Acting on Acne

Troubled skin can leave physical and emotional scars

Acne is often considered a normal rite of passage for adolescents. Some cases resolve on their own. However, severe cases can lead to scarring that lasts a lifetime. Before it gets to that point, medical intervention can help.

“Acne is a real disease,” says Dr. Peter Teichman, family physician at Asante Family Medicine in Ashland. “It probably causes more suffering than any other disease because it comes at adolescence when kids are already self-conscience about their appearance. Acne can cause them to withdraw socially. It can cause a sense of shame. I think the psychological damage is underrated.”

Teichman stresses that acne is an inherited condition and is not caused by bad hygiene.

“Acne is caused by a combination of hormones and increased production of oil during puberty,” he says. “The sebum glands get clogged. This obstruction can lead to infection which produces blackheads and whiteheads. It’s not dirt. In fact, many of my patients actually overclean which can lead to irritation.”

Joe Gatti, physician assistant at the Clinic for Dermatology and Wellness in Medford, says that the most severe type of acne is inflammatory acne which causes nodules and cysts.

“These cysts can be big, red and painful,” he says. “This is the type of acne that causes disfiguring scars. The goal is to get the patient on products quickly to lessen the lesions and prevent scarring.”

Teichman says the first thing to do is dry up the oil.

“I tell my patients that we want to turn the body jungle into a body desert,” he says. “Topical medicines like benzoyl peroxide are relatively inexpensive and are available in over-the-counter products. This may be all that is needed for mild acne. For moderate acne, Retin A can be used alone or in conjunction with oral antibiotics.”

Isotretinoin is the medicine of choice for severe cases, according to Gatti.

“Most of the people I see have tried many different therapies before they see a doctor. For inflammatory acne where nothing has worked, we prescribe isotretinoin. This is the medicine that most people know as Accutane,” he says. “It has to be prescribed by a doctor and must be closely monitored.”

Teichman says that isotretinoin, a vitamin A derivative, substantially reduces oil production.

“It turns off the faucet. It is incredibly effective for cystic scarring and resistant acne,” he says.

Doctors and patients must agree to regulations established by the I Pledge program, Teichman explains. After a lengthy consent process, the patient starts with a blood test. Female patients also get a pregnancy test. The treatment lasts for six months. Each month, the blood and pregnancy tests are repeated. Girls can also use hormone therapy in the form of oral contraceptives or the vaginal ring. Both do a fairly good job of reducing acne, he says. In fact, girls are required to use two forms of contraception during the time they are on isotretinoin because isotretinoin is known to cause birth defects during pregnancy.

“Some say that these treatments can cause depression, but I have found it to be an antidepressant,” Teichman says. “The psychological toll and sense of shame are removed. By improving their skin, it improves their outlook in general. Their heads are held high for the first time in years. Those who are motivated do very well. We tell them to take heart. Their expectations are always exceeded. The most important thing is to get treatment early to prevent scars. Although there is no cure for acne, we have products that substantially reduce acne.”

Potential Raised Quote:

“The most important thing is to get treatment early to prevent scars.” Dr. Peter Teichman, Asante Family Medicine, Ashland

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More to Explore

Do personal habits affect acne?

According to Dr. Peter Teichman, family physician at Asante Family Medicine in Ashland, patients should avoid oil-based makeup. Other than that, he says there is no evidence that any one facial cleanser is better than another.

As for diet, Teichman says the relationship between diet and acne is highly contentious.

“The impact of diet on the course of acne remains unclear,” he says. “Therefore, I don’t emphasize diet changes specific to acne. I do give general nutrition advice. A concern I have about food and acne is that patients or their parents may blame the patient for having acne, including ‘causing’ acne by eating the ‘wrong’ foods. My professional approach is to do what we have proof works.”

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