PHOTO ILLUSTRATION/ANDREW VON ENGEL
With spring in full swing and summer right around the corner, many people are taking steps to improve their appearance. For high school students this may include preparing for prom, a formal event or graduation pictures. But wait – oh no! What is this red blotchy spot that came up overnight? Perhaps I’ll stay home sick…or wear a mask….
For many adolescents, the inconvenience of episodic acne is a reality, and may seem socially devastating when it worsens at the wrong time. The good news is that most patients will grow out of this, and by their 20s acne will be just another memory about the passage into adulthood.
There are a lot of myths regarding acne causes and treatments. In general, acne is not related to hygiene, and with rare exceptions is not in response to any particular dietary concerns. The best information indicates there is a strong genetic component for patients with severe acne (blame a parent), and that it can also be triggered by changes in hormonal production – which is why it often shows up during adolescence and resolves during early adulthood.
For patients bothered by only occasional or mild acne, over-the-counter topicals may be sufficient, using a combination of methods for drying the skin and removing excess oils that may clog pores. For those with moderate acne, there are several prescription options that may be appropriate when reviewed with a knowledgeable provider. These include topical medications as well as systemic medications that may be taken by mouth to modify the development of acne in the skin.
For certain individuals, the answer may not be so simple. Unfortunately patients with a more severe form called nodulocystic acne, or severe inflammatory acne can develop scarring and other skin damage if untreated. Some indications that acne may be in the severe category include involvement of the skin with large nodules; pitting or scarring following outbreaks; or a significant inflammatory component with redness involving a large surface area of the face, neck, shoulders or trunk in addition to the individual acne eruptions.
Another important marker for patients that may experience lifelong difficulties with acne is how far down the trunk the acne extends. Patients with involvement on only the tops of the shoulders can expect to see complete resolution sometime in their 20s. Unfortunately, for those with involvement to the middle or lower back, symptoms may persist well into late adulthood if left untreated. For these patients, specialized treatment with a medication called isotretinoin may be appropriate.
Isotretinoin is a medication that has been marketed under several different names. It works to fundamentally change new skin cell production and can be life-changing for patients with severe scarring acne. A successful course of therapy lasting typically three to six months can often result in full remission.
There are several particular risks with this medication and as a result it has to be prescribed by a doctor with special certification and through a centralized monitoring program. Most importantly, the medication is known to increase significantly the risk for certain types of birth defects in women of childbearing age, and therefore exceptional care has to be taken in this population. It is also important for patients taking Isotretinoin not to share it with anyone else and to keep it in a secure location.
So, for patients concerned about skin changes in adolescence, the good news is that most of the time episodes are self-limiting and not a concern regarding overall health. For patients with more significant involvement however, help is available. A good place to start is with your family physician or pediatrician, although for severe acne a dermatologist or someone with advanced training in skin conditions may be required.
Dr. Armitage, medical director at Camas Swale Medical Clinic in Creswell, has a special interest in dermatological conditions and is a registered prescriber with IPLEDGE, the central monitoring program for Isotretinoin products.
