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Treatments save faces from acne

Making new friends, meeting new people, going out on weekends and interacting with new peer groups are all staples of a normal college social life.
Students with moderate to severe acne, however, might find difficulty in doing those things.
While many students have dealt with acne by the time they reach college age, the irritating and sometimes painful affliction and the scarring it causes can damage a person’s complexion and self-esteem well into adulthood.
Thomas Beaumont, assistant professor in Boynton Mental Health Clinic, said while most college students develop coping mechanisms to deal with the self-esteem problems associated with acne, for some students, particularly ones who are attending college in a new area, it poses a problem.
“People who are going to be making choices and doing things that negate any chance or opportunity to connect with people because they are afraid of that original encounter, then they’re going to feel alone and lost,” Beaumont said.
Beaumont said feelings of loneliness can sometimes be a precursor to depression.
As many as 95 percent of people suffer from some form of acne in their lifetimes. Most, but not all, of the outbreaks occur in the person’s adolescent years. Many people suffer occasional outbreaks of pimples and blackheads and will be relieved of the problem by their early 20s.
More than 40 percent of these adolescents, however, will have acne severe enough to contact a physician. Some people, especially women, experience outbreaks in their late 20s and acne rosacea, a chronic form of acne that affects adults.

The root of the problem
Acne begins when the glands at the base of hair follicles produce too much sebum, an oily substance that normally passes through the skin’s surface.
When hair follicles become clogged, they become a breeding ground for bacteria that feed on the sebum and infect the area.
In adolescent acne, male hormones, which are present in both males and females during puberty, overstimulate the glands in the follicles, producing too much oil and clogging the follicles.
While acne remains somewhat mysterious, one issue on which dermatologists agree is what constitutes proper hygiene. Dr. Peter Lee, University assistant professor of dermatology, says excessive face washing will not help the situation.
“If you wash your face twice a day with any soap, it should be good enough,” Lee said. “People who have acne, no matter how much they scrub their face — it’s not going to improve.”
In fact, Lee said continued scrubbing might actually worsen acne.
There are differing severity levels of the affliction, but conditions ranging from just a few pimples to deeper inflammatory lesions are all considered acne.

Treatment options
Numerous over-the-counter products are available for treatment of minor acne, and, for those patients who do not respond to these regimens, Lee recommends seeing a dermatologist.
“I would say anybody that has more than a couple lesions that don’t improve with over-the-counter topical medications, they would be a very good candidate for Retin-A or other topical retinoid products,” Lee said.
Retinoids, including Retin-A, are topical treatments that work by reducing the bacteria present, opening up clogged pores and down-regulating oil production.
A powerful medication also available is Accutane. Unlike Retin-A, it is an oral treatment and reduces much more oil and decreases the number of organisms that could potentially cause irritation to the skin.
Not everyone is able to tolerate Accutane, which has serious side effects, including dry skin. Also, women on Accutane must take birth-control pills because it has a significant incidence rate of causing birth defects.
Despite these drawbacks, Lee said Accutane remains the closest thing dermatologists have to a cure for acne and recommends the five-month course for patients who have scarring or who are not improving with oral antibiotics.
“For the ones who are qualified to receive it and who don’t have any side effects from it and who take the proper dosage, approximately 75 percent will get rid of acne for the rest of their lives,” Lee said.
For the other 25 percent, Lee recommends a second course of Accutane. If that is not successful, he said patients might just have to live with occasional acne breakouts.

A clearer future
With the development of these new treatments, including Accutane, Retin-A and even new oral antibiotic treatments in the last 10 to 15 years, the future looks bright for new methods of fighting acne.
“I’m very excited,” Lee said. “We are only going to get better in terms of how we understand acne and how we treat it.”
One barrier to progress Lee envisions is cost. He said many people shy away from the cost of medications and dermatological visits if their health care plan doesn’t cover it.
A tube of Retin-A, which will last a person only one month, can cost up to $40, while a five-month course of Accutane might cost up to $800, depending on the patient’s need.
Lee said many providers force doctors to seek prior authorization on a case-by-case basis.
“Every time you write a prescription for this condition, you have to be willing to write letters and answer phone calls from them. It’s a huge hassle,” he said.
The University provides students with several options.
David Golden, community program specialist at Boynton, said the University insurance plan fully covers dermatology visits at the University and 80 percent of visits outside the University.
He added that student services fees cover visits at Boynton with professionals well-versed in the area.
Despite the advances in treatments and understanding of the disease and the breakthroughs that are in the future, Lee does not see a cure for acne anywhere on the horizon.
“What we are trying to do is just treat the symptoms now. Acne seems to be one of those things where people are just going to get it.”

Justin Costley covers the Medical School and welcomes comments at [email protected]. He can also be reached at (612) 627-4070 x3224.

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