from the Spring 2005 issue
Recent research is advancing our understanding of the cause of acne and finding new ways to treat it. Investigators from the Harvard School of Public Health found a positive association between teenage acne and teenage milk intake. Instant breakfast drinks, sherbet, cream cheese, and cottage cheese were also significantly associated with acne, but other dairy foods, soda, french fries, chocolate candy, and pizza were not. The authors of the study postulate that hormones or other bioactive molecules in milk stimulate acne in teenagers. More studies are needed to actually prove that milk intake causes acne. In the meantime, however, if your teenager is battling acne, there is probably nothing to lose by trying a dairy-free diet to see if that helps. Just be sure to have him or her take calcium and vitamin D supplements. For patients who want to learn more about the possible effects of diet on acne, I recommend Dr. Nicholas Perricone’s book, The Acne Prescription.
Just as hormones in milk can be associated with acne, we know that teenagers’ acne closely parallels their levels of hormonal activity. Androgens are the male hormones that kick in at puberty in both young men and women. Androgens stimulate the oil glands to produce oil, which starts the acne process. The active oil glands tend to get blocked by oil and skin cells, thus creating “clogged pores” (blackheads and whiteheads). The blocked pores trap bacteria below the surface, and these bacteria grow, resulting in red bumps and puss-filled cysts.
For young women, one treatment option that can modulate the acne-causing hormones is birth-control pills. Research has shown that one of the best birth-control pills for young women prone to acne is Yasmin. Yasmin contains the synthetic progestin drospirenone, which is different than the progestin in the other birth-control pills on the market. It blocks the action of androgens, which is how it works to suppress acne. Yasmin provides 99 percent efficacy as a birth-control agent, and unlike some birth-control pills, it does not tend to cause weight gain.
Another rapidly growing area in acne treatment is the use of lasers and light. These treatments are particularly helpful for people who either can’t tolerate or are not candidates for Accutane®. There are a multitude of lasers and light sources on the market. We have three in our office. First is the Aurora acne treatment system. It uses a combination of blue light, which kills the acne-causing bacteria and radio frequency, which helps to shrink the sebaceous gland. Treatments are done either once or twice a week for a series of eight, then once a month for maintenance. The CoolTouch® laser is another option that treats acne scarring in addition to active acne. Heat generated by the laser helps to kill bacteria, shrink oil glands, and stimulate new collagen production, which improves acne scars. Treatments are done once a month for four to five months. The third light-based acne treatment we have is called photodynamic-therapy (or PDT for short). First, a medication called Levulan is applied to the skin, then a blue light is shined on the skin to activate the Levulan. This procedure causes bacteria in the pores to be killed and the oil glands to shrink. Treatments are done every two weeks for up to four sessions.
For really difficult cases of acne, the gold standard of treatment remains the drug Accutane® (isotretinoin). Isotretinoin is not a first-line treatment. It is used when patients have failed to respond to topical therapy and oral antibiotics. Because of potential side effects, patients on isotretinoin must be closely monitored with monthly blood tests. The most potentially serious side effect of the drug is severe birth defects that can occur when a pregnant woman takes it. In spite of strict procedures put in place to try to prevent pregnancies in women taking isotretinoin, the pregnancy rate has remained steady at about 120 a year. Because of this news, even stricter rules for people taking isotretinoin will go into effect in July 2005. Although some doctors may stop prescribing isotretinoin because of the hassles involved, we will continue to offer it to patients with severe acne because it truly is a miracle drug for them.