has salicylic acid and benzoyal peroxide at low concentrations," said Dr. Roopal Kundu, dermatologist, Northwestern University Feinberg School of Medicine.

There's some newer acne products that are getting a lot of attention.

Dr. Kundu says, yes, they do work but so do the popular old standbys. The key to success with any product is sticking with one routine and giving it time to work. Know the active ingredient. For example, experts say benzoyl peroxide works best on inflamed pimples killing off the bacteria and drying up some oil. Salicylic acid helps correct abnormal shedding of cells lining hair follicles so black heads and white heads often respond best. Dr. Kundu recommends starting with an active ingredient that's in the 2 to 5 percent range.

"If you try that regimen for about 4 to 6 weeks and you are not making any improvementm, you are getting new outbreaks continuously and they're starting to leave any discoloration or scarring, it's time to come and see a dermatologist," said Dr. Kundu.

"It's the latest and greatest when it comes to acne treatment right now," said Dr. Simon Yoo, dermatologist, Northwestern University Feinberg School of Medicine.

Lasers and light therapy are the most modern treatments available, but there's still debate about their effectiveness. They work by killing off bacteria and promoting anti-inflammatory effects. They can be expensive, costing hundreds of dollars for one treatment and are usually not covered by insurance.

Michelle Lau has been battling acne since her teens. Now she's giving photo dynamic therapy a go.

"My acne is pretty severe so it's not going to be perfect but it's helped a lot," said Lau.

While no one treatment is effective for everyone, the key is finding the right product and giving it time to work.

Finally, when it comes to anything beyond mild acne, doctors say the most effective medications require a prescription.

Dr. Kelle Berggren
Central DuPage Hospital
DuPage Medical Group
199 Town Square
Suite A
Wheaton, Il.

Dr. Roopal Kundu
Northwestern University Feinberg School of Medicine
Suite 1600
NMH/676 N Saint Clair
Chicago IL 60611
Department of Dermatology
Patient Care Offices:
Northwestern University, Feinberg School of Medicine
Phone: (312) 695-8106 / Fax: (312) 695-0537
676 North St. Clair Street, Suite 1600
Chicago, IL 60611

Dr. Simon Yoo
Northwestern University Feinberg School of Medicine
Suite 1600
NMH/676 N Saint Clair
Chicago IL 60611

American Academy of Dermatology
PO Box 4014 Schaumburg, Il 60168

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)