Guideline$: Following the Money in Acne Treatment

Are expensive acne prescriptions worth the cost?

MONDAY,  Sept. 16, 2013 (Medpage Today) — When the American Academy of Pediatrics endorsed guidelines recommending expensive prescription drugs to treat childhood acne, it didn't tell doctors this: 13 of the 15 experts who drafted the guidelines were paid consultants or speakers for companies that market the drugs recommended in the guidelines.

Or this: The organization that developed the guidelines — paid the academy to publish them — received 98% of its 2011 revenue from companies that make acne drugs.

The guidelines recommend prescription drugs that cost as much as $1,700 for a year's treatment. By contrast, benzoyl peroxide, an effective over-the-counter product that is a primary component in some of the prescription drugs, costs less than $80 a year.

In 2012, the top five prescription acne drugs racked-up $1 billion in U.S. sales, according to the drug-market research firm IMS Health.

How Acne Treatments Affect People of Color

People of all races and ethnicities have acne, but people with darker skin tones face certain specific side effects from the treatment for acne.

Treatments for acne are the same regardless of your ethnicity, but side effects can vary, depending on your skin tone, says Joyce M. Teng, MD, assistant professor of dermatology at the School of Medicine and Public Health at the University of Wisconsin in Madison. If you have black skin and acne flares, you will have to be more careful in dealing with your pimples to avoid problems.

Common after-effects of acne treatment are dryness and irritation. “For people with darker skin, if the skin gets too dry, the treated area can become either lighter or much darker than the rest of their skin,” explains Dr. Teng.

Does Over-the-Counter Acne Treatment Work?

Not every breakout calls for a trip to the dermatologist for prescription medications. But if you're using over-the-counter products, you need to know which ones have the right ingredients for your pimples.

Depending on how serious your acne is, you may be able to get effective acne treatment with over-the-counter products at the drugstore instead of by prescription. To get the best results, you need to know what ingredients to look for and, perhaps more importantly, what to avoid when trying to conquer your pimples.

The first step to getting successful treatment for acne in your local pharmacy aisles is to be realistic about the type of acne you have. Over-the-counter products are best for acne that can be described as superficial, rather than deep pustules or cysts, explains dermatologist Suephy Chen, MD, associate professor of dermatology and director of the dermatology clinical and outcomes research unit at the Emory University School of Medicine in Atlanta. “Once people start having cystic acne, over-the-counter products won’t do anything,” says Dr. Chen.

You're Never Too Old for Acne

Acne doesn't necessarily end once you're out of your teens — it can affect adults in their twenties, thirties, forties and beyond. What does change is the way you treat breakouts.

You may have thought that once you graduated from college, you'd be done with acne. Maybe you've even turned 30 or are starting to see the first signs of wrinkles, but find that your acne lingers on.

Acne sometimes continues beyond the teen years, or it may begin anew later in your life. However it happens, adult acne can be embarrassing and frustrating — but it is treatable.

Find the Best Acne Treatment for You

There are a number of options when it comes to prescription medications for your acne. How will you know what's best?

Acne is a very common, sometimes serious skin condition. While mild cases of acne can usually be treated with over-the-counter products, more severe cases may require the expertise of a dermatologist who can recommend prescription drugs.

“The medications one uses for acne depend on type and severity,” says Adelaide A. Hebert, MD, a professor in the dermatology department at the University of Texas-Houston Medical School.

Acne treatment may involve combinations of different kinds of medication: Some remove the dead skin and oils that clog pores and create acne, while other types of acne treatment target the formation of cysts typical of severe acne. Still other acne treatment works by attacking overgrowths of Propionibacterium acnes, a type of bacteria that occurs naturally on your skin but can cause acne when its growth is uncontrolled .

The Social and Emotional Fallout of Teen Acne

Teens experience enough physical and emotional growing pains without the stress of acne. That's why it's important to get early acne treatment for a teen with problem skin.

More than just your child’s complexion is affected by acne. Studies have shown that teens with acne often suffer emotional and social distress and sometimes even depression.

"Teen acne can have a devastating effect on self-esteem and body image, and can really do a number on kids," says Ted Grossbart, PhD, a licensed clinical psychologist and assistant clinical professor of psychology at Harvard Medical School in Boston.

The Tolls of Teen Acne

Teens with acne can experience:

• Embarrassment
• Shame
• Depression
• Anxiety
• Problems with socialization

The Truth About Natural Acne Remedies

When you have a bad case of acne, sometimes you're so desperate for a cure, you'll try anything, but do natural acne remedies really work?

If you have acne, you’ve probably heard about one natural acne remedy or another that your friend, mom, or maybe even a Web site claims will clear up your skin. You may be tempted to try one of these remedies if you’re not satisfied with conventional acne treatments, you like the idea of a natural, "non-toxic" acne treatments, or you’re desperate for anything that will cure your severe acne.

But the truth of the matter is most natural acne remedies haven’t proven to be effective, and some can even make acne worse.

Unproven Natural Acne Remedies

Among the home remedies that you may have heard about or used are:

How to Treat Back Acne

While genes and hormonal fluctuations are generally the cause of back acne, you can take steps to control it.

Your face isn’t the only place where acne can appear. It can affect any body part that has oil-secreting glands or hair follicles, including your back, chest, and shoulders. Back acne — sometimes referred to as “bacne” — can be particularly troublesome.

While 92 percent of people with acne have facial acne, 60 percent have back acne and even chest acne. Having acne on your back and chest is a sign that your acne is more likely to be severe.

Your back, like your face, has numerous sebaceous glands that secrete sebum, an oily substance. Sebum, along with dead skin cells and bacteria, can build up in the hair follicles on your back and clog them. A clogged follicle eventually breaks down and forms an acne lesion.

Drugstore Remedies for Acne

Before you see a dermatologist for prescription acne medications, try over-the-counter treatments for minor acne breakouts.

XYZPRAT A severe acne breakout that covers your face or body may require professional acne treatment from a dermatologist. But for most people, the occasional pimple or blemish can be handled at home with an over-the-counter acne treatment. There are many options to choose from and different ingredients to consider, so do your homework before putting anything on your face.

About Over-the-Counter Acne Treatments

Healthy habits — including a good skin care regimen, regularly washing your skin, and keeping your hands and oily products off of your face — are your first line of defense in preventing an acne breakout. But no matter how hard you try, you're likely to get a pimple or two at some point.

If you have regular acne breakouts, take steps to improve your skin care regiment. When problem skin is left untreated, you may experience frustration, problems with self-esteem, and physical scars from your acne. You can treat your acne breakout — so don't just live with it and hide your face until it goes away.

The Birth Control Pill as an Acne Treatment

Women taking oral contraceptives may experience a positive side effect of the birth control pill — it also serves as an acne treatment. Find out how the birth control pill can help you manage acne.

Women who are already taking birth control pills may notice a side effect that they enjoy — clear, smooth skin. “Oral contraceptive pills work well for mitigating acne,” says Amy Derick, MD, a board-certified dermatologist in Barrington, Ill.

While the connection between birth control pills and acne may not be obvious, changes in hormone levels in women can often trigger acne outbreaks. These changes — during puberty, pregnancy, menstruation, or menopause — affect oil glands in the skin. When these glands produce excess oil, called sebum, it can clog the pores and lead to unsightly pimples and blemishes. “Hormonal acne usually manifests as deeper bumps around the mouth and jaw line,” explains Dr. Derick.

Acne Extraction: Don't Try This at Home

When done by a skilled professional, acne extraction can clear up an acne breakout. But extraction is much more than just popping a pimple — and it can be dangerous to do at home.

You're carefully inspecting your skin in the mirror and see a glowing red pimple, just begging to be squeezed or popped. While popping that pimple may seem like a satisfying solution, it could make your acne problem worse. When you do attempt to extract a pimple yourself, you may push the contents deeper into your skin, introduce more bacteria into it through unclean nails, and risk scarring. Your best bet is to visit a dermatologist or aesthetician who will have sterile hands and use the appropriate tools.

9 Bad Habits That Can Cause Pimples

Avoiding certain behaviors can lessen your risk of having acne breakouts.

Clear, healthy, blemish-free skin is a dream for many — and though you can’t do anything about your hormones or hereditary, two main causes of acne, you can alter your daily routine to improve your skin’s appearance. Break your skin care bad habits to prevent acne and enjoy the healthy glow of clear skin.

Acne, the term for what's commonly called pimples or zits, occurs when oil, bacteria, and dead skin cells clog hair follicles. People with oily skin may be more susceptible to pimples because of their acne-prone skin, but breaking bad habits can still help them — and everyone else — prevent acne.

Break These Acne-Causing Habits

Here are the top bad habits that can take a toll on your acne-prone skin, resulting in pimples and blemishes:

How Julie Conquered Severe Acne

Julie Lin suffered physically and emotionally because of severe acne. But she found successful treatment and started a web site to help others.

Like many people, 28-year-old Julie Lin of Austin, Texas, thought that acne was mainly a problem for teenagers. She learned through personal experience that that’s not always the case — especially if you develop acne vulgaris.

“I first got mild acne when I was in high school, mostly small pimples all over my forehead,” Lin said. “They went away on their own, but my first serious bout of severe acne happened when I was 21. I thought you were supposed to grow out of acne, but acne seemed to be happening to me in reverse!”

Lin’s problem is not uncommon. Acne often starts at about age 11 or 12 and can be the first sign of puberty, but it doesn’t always end there.

Large Pores and Acne: What's the Connection?

If you have acne, you may also have enlarged pores. Following the right skin care regimen can help correct both beauty woes.

If you have acne, chances are you also have large pores. “A large pore is an indication of increased size of oil glands and oil production, and people with oily skin tend to have acne,” explains Joyce M. Teng, MD, assistant professor of dermatology at the School of Medicine and Public Health at the University of Wisconsin in Madison. “The size of oil glands is usually controlled by hormones, especially estrogen.”

For many people, both acne and large pores tend to be inherited, says Dr. Teng — and if acne runs in your family, you may experience more severe acne than in people without this family history.

How to Deal With Buttocks Breakouts

While it's not true acne, pimples on the buttocks can still be bothersome and painful. They often disappear on their own, but if they don't, there are treatments that can help.

Pimples on your buttocks are unsightly, annoying ... and not considered acne.

“Technically speaking, you don’t get acne on the butt,” says dermatologist Suephy Chen, MD, associate professor of dermatology and director of the dermatology clinical and outcomes research unit at the Emory University School of Medicine in Atlanta. “Acne is usually a facial or trunk [back and chest] eruption.”

In general, acne is defined as plugged pores, pimples, and cysts (which go deeper under the skin than pimples) that occur on the face, neck, shoulders, upper arms, and upper back or chest.

Common Acne Triggers and How To Avoid Them

Acne triggers are lurking where you least expect them — in things you use, wear, and do each day. If you identify your acne triggers, you can avoid them and keep skin clear.

If you've got problem or sensitive skin, you may have frequent acne breakouts — those pimples that dot your face no matter what you seem to do. Actually, what you do may be the reason that your face and skin breaks out — but understanding what acne triggers are and how to avoid them can help.

Common Acne Triggers

There are quite a few things you use, wear, and do every day that can trigger an acne breakout on sensitive skin that's prone to pimples. Here are some of the most common acne triggers:

Acne and Skin Care Resources

Dealing with acne can be challenge, but there are many organizations that can provide help and support for people with problem skin.

Acne can sometimes be a difficult problem to treat. And dealing with the consequences of problem skin — poor self-esteem, concerns about physical appearance, and even anxiety and depression — can be just as difficult. These acne organizations can help:

The American Academy of Dermatology (AAD) 

The professional organization for dermatologists, the AAD promotes research into dermatology and skin health, including acne, as well as education and support of patients throughout their care. The AAD Web site has tools to help patients find dermatologists, as well as helpful, easy-to-read information on acne and skin health.

The Right Cover-Up: Cosmetics That Can Prevent Acne

When the right type of makeup is used the right way, women with acne can cover their blemishes and even improve their skin.

If you've got acne, you may want to pile on the makeup concealer and skin foundation to hide a breakout. But you probably also know that makeup can clog pores, causing acne to get even worse. So what's a woman to do when she wants to put on her face without aggravating her acne? It's all about choosing the right cosmetics for acne-prone skin to prevent clogged pores.

Makeup Ingredients to Avoid

Acne occurs when too much oil builds up on the skin, clogging pores and resulting in a breakout of pimples. Many cosmetics contain oil, and adding even more oil to your face when you've got oily skin can cause an acne breakout.

Acne and Depression: More Than Skin Deep

Acne may appear on the skin, but its effects can go much deeper, even causing depression in some people. Fortunately, both are treatable.

You can use make-up to cover up some facial flaws, but if you have serious acne on your face, you can't completely hide it. You may feel that you have no way to conceal your imperfections from a world that judges you based on your appearance. Severe acne can have a significant impact on social relationships, and affect a person’s confidence and self-esteem in a way that leads to depression — particularly during the teen years. Depression is very common in people with severe acne, who may feel especially self-conscious about their skin.

Smooth Skin Again: Removing Acne Scars

If acne scars are a constant reminder of your past breakouts or unhappy teen years, you may want to investigate skin-smoothing procedures to help lessen their appearance.

If acne scars are making you self-conscious or embarrassed about your skin, learn about treatments that can remove or reduce their appearance. These acne scar treatments are not cure-alls, and insurance usually doesn’t cover them, but they do help to minimize the appearance of scars.

Types of Acne Scars

Some acne scars are permanent and some go away over time. Acne scars may be in the form of:

Getting Warmer: The Seasons and Your Skin

Dermatologist Ava Shamban, MD, shares the cold, hard facts about the havoc weather can wreak on your skin.

Growing up in Southern California, I knew winter existed, of course, but I didn’t really know it in my bones (literally) until I went to college in New England and medical school in the Midwest. Weathering the storm — the cold, the coats, the chaos — represented a whole other skillset for an L.A. lightweight like myself. And one of those was the negotiating the havoc of what winters, real winters, can do to the skin.

The cold alone can make your skin dry, cracked and irritated. It can even cause unexpected flare-ups for various skin conditions such as rosacea, psoriasis, and eczema.

The High Glycemic Food-Acne Connection

A new report confirms what dermatologists like Ava Shamban, MD, have long suspected: The very same foods that contribute to development of heart disease and diabetes can also bump up your risk of having acne.

Anecdotally, I’ve always felt there was a connection between diet and acne. Now, we've finally accumulated enough solid science to confirm this.

A new report published in the Journal of the Academy of Nutrition and Dietetics reviews research on acne and food from 1960 to 2012 and confirms the link. According to a press release on the report, the researchers "concluded that a high glycemic index/glycemic load diet and frequent dairy consumption are the leading factors in establishing the link between diet and acne."

For generations, dermatologists, researchers, moms, and the media have gone back and forth on the issue of whether acne breakouts are caused by diet. When I was growing up, the perceived wisdom was that chocolate and French fries were the major cause of acne. Then when I was in medical school the pendulum swung the other way and word had it that teenagers were going to get acne regardless of what they ate.

Severe Acne: A Problem With Mysterious Causes

Though many people endure the occasional pimple, it's possible to have acne so severe it significantly impacts your life.

When bad acne inflames and scars your skin and also affects your self esteem, you need professional treatment. Four main types of severe acne can cause chronic breakouts. Unfortunately while there are a number of good treatments for severe acne, the causes remain somewhat of a mystery.

What Is Severe Acne?

The pimple that pops up every so often — no matter how big and red it is, or how terrible the timing may be — isn't considered severe acne. Even a monthly acne breakout with a few bumps here and there that disappear isn't typically serious enough to need the extensive treatment that severe acne requires.

5 Common Myths About Acne

Does eating potato chips lead to breakouts? Can you prevent acne by washing your face three times a day? A dermatologist sorts acne myth from reality.

If you're trying to find out what's behind your acne breakout, first get the facts about acne.

Clare A. Pipkin, MD, a dermatologist and an assistant professor of medicine at the Duke University School of Medicine, clears up some of the confusion about acne.

Acne Myth No. 1: Poor Hygiene Causes Acne

A lot of people have heard this one — that acne is caused by dirty skin.

"Some patients believe this and end up washing their face numerous times a day, sometimes scrubbing vigorously and using harsh astringents," says Dr. Pipkin. In fact, washing your skin too frequently and too aggressively can make an acne breakout much worse.

Excoriated Acne — More Than Skin Deep

Acne may be a physical problem, but its origins sometimes lie in an emotional disorder. Excoriated acne is caused by an uncontrollable urge to pick at the skin, which can leave deep acne scars.

You may be tempted to squeeze or pick at a particularly large pimple that erupts on your nose or cheek or chin. But when the urge to pick and pop is overwhelming, and you spend hours scrutinizing and picking at your skin, excoriated acne can result.

Excoriated acne is a type of acne with a unique cause. The word excoriate means to tear or scratch off the skin. Excoriated acne is characterized by an intense, uncontrollable urge to squeeze and pick at every pimple on the skin — even a tiny, barely noticeable blemish. Squeezing the occasional pimple isn't considered excoriated acne — it occurs only when the habit becomes constant and uncontrollable.

What Is Acne mechanica?

Acne mechanica is common among people who play sports and young soldiers in hot climates.

If acne lesions start to sprout in places where your skin gets rubbed — such as on your shoulders where you carry your backpack, across your forehead beneath your hat or helmet, on your chin just under your helmet chin strap, or where you hold your cell phone — acne mechanica may be to blame.

The Basics of Acne Mechanica

Acne mechanica is a type of acne or pimples that’s caused by skin friction, heat, pressure on the skin, or when skin isn't exposed to the air. Sweaty, constantly rubbed skin can quickly break out in a bothersome rash that's really acne. The most common causes of acne mechanica include wearing:

Acne

If you're almost a teen, chances are pretty good that you have some acne. About 8 in 10 preteens and teens have acne, along with many adults. In fact, about 17 million people in the United States have acne. Acne is so common that it's considered a normal part of growing from a kid to an adult.

But knowing that doesn't make it easier when you look in the mirror and see a big pimple on your chin! The good news is that learning about acne and taking some simple steps can help you feel better about your face.

Acne is a skin condition that shows up as different types of bumps. They include whiteheads, blackheads, red bumps (pimples), and bumps that are filled with pus (called pustules). What causes these annoying bumps? Well, your skin is covered with tiny holes called hair follicles, or pores. Pores contain sebaceous (say: suh-BAY-shus) glands (also called oil glands) that make sebum (say: SEE-bum), an oil that moistens your hair and skin.

Myths About Acne

Do you think you already know all there is to know about acne? You may be surprised that some of the things you've heard about acne — like what causes it and how to deal with it — aren't actually true. Keep reading to find out some fast facts.

Myth #1: Tanning clears up skin.

Fact: Although a tan may temporarily mask acne, the sun can make the skin dry and irritated, leading to more breakouts in the future. In fact, there's no link between sun exposure and acne prevention, but the sun's rays can cause premature aging and skin cancer. Always protect your skin by choosing a sunscreen of at least SPF (sun protection factor) 15 that says noncomedogenic or nonacnegenic on the label, which means it won't clog pores.

Can Acne Scars Be Removed?

Different Types of Acne

Scars from acne can seem like double punishment — first you had to deal with the pimples, now you have marks as a reminder.

It helps to understand the different kinds of acne so you can figure out what to do about different types of scarring: Acne lesions or pimples happen when the hair follicles (or "pores") on the skin become plugged with oil and dead skin cells. A plugged follicle is the perfect place for bacteria to grow and create the red bumps and pus-filled red bumps known as pimples.

Acne comes in different forms:

Tips for Taking Care Of Your Skin

Sometimes it may seem like your skin is impossible to manage, especially when you wake up and find a huge zit on your nose or a cold sore at the corner of your mouth. The good news is that there are ways to prevent and treat common skin problems — read on for some tips.

Acne

A pimple starts when the pores in the skin become clogged with a type of oil called sebum, which normally lubricates the skin and hair. Acne is common during puberty when hormones go into overdrive, causing the skin to overproduce sebum. Because many oil-producing glands are on the forehead, nose, and chin, this area — the T-zone — is where a person is most prone to pimples.

Why Do I Get Acne?

If you're a teen, chances are pretty good that you have some acne. Almost 8 in 10 teens have acne, as do many adults.

Acne is so common that it's considered a normal part of puberty. But knowing that doesn't always make it easier when you're looking at a big pimple on your face in the mirror. So what is acne, and what can you do about it?

What Is Acne and What Causes It?

Acne is a condition of the skin that shows up as different types of bumps. These bumps can be blackheads, whiteheads, pimples, or cysts. Teens get acne because of the hormonal changes that come with puberty. If your parents had acne as teens, it's more likely that you will, too. The good news is that, for most people, acne goes away almost completely by the time they are out of their teens.

What Causes Acne?

Contrary to what you may have heard, acne is not caused by dirty skin. Acne is caused by overactive oil glands in the skin and a build-up of oil, dead skin cells, and bacteria, which leads to inflammation in pores.

Oil glands become stimulated when hormones become active during puberty, which is why people are likely to get acne in their teens. Because the tendency to develop acne is partly genetic, if other people in your family had (or have) acne, you may be more likely to develop it too.

Although there is no surefire way to prevent acne, try these tips to help reduce the number and severity of your breakouts:

• Washing your skin is essential (it helps remove excess surface oils and dead skin cells that can clog your pores), but washing too much can actually cause damage by overdrying your skin or irritating existing acne.

• Remember to wash after exercising because sweat can clog your pores and make your acne worse. If you work around greasy food or oil, or if you've been sweating from heat or because you've been working hard, wash your face and other acne-prone areas as soon as possible.

Acne: Signs and symptoms

Acne signs

Many people think that acne is just pimples. But a person who has acne can have any of these blemishes:

• Blackheads.

• Whiteheads.

• Papules.

• Pustules (what many people call pimples).

• Cysts.

• Nodules.

Acne appears on the face in all of the photographs above, but it can appear on other areas of the body. Acne can appear on the back, chest, neck, shoulders, upper arms and buttocks.

Acne scars: Tips for preventing

Gentle skin care can help you prevent acne scars.

It may seem that acne scars are inevitable; however, there are things you can do to reduce your risk of seeing scars when the acne clears.

Dermatologists recommend the following:

Treat the acne

The fewer breakouts you have, the less likely you are to develop acne scars.

Treating acne is especially important to prevent scarring, if you have any of the following:

Many Patients With Acne Take Antibiotics Too Long: Study

Prescription Accutane can often help and should be tried sooner, experts say

Many patients with severe acne remain on antibiotics too long before they are prescribed more effective medication, researchers say.

A team led by Dr. Seth Orlow, chair of dermatology at NYU Langone Medical Center in New York City, reviewed the medical records of 137 patients over the age of 12. All were treated for severe acne at Langone between 2005 and 2014.

On average, the patients were kept on antibiotics for 11 months before their doctors decided the antibiotics were not effective. Patients were then switched to the acne medication isotretinoin (brand name Accutane).