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This article originally appeared in the July-August 1992 FDA Consumer. The version below is from a reprint of the original article and contains revisions made in December 1995.

On the Teen Scene:
                  Acne Agony

by Judith Levine Willis

 This article is a part of a series with important health information for teenagers.

 Tonight's your first date with the person of your dreams. You're standing in front of the mirror, coaxing your hair into a more sophisticated style when there it is--right on the tip of your chin--a big fat zit! You look at your face more closely and see another smaller pimple on your cheek. Lifting your hair, you spot several on your forehead, too.

 Why did this have to happen just when you want to look your best? And, while we're at it, why you?

 No one knows for sure exactly what causes acne vulgaris, the technical name for the zit attack. But researchers do know that it usually starts in adolescence and that heredity plays a big role. If one of your parents had acne, there's a good chance you'll develop it. If both of them had serious pimple problems, then your chances are even higher.

 If you have acne, you have lots of company--about 85 percent of the U.S. population between ages 12 and 25 develops some form of the skin condition. Most teens who get acne have the milder form, called noninflammatory acne, and get just a few blackheads or whiteheads every now and then. But some people suffer from the more severe form, called inflammatory acne, and have a constant outbreak covering the face, and sometimes also the neck, back, chest, and groin. These pus-filled pimples and cysts can cause deep pitting and scarring.

 Acne develops when glands that produce an oily substance called sebum begin to work overtime, possibly due to hormone changes that are at their peak in the teen years. One of the jobs of the sebum is to carry cells shed by the glands to the surface of the skin. But because the excess sebum is blocking the openings of the glands, called ducts, both cells and sebum accumulate, forming a plug called a comedo. If the plug stays below the surface of the skin, it is light in color and called a whitehead. If the plug enlarges and pops out, the tip looks dark and it's called a blackhead. This isn't dirt and it won't wash away. The darkness is due to a buildup of melanin, the dark pigment in the skin. If the process continues, a pimple forms.

 What Causes Acne?

 Acne most often starts at around age 11 for girls and 13 for boys. Scientists think a hormone called androgen plays a role in acne. Among other things, androgen stimulates the sebum-producing glands. After puberty, boys produce 10 times as much androgen as girls, and so it's not surprising that more boys than girls develop severe cases of acne. Also, bacteria called Corynebacterium acnes, which cause skin fats to break down into irritating chemicals, can directly contribute to an outbreak.

 Other things that can cause acne, or make it worse, are certain drugs, such as those used to treat epilepsy or tuberculosis; exposure to industrial oils, grease, and chemicals; and stress and strong emotions (which may account for the big date breakout). Some oily cosmetics and shampoos can, on rare occasions, trigger acne in people who are prone to get it.

 The American Academy of Dermatology says it's a good idea for acne sufferers to check with a dermatologist to ensure the skin condition really is acne. Rashes from other sources, such as make-up and oral medicine, can create acne-like symptoms.

 Many young women notice that they get more pimples around the time of their menstrual periods. In fact, some studies have shown that up to 70 percent of women notice their acne worsening the week before their periods.

 You may have heard that certain foods, such as chocolate, nuts, cola drinks, potato chips, french fries, and other "junk food" cause acne or make it worse. But there's no scientific evidence to back up these claims. Still, if you notice that outbreaks increase after you eat certain foods, it makes sense to eat as little of them as possible.

 Oily skin and hair don't actually cause acne, experts say. Although there is an association between the severity of acne and the amount of oil a person's skin produces, not all people with oily skin have acne. And some people with dry skin do!

 Does Anything Help?

 In one Swedish study, most people's acne improved after exposure to the sun. But not all doctors agree that sunlight is helpful. Some say it may just be relaxing in the sun that makes the pimples vanish. At any rate, the idea that the sun improves acne by drying out greasy skin doesn't hold water; sun and heat increase oil production.

 Mild acne can often be cleared up simply by washing your face once or twice daily and avoiding any food or drink you think triggers an outbreak. If these measures alone don't work, you may want to try one of the acne medicines that you apply directly to the skin and that are sold without a prescription. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid, all of which the Food and Drug Administration has found effective for treating mild acne.

 All of these drugs are "peeling agents," which cause irritation and drying that help the body loosen plugs and shed dead cells. The drugs also can keep bacteria from forming, which reduces the fatty acids that contribute to acne.

 (FDA officials are concerned about what happens when skin treated with benzoyl peroxide is exposed to sun. Research done so far hasn't shown the combination to be harmful. But the agency plans to review other studies currently in progress to ensure the safety of benzoyl peroxide products.)

 What won't work is picking at pimples. This can injure skin and underlying tissues. If you have acne that won't clear up with home treatment, see a dermatologist, a doctor who specializes in treating skin problems.

 Sometimes dermatologists use instruments called comedo extractors to remove blackheads. They may also surgically drain large pustules or abscesses.

 There are also drugs that can be prescribed for more severe cases. These include both topical and oral antibiotics such as tetracycline and erythromycin, and Retin-A (tretinoin), a derivative of vitamin A that comes in cream, gel or liquid. Another acne drug, Accutane (isotretinoin), is also derived from vitamin A. But this medication, taken by mouth, has serious side effects and isn't for everybody.

 In very rare instances, where these measures don't work or haven't been used before the acne causes permanent skin damage, plastic surgery can be used to smoothe over deeply pitted and scarred skin.

Acne may be an inevitable companion of the teen years. But today, with proper measures, it can usually be controlled before it becomes totally unsightly. And if pimples pop up for that big evening, don't let it get you down--your date will probably have a few, too.

 Judith Levine Willis is editor of FDA Consumer. Sharon Snider, an FDA press officer, also contributed to this article.

There is a treatment available.  Go to (see below).

One Acne Drug Causes Birth Defects

There is one medication for acne that teenage girls should be particularly cautious of. The name of the drug is Accutane (isotretinoin). It's a capsule taken by mouth and it's derived from vitamin A, which has for some time been known to cause birth defects.

 Accutane is approved by FDA for treating severe cystic acne for people whose skin condition does not sufficiently improve with other treatments, including antibiotics taken by mouth. Accutane completely clears acne in many people, but there continues to be concern about its use in young women who may become pregnant.

 The instructions that doctors receive for prescribing the drug warn:

Another acne medication, Retin-A (tretinoin), is also derived from vitamin A, but it is applied to the skin, not taken by mouth, and there have been no reports of birth defects related to its use.


 Publication No. (FDA)96-1197

Treatment for Acne

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