March 2001

Tip of the Month

People with acne often recognize that acne seems to "run in the family." One or both parents may have acne, or had acne earlier in their lives. Brothers or sisters may have acne. By comparison, other families seem to have no particular pattern of acne.

The observation of acne "running in the family" has also been made by acne investigators. Acne vulgaris frequently has a recognizable pattern of familial inheritance, especially in the case of severe acne. The genetics underlying this pattern are still not clear. There has been no discovery of an "acne gene." There have been studies highly suggestive of genetic predisposition, however.

In studies of acne in identical twins, for example, both twins are found to be affected in the great majority of cases. But, even though the rate of sebum production is the same in both twins, the severity of acne is not always the same in both twins. This indicates that, as in other diseases with a genetic basis, the interaction of genetic predisposition with environmental factors often determines (1) whether or not the disease will appear, and (2) the severity of disease if it does appear (Click on Why and how acne happens to learn more about bacteria and other environmental factors in acne).

While acne may not always be entirely preventable in a person with a strong genetic predisposition to acne, preventive measures such as regular examinations by a dermatologist can help to moderate the disease.

Fact of the Month

Studies of sebaceous follicles in people with and without acne have shown that in people with acne something happens in the sebaceous follicle that makes it susceptible to forming acne (Click on Why and how acne happens for information on the influence of androgenic hormones on the sebaceous follicle). Normally, cells shed inside the follicle in large "clumps." In people who get acne, these clumps together with increased sebum form a mixture that clogs pores. The aggregated plug of sebum and dead cells first causes a micro-comedo to form; the micro-comedo may develop into a blackhead and become inflamed.

Retinoids, derivatives of vitamin A which interact with so-called retinoid receptors on skin cells, work to correct the abnormal shedding of cells. Read more about retinoids in next month’s answer to this month’s Question of the Month.

Question of the Month

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

My doctor is prescribing a topical retinoid for my acne. He said a retinoid is a substance related to vitamin A. If the drug is related to vitamin A, shouldn’t vitamin A dietary supplements be helpful in getting rid of acne?

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

Last months question was:

My 15-year-old daughter has what I would describe as a very mild case of acne. She has made it much worse by constant picking and squeezing. She looks in the mirror for hours, looking for some blackhead or blemish she can pick or squeeze. Does she need psychological counseling?

The typical person with excoriated acne is a person—often a young women—who is so distressed with her appearance due to acne that she literally tries to "squeeze the acne out of existence." The acne is often very mild, but the person’s face may constantly be covered with red marks from squeezing, and open sores where lesions have been picked open.

The word excoriate means to scratch or abrade the skin. Excoriated acne is a medically recognized condition that should be discussed with a dermatologist. Occasionally giving in to a temptation to squeeze a blackhead is not defined as excoriated acne. Hours in front of a mirror, squeezing and picking every blemish, is a definition of excoriated acne. A dermatologist may be able to counsel the patient regarding a course of treatment in which the patient can participate, but keep "hands off."