August 2001

Continuous exposure to a hot, humid atmosphere may be a factor in causing or worsening acne in some people, especially younger people who are at higher risk for acne due to hormonal changes of adolescence (Click on Why and How Acne Happens for information about the causes of acne). Some investigators have observed an increased risk for acne in people (especially young people) who work in kitchens, laundries and industrial settings with high heat and humidity. Some patients with acne may notice a worsening of their acne in summer heat and humidity, or in exposure to tropical regions when on vacation or military duty. In contrast, summer sun and dry atmosphere may improve acne in many people. (While the sun may temporarily mask acne, tighten up pores, or dry up the oil glands, the sun will also damage follicular walls and clog pores – resulting in more acne that usually surfaces three to four weeks after sun exposure.)

One investigator’s proposed explanation for the effect of heat and humidity on acne is that absorption of excessive moisture by the skin causes the skin to swell. As the skin swells, it restricts the openings of sebaceous follicles, thus restricting the outflow of sebum and initiating conditions that can result in the formation of comedones.

A person with acne who believes that high heat and humidity may contribute to the precipitation or worsening of the condition should discuss the situation with a dermatologist.

Fact of the Month

While recurrent, severe acne that persists for many years despite repeated courses of treatment is an uncommon problem, it is a major problem for those affected.

For the majority of patients, acne is a condition that is a treatable medical condition. In addition, when severe, untreated acne can result in disfiguring scars.

Recurrent, severe acne is a problem that resists easy explanations. Possibilities that may be considered by the patient and physician include:

• Inability to tolerate side effects has affected the patient’s use of the most effective acne medications
• The patient’s physician is not as knowledgeable and experienced as a dermatologist in the diagnosis and treatment of severe acne
• The acne lesions have become secondarily infected by pathogenic (disease-causing) bacteria, and a full microbiological work-up is required to identify the bacteria and initiate effective antibiotic therapy
• The condition is not acne vulgaris but an acne variant such as 
  acne conglobata, a highly inflammatory disease with comedones, nodules, abscesses, and draining lesions that usually has its onset in adulthood. The diagnosis and treatment of this disease requires a dermatologist
• Over time and with increasing frustration, the patient becomes less compliant in the use of effective medication
• If the patient has many nodules or cysts that do not respond to medical therapy, a surgical approach may be considered if recommended by a dermatologist
• The patient’s acne fails to respond to adequate therapy despite maximum compliance, and both patient and dermatologist must continue to seek a diagnosis and effective treatment

Treatment-resistant acne requires persistence and patience by both patient and dermatologist. Click on Find a Dermatologist for assistance in locating a dermatologist in your geographic area.

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

I have been using topical benzoyl peroxide and an oral antibiotic for my acne and have noticed blue-black and brown marks developing on my face and some discoloration on my body. The marks are especially noticeable around acne scars and recently healed lesions. Is this a side effect of medication and is it permanent?

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

Last month’s question was:

I have been using topical benzoyl peroxide and an oral antibiotic for my acne and have noticed blue-black and brown marks developing on my face and some discoloration on my body. The marks are especially noticeable around acne scars and recently healed lesions. Is this a side effect of medication and is it permanent?

Answer: It is not possible to make general statements about side effects of medications that apply to individual cases. A dermatologist should be consulted. The facial marks and body discoloration described by the patient in this case do fall within the range of side effects of some antibiotics.

Unique patterns of pigmentation are sometimes seen in acne patients treated with certain oral antibiotics—particularly minocycline. The pigmentation patterns that appear may include:

• Localized blue-black or brown marks in and around acne scars and in areas of previous acne inflammation
• A "muddy skin" appearance that may cover much of the body
• Diffuse brownish pigmentation of the feet and lower legs.

The pigmentation side effect gradually disappears after the therapy 
is discontinued.

Any side effect of a medication should be noted by the patient and brought to the attention of the physician. While most side effects are temporary they should be discussed with the physician and monitored.