Jewish World Review July 31, 2003 / 2 Menachem-Av, 5763


Lasers join the healing arsenal of acne-fighting options

http://www.NewsAndOpinion.com | (KRT) When it's time for hot weather and skimpy clothes, which part of your body are you most reluctant to bare in public?

If you have acne, you might say "my face."

It's hard to confront the world while coping with the blackheads, whiteheads, bumps and cysts of acne. It's especially challenging to get the fresh-faced look that goes with summer's straw hats and beach gear.

But doctors say prompt treatment should enable most people to put a stop to acne - ideally, before it does lasting damage.

"The aim is to prevent scarring, which you carry with you the rest of your life," said Dr. Jon Morgan, dermatologist with Carolinas Dermatology Group in Columbia, S.C.

Dermatologists treat acne internally and externally, with medications, cleansers, lotions and gels. During the past year, Morgan also has been using a laser to treat acne as well as the scars it leaves.

It's not about vanity, Morgan said. It's about helping people to have the poise and self-assurance they need to be successful in their occupations and personal lives.

"When you have bad skin, it affects your confidence," he said. "And it also affects the way people see you."

What causes acne?

Acne develops when the skin's oil glands become clogged, which leads to bacterial growth and inflammation. It often develops during puberty, when sex hormones work overtime and produce more oil.

Hormone changes during a woman's menstrual cycle also can cause acne, and some people are more prone to problems because acne runs in their families. Keeping your face clean won't necessarily prevent acne, and eating greasy food doesn't cause it. But working in a greasy environment - fast food preparation, for example - can aggravate it, said Dr. Amie Shannon, a dermatologist with the Medical University of South Carolina.

And especially during warm, humid weather, she said, acne can develop in an area where there is friction, such as beneath the strap of a bicycle helmet.

Most common on the face, neck, chest and back, acne symptoms are mimicked by some other conditions. These include the redness and breakouts of rosacea, and acne-type breakouts on the back that are treated with antifungal medication.

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Shannon said that as acne heals, pigment-producing agents in the skin are stimulated and inflammation results. This stage can be especially troubling to those with dark skin, such as blacks and Asians, who may be dotted with darker blemishes.

Even a small-scale acne breakout can be serious to a person whose confidence and self-esteem are affected, Morgan said.

"My definition of `serious' is that it bothers you."

Over-the-counter remedies such as benzoyl peroxide can kill the acne bacteria and dry up the excess oil.

But if acne gets progressively worse and over-the-counter products don't help, it may be - time to see a dermatologist.

Many people feel that summer sunlight helps acne. There's some truth to that, "but it's not really something that a dermatologist would recommend," Shannon said, because it increases skin damage and risk of cancer.

Treatments of choice could include antibiotics, either oral or topical (applied to the skin). If the outbreaks are mostly blackheads and whiteheads rather than inflammatory, cystic acne, Shannon probably would try retinoids. These come in lotion and gel form, in Retin-A and other brands.

Morgan believes that oral antibiotics aren't effective. But both he and Shannon said they've seen good results with Accutane, a medication that's somewhat controversial. Accutane use must be monitored carefully, the doctors said. Female patients must not become pregnant while using it because of the risk of birth defects. It also has been linked with psychiatric side effects in some patients - though Shannon said she frequently finds it has the opposite effect.

"Often they're depressed by their acne to begin with," she said, "and after using Accutane, they're usually happy that their skin is looking better."

For some patients, nothing seems to work.

"I have tried everything," said Karen Ramos, 45, of Columbia.

The only thing that has helped is treatment in Morgan's office with the Candela Smoothbeam laser, FDA-approved for treating acne last year.

Laser energy targeted at the oil glands reduces acne lesions without damaging the upper layer of the skin, according to the manufacturer.

Recently, Ramos went for her second full treatment. A topical anesthetic numbed her skin first. Morgan mapped her face into sections. Then, after they both donned protective eyeglasses, he methodically zapped her face with the tip of the laser.

There was a crackling sound and small, snapping sensations. "It doesn't hurt," Ramos said. A bit of redness on her face was the only side effect. Laser treatments can vaporize current blemishes as well as diminish scars, Morgan said, and they work equally well on dark skin.

"If you fail with Accutane, you don't have too many alternatives, except this," he said.

Costs may be comparable as well. One full treatment with the laser costs $300, and three to five treatments usually are needed. Accutane costs about $12 per pill, or $360 for a 30-day supply.

___

ACNE Q&A

So common yet so aggravating, acne can be treated successfully.

Q: What causes acne?

A: Clogged oil glands that become infected and inflamed. Contributing factors include hormones and genetics.

Q: Do greasy foods cause it?

A: No. But it can be aggravated by grease in the air (as in a fast-food kitchen) or greasy hair products.

Q: Lots of people get pimples; when should one see a doctor?

A: See a dermatologist if over-the-counter remedies don't help. Untreated, serious acne, especially the cystic type, can be painful and can cause scarring.

Q: How do doctors treat acne?

A: Oral medications as well as gels and lotions applied to the skin. Laser treatments were FDA-approved last year to treat acne and its scars.

Q: How about acne and black skin?

A: Treatments work on black skin as well. The dark blemishes that plague blacks and Asians with acne occur because of pigment changes while lesions are healing.

Q: Are bleaching products effective on these dark spots?

A: Be cautious. Sometimes it's better to wait for them to heal. With these products, you have to be careful not to bleach the acne areas lighter than the rest of the skin.

Q: What are common mistakes people make in trying to cope with acne?

A: Many people do not realize how frequently they touch their faces during the day. (That's a no-no.) Also, they should be careful to buy skin-care products that are noncomedogenic. That means they won't clog pores.

_Source: Dr. Amie Shannon, dermatologist at the Medical University of S.C.

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