AcneNet This Month
August 1999

Tip of the Month

Knowing as much as possible about the causes of acne can be one of the best ways to deal with the social and emotional impact of acne.

Why? Because knowing as much as possible about the "why" of acne can bolster your self-esteem. Acne is not "your fault". Much of the emotional and social stress of acne is caused by what other people say about you, or how other people act toward you—or, by your perception or fears of how other people are talking or acting about your acne.

You often can’t do much to change what other people say or do, but you can modify your reactions to what other people say or do in regard to your acne. Often, people are not purposefully cruel in their words or actions, but they may be thoughtless—perhaps because of their own misguided beliefs that acne is caused by poor personal hygiene or by poor diet. Other people may also say thoughtlessly hurtful things because they think of acne as a trivial problem that can be the subject of "pimple jokes". As a respondent to our Tell us about yourself questionnaire noted, it can be difficult to be the constant butt of "pimple jokes" from coworkers who just cannot understand the pain caused by their supposedly funny remarks.

A British dermatology investigator found, in a study of 2,000 young people, that those who were better informed about acne were more likely to deal effectively with social and emotional problems associated with acne. Information and education can be effective in helping you feel better about yourself, and in dealing with the words and actions of people around you.

Fact of the Month

"Compliance" is a word that has a specific meaning in medicine, and it is a word with specific importance for patients.

"Compliance" with treatment means complying with the physician’s instructions if you are under a doctor’s care, or following label instructions if you are using a nonprescription medication. Noncompliance can render a treatment ineffective, or even harmful.

Here are some common failures of compliance:

• Doubling or tripling a prescription medication dose ("If one pill is good for me, then two or three may be better")
• Increasing a prescription medication dose is dangerous; side effects of a doubled or tripled dose of some medications can send you to the hospital.

• Skipping a prescription medication dose ("Missing one or two doses couldn’t hurt that much")
• The timing of medications is usually important for maintaining an effective level of the medication in your body; skipping doses can make a medication much less effective.

• Using a topical medication more often than prescribed or recommended ("If I use it more often, my acne may go away faster")
• Most topical acne medications are used to gently cleanse the skin of excess oils and remove bacteria; used more frequently than prescribed or recommended, topical medications may actually irritate the skin and contribute to increased inflammation.

• Using other medications in addition to those prescribed or recommended by your physician ("My friend used this herbal treatment, and said her acne went away")
• Some herbal medications can cross-react with other medications, and produce unpleasant or harmful side effects; if you are following a treatment plan under a physician’s care, you should not add other medications to the schedule without your physician’s knowledge.

Sometimes a person with acne is "willing to try anything" to bring the acne under control. The best approach, however, is one based upon scientific medicine. With this approach, both the physician and the patient have important roles in making a treatment maximally safe and effective.

Question of the Month

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

Is acne an infectious disease? If a person with acne kisses another person, can that other person get acne from contact with acne lesions?

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

Last month’s question was:

A person who is taking isotretinoin (Accutane) for severe acne is told to stop taking vitamin A, or a multivitamin containing vitamin A, during the Accutane treatment. Why is that?

Isotretinoin is a biochemical in the retinoid family of biochemicals that includes vitamin A. Retinoids, and especially isotretinoin, have very potent effects in the skin, which is why they are used as drugs to treat acne. However, they also have effects throughout the body. Taking vitamin A, or a multivitamin containing a high dose (25,000 IU or more) of vitamin A, while you take isotretinoin may put you at risk for suffering the effects of vitamin A overdose in your skin, bones, liver and other organs.

Isotretinoin, or any potent drug, must always be taken precisely as indicated by your physician. Skipping doses can lessen the drug’s effect. Combining or "doubling up" on doses can lead to uncomfortable side effects. Taking the drug together with another drug not approved by your physician can lead to dangerous drug interactions.

While you might not think of a vitamin pill as a "drug", the warning against taking vitamin A while you are taking isotretinoin must be regarded as seriously as a "drug interaction" warning.

To learn more about the retinoids, click on Acne Treatments.