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Acne leaves emotional marks

By Mary Brophy Marcus, Special for USA TODAY

Even a guy who’s comfortable in his own skin can feel uneasy in it.
Especially if it’s covered with acne, says Andrew Murray, 15, a laid-back high school freshman from Imperial, Mo., who has battled pimples and breakouts on his face for the past three years.

“It bothers me because your face is usually the first part of your body that people notice, and when you have acne, it makes you feel awkward,” says Murray, who has tried a myriad of medications.

There’s no reason to suffer, experts say. With proper treatment, the acne-afflicted can have healthier-looking skin and avoid long-term scarring. New medicine and technologies may help, too.

“I’m always crushed when patients come in with horrible acne scarring. It doesn’t have to be that way,” says Alicia Barba, a dermatologist in Miami.

Acne happens when sebaceous glands in the skin, which share a canal with tiny hair follicles, produce too much oil, called sebum. The sebum can plug pores, mix with bacteria and lead to inflammation, says Susan Bayliff Mallory, director of pediatric dermatology at St. Louis Children’s Hospital. The National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Md., says 80% of people will get acne at least once in their lives. Hormone changes play a key role. In teenage boys and girls, a surge in male sex hormones called androgens can cause sebaceous glands to enlarge and make more sebum.

More than just a teen phase

Doctors used to think adolescent acne was a benign rite of passage, but in the past few years, a number of studies have documented its psychological effect, says David Sarwer, an associate professor of psychology at the Center for Human Appearance at the University of Pennsylvania School of Medicine in Philadelphia.

Research suggests that up to 50% of adolescents with acne experience increased body image dissatisfaction, social anxiety, low self-esteem, and symptoms of depression. “Some become so upset they may think about or actually attempt suicide,” Sarwer says.

When Sterling Osborne’s acne flared up, the 15-year-old from El Portal, Fla., asked his mother if he could see a doctor about it. “He is good-looking, but when the acne got bad he would say, ‘Why would anyone want to go out with me?’ His confidence was low,” Sandra Osborne says.

Acne can take a toll on adults too, Sarwer says. Alicia Garnes, 34, a stay-at-home mother from Denver who has struggled with acne since her teens, says it can be brutal on self-esteem. “When I was in a professional environment, it felt like I was hard to take seriously,” Garnes says.

Hormonal changes related to pregnancy or stopping or starting birth-control pills also can lead to outbreaks. And some drugs may aggravate or cause acne. Though more research is warranted, stress and environmental factors may contribute, Barba says.

There’s also a genetic component, says James Leyden, emeritus professor of dermatology at the University of Pennsylvania School of Medicine. Children whose parents had are more likely to have it.

“Chronic acne is a valid medical condition,” Barba says.

But it’s a myth that chocolate and greasy foods cause acne, says Diane Berson, assistant clinical professor of dermatology at Weill Medical College of Cornell University-New York Presbyterian Hospital, in New York.

Dermatologists suggest treating mild acne with over-the-counter medicines. Look for topical creams, cleansers, and toners with benzoyl peroxide, salicylic acid, and sulfur, Barba says. If acne does not respond within a couple of months, or if there are pustules — fluid-filled lesions — or larger cysts, it’s time to see a dermatologist, Bayliff Mallory says.

Other treatment options

If a patient has severe acne and other treatments fail, a dermatologist may prescribe isotretinoin, generic for Accutane, which is derived from vitamin A. It has an extensive list of side effects — including dry lips, liver changes, and birth defects in pregnant women — that scares off some patients.

But Bayliff Mallory says it’s the closest thing to a cure. “If its use is monitored carefully, I think it’s a great drug. I put both my daughters on it,” she says.

Berson recommends various types of photodynamic therapy, one of which uses a blue light with anti-bacterial properties that may help ease lesions.

Barba says photodynamic light therapy is not an alternative to Accutane, but it may help shrink sebaceous glands temporarily. “What Accutane does is pretty miraculous. I do not think we’re there yet with photodynamic therapy,” Barba says.

Be cautious before submitting to newer laser technologies for acne or scars, warns Sewon Kang, professor of dermatology at the University of Michigan Medical School. “It’s unclear yet whether any of these lasers make a significant impact,” Kang says.

Finding medicines that work should clear up acne in most people. “Be compliant and be patient,” Barba says. “It can take months to see results. And it’ll probably get worse before it gets better.”

Posted 2/11/2007 8:30 PM ET