AcneNet This Month
May 2000

Tip of the Month

Acneiform (acne-like) skin lesions can occasionally be caused by iodine-containing drugs or by foods that have heavy concentrations of iodine. The skin eruption may closely resemble acne. Iodine-containing drugs or foods may also cause a flare-up of pre-existing acne.

A few differences between iodine-caused acneiform eruptions and acne vulgaris (common acne) include:

• an acneiform eruption can occur at any age, whereas acne vulgaris is more likely to occur before age 30
• an acneiform eruption can occur rapidly and be widespread rather than concentrated on the face or limited areas of the body
• comedones tend to be rare in iodine-related acneiform eruptions, whereas they are common in acne vulgaris
• pustules and inflammatory lesions are common in acneiform eruptions, and develop rapidly

Treatment includes avoidance of foods with heavy concentrations of iodine. If an iodine-containing drug is necessary to the treatment of a medical condition, a dermatologist should be consulted regarding the best approach to prevention and treatment of iodine-related acne or acneiform eruptions.

Fact of the Month

Steroid drugs are used for both medical and non-medical purposes. In either case, they can cause acne or aggravate existing acne, or cause an acneiform (acne-like) skin outbreak.

Steroid-related acne or acneiform eruptions are illustrated in the next four slides:

Probably the most common non-medical use of androgenic (male) hormones is for "muscle building" by athletes and weight lifters. These uses are usually illegal and always dangerous. Androgens are the male sex hormones closely associated with development of acne in adolescence as the body matures from child to adult.

When androgenic drugs are taken to "bulk up" muscle tissue, the hormone may stimulate sebaceous follicles to overproduce sebum, the oily substance that can give skin an "oily" look and can form part of the "plug" in a comedo. However, the androgenic drug may also over-stimulate the sebaceous follicles and cause degeneration of follicular tissue, resulting in inflammatory papules in addition to comedones.

Steroid-related acne and acneiform lesions are not restricted to any one part of the body. They can appear on the face, scalp, neck, torso, arms and legs.

Acne can be a side effect of medical uses of steroids. Steroids—in pills for systemic diseases, in cremes or salves for skin diseases—may be essential to treatment of those conditions. A dermatologist should be consulted regarding control of acne induced or aggravated by medically-necessary steroids.

Other medically-necessary drugs may occasionally cause or aggravate acne—for example, lithium, gonadotrophin, and certain antibiotics that can change patterns of bacteria on the skin.

Question of the Month

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

How early in life can acne develop? Can infants get acne?

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:

The mother of a 12-year-old daughter writes:

My daughter is beginning to have outbreaks of blackheads, whiteheads and pus-filled pimples. As a teen-ager and young woman, I had severe acne and was treated twice with isotretinoin (Accutane). I was a virtual recluse because of my appearance until I was in my early 20s. At age 40 I haven’t had any acne outbreaks for five years, but I have many acne scars on my face. I’m afraid my daughter is beginning to develop acne and I don’t want her to experience the emotional pain and isolation I went through. What should I be doing for her?

It is a common observation that acne "runs in the family", and this can be true up to a point. A 12-year-old whose mother had severe acne is at high risk for developing severe acne. Having a parent or sibling (brother or sister) with severe acne puts a child at high risk for developing the same condition.

There is no way to "turn off" an inherited predisposition to severe acne, but if the predisposition is recognized a long-term treatment plan can be put in place. While a predisposition does not absolutely predict that acne will develop, it is a high-risk warning that should not be ignored.

The role of genetics in acne becomes less clear-cut after one gets beyond the immediate family. There do seem to be families in which patterns of acne are apparent—types of acne, severity, age at which acne develops, etc. A more generalized genetic influence is suggested in the slightly higher incidence of acne in Americans of European descent than in those of African or Asian descent.

As work on the human genome progresses, it is possible that the genetics of acne will eventually be better understood. Until that time, we can use what we know about genetic influences to help people at high risk for severe acne.

Click on Acne treatments to learn more about daily skin care as an acne control measure.