AcneNet This Month
August 2000

Tip of the Month

Menstruating women and pregnant women may notice a change in the appearance or severity of their acne during menstruation or pregnancy. The change is real, and probably due to the alteration in hormonal balance during menstruation and pregnancy.

A dermatological investigator with a large number of female acne patients found that 35% to 40% of the menstruation-age women had more prominent acne lesions in the week before menstruation, with the lesions remaining more prominent for the next 7 to 10 days. After the menstruation cycle was completed the lesions usually returned to their pre-menstruation appearance.

Pregnancy causes improvement in the appearance of acne in most women, but in others pregnancy may be associated with deterioration in acne—an "acne flare" as seen in this photo:

(Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides, and the Sulzberger Institute for Dermatologic Education)

A dermatologist may recommend safe and effective treatment of the acne of pregnancy.

Hormonal therapy that is similar to hormonal changes occurring during menstruation and pregnancy is sometimes used by dermatologists to treat acne that is resistant to other treatment. This therapy should be carried out only under the supervision of a dermatologist and/or gynecologist.

Fact of the Month

Isotretinoin (Accutane) is the most potent and effective drug available for treatment of severe acne. When and why should it be used? (Click on Acne treatments for more information about isotretinoin).

If you have moderately severe to severe acne you have probably heard or read about isotretinoin, and have wondered if it is a drug you should be using. This is a decision that must be made jointly by you and your dermatologist.

Isotretinoin is an orally-taken drug with a number of possible side effects that can be unpleasant or even dangerous—and most people who use isotretinoin experience side effects. Women who are pregnant, or who may become pregnant during isotretinoin therapy, should not use this drug. Isotretinoin must be used with caution in people with certain medical conditions. These are points to discuss with your dermatologist.

However, used with all due caution, under close medical supervision, isotretinoin may be the only effective treatment available to some patients with severe acne that has not responded to other therapy. One of the severe, treatment-resistant forms that usually responds to isotretinoin is cystic acne.

The following photos show cystic acne before treatment with isotretinoin:

The next photo shows cystic acne after treatment with isotretinoin:

(Photos used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides, and the Sulzberger Institute for Dermatologic Education)

The duration of effective isotretinoin therapy may vary from person to person. At the end of an effective course of isotretinoin therapy, all or most acne lesions should be cleared up, and use of the drug discontinued. For a substantial number of patients, one course of isotretinoin therapy is all they will ever need, although they should continue to observe rules of good skin care. After a course of isotretinoin, there may be residual erythematous (reddish) macules (flat red spot) where acne lesions were formerly present. These macules are not scars and they will fade in six to eight weeks. A small number of patients require more than one course of isotretinoin therapy for severe acne.

Question of the Month

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

A 15-year-old male has blackheads, whiteheads and oily skin—in other words, mild acne vulgaris. He is embarrassed and feels socially isolated because of his appearance. His father tells him that acne no worse than this is "normal" in a teen-ager, and if left alone will disappear in a few years. Is the father correct?

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:

My doctor insists that acne is not an infectious disease, but he wants to treat me with antibiotics because he thinks Propionibacterium acnes is contributing to the severity of my acne. If acne isn’t an infectious disease, why do I have to take antibiotics?

Answer: Even though P. acnes may be a contributing cause of some cases of acne, P. acnes is not transmitted from one person to another. You cannot "catch" acne from another person, and therefore acne is not called an infectious disease.

As discussed in Fact of the Month in last month’s AcneNet Update, P. acnes is a normal resident of human skin. Whether or not you have acne, you have P. acnes living on and in your skin. Because P. acnes likes an air-free environment, it likes especially to live in the air-tight microenvironment of sebaceous follicles. Under certain conditions—for example, when sebum production is copious—P. acnes populations may increase and chemical by-products of P. acnes metabolism may contribute to acne severity.

A dermatologist may determine that antibiotics are justified in order to reduce the P. acnes population both on the skin and in sebaceous follicles. Antibiotics are potent drugs, and they must be used only under the direction of a physician.