AcneNet This Month
April 1999

Tip of the Month

If you are like many people, you hesitate to "run to the doctor" for what you, or your friends and family, perceive as a minor health problem. You may have friends or relatives who would criticize you for seeing a physician about a seemingly minor problem such as an ingrown toenail that is becoming infected, or diarrhea that has lasted for more than a week—or, for acne that won’t go away or seems to be getting worse.

There are circumstances when seeing a doctor makes sense because a "minor" problem is not minor at all. An ingrown toenail that is becoming infected can become the focus for a serious infection of the entire toe. Diarrhea that lasts for more than a week may be a symptom of a serious underlying disease. Acne that won’t go away, or is getting worse, can affect your entire emotional and social life and become one of your most serious problems.

When is acne "serious" enough to see a doctor about it? Here are some guidelines:

• The acne makes you so shy and embarrassed that it literally changes your outlook on life.

• None of the non-prescription products you have used has been effective in clearing up your acne.

• You are beginning to see acne scars after acne lesions clear up.

• You have painful, pus-filled lesions (nodules) in addition to blackheads and whiteheads (comedones), and reddened spots on your skin.

• If you are a dark-skinned person, acne is beginning to cause darker patches on your skin.

Acne can usually be effectively managed by proper medical care. You shouldn’t hesitate to seek medical help for a problem that seriously affects your life. For information about how to contact a dermatologist in your area, click on Find a Dermatologist.

Fact of the Month

Some of the most common questions asked by visitors to the AcneNet website are about the value of "alternative medicine" for treatment of acne. In most instances, these are questions about pills or lotions made from "natural" ingredients such as herbs. They are "alternative" because they are not medicines prescribed by a physician, and people may think of them as being alternatives to non-prescribed (over-the-counter) acne treatments such as benzoyl peroxide. "Alternative medicines" may have a long history of use as home remedies.

It is usually not possible to provide definitive information about "natural" or "alternative" health-care products. They are not regulated by any agency such as the Food and Drug Administration, so they are not required to be subjected to carefully designed testing in animals or humans. Thus, there is no scientifically acceptable record of their effectiveness or side effects. There may be anecdotal (word-of-mouth) claims by manufacturers, sometimes with testimonials from satisfied customers. Anecdotal claims are not scientifically acceptable evidence.

Alternative medicines and home remedies for acne are often recommended by acquaintances, friends or relatives. A friend of a friend, for example, may tell you about a home remedy that cleared up his or her acne. Should you try the remedy?

Here are some questions you should think about before you try an "alternative" or "natural" acne treatment (they are questions a doctor would ask about a medical product):

• How many people has it helped, other than the person who recommended it to you? Can you find out if these claims of being helped are true? Are there studies of this treatment published in medical journals - that is, medical journals you could find in a medical library?

• Has it been harmful? What are its side effects? What are its interactions with other medications you may be taking? Would it affect any allergies you may have?

The bottom line on "alternative" and "natural" treatments for acne is that there is often no proven evidence that they are effective, and not much evidence that they are harmful. However, some have known interactions with prescribed medications, so if you are taking prescribed medications you should always tell your doctor before using an "alternative" medicine.

Each month we pose a question that is answered the following month. This month’s question:

I have both blackheads (open comedones) and whiteheads (closed comedones).The whiteheads sometimes become inflamed and painful, and take weeks to go away. The blackheads are just unsightly. Why can’t I squeeze the blackheads to improve my appearance, and pop open the whiteheads before they get inflamed?

We’ll have the answer, and a discussion of the answer, on AcneNet next month.

Answer to Last Month’s Question of the Month

Last month’s question was:

Why does acne clear up on the faces of some women while they are taking birth-control medication?

Women with acne who take birth-control medication may experience improvement or clearance of the acne. Sometimes the acne returns when birth-control medication is stopped; in other instances, acne does not return. The full effect of birth control mediciation on acne is usually seen three to five months after the medication started.

The female hormone estrogen, a component of birth-control pills, is the reason acne clears up while a woman is taking birth-control medication. Estrogen counteracts the male hormone testosterone, which stimulates production or over-production of sebum by stimulating the oil glands in the skin, and may thus lead to formation of comedones. 

Sometimes a dermatologist may prescribe estrogen for a woman who does not respond to other acne therapy. However, estrogen use must be carefully considered. Estrogen is never given to a man to treat acne, as it may have an inappropriate ‘feminizing’ effect.

Whether or not estrogen may be used to treat acne is a matter each girl or woman needs to discuss with her dermatologist.