In ancient times, bad skin was considered such a curse that the complexion- challenged were shunned or stoned.
Times haven't changed all that much.
As beauty standards narrow, a faceful of acne can present a serious barrier to social and occupational success. A British study shows that people with acne are nearly twice as likely as those with clear skin to be unemployed.
"There's a great deal more importance placed on appearance than there used to be," says Dr. Roger Ceilley, past president of the American Academy of Dermatology. "We've promoted a very unreal image that people can't live up to."
As social pressures have intensified, however, so have efforts to develop effective treatments. Now that some prescription treatments are up to 100 percent effective, dermatologists say, there's no longer any need to suffer from acne.
Still, although an overwhelming majority of teens have acne, a recent study by the American Academy of Dermatology shows that only 7 percent of them have consulted a dermatologist.
When Ceilley began practicing dermatology in the early 1970s, his mostly teen-age patients were relatively unself-conscious about their acne. Not anymore. Today, even a mild case of acne is enough to trigger a full-blown depression.
"Sometimes it's out of proportion," Ceilley says. "But this is an age when children are already insecure about their self-image and how they fit in."
Teens with more severe acne worry if they'll ever fit in.
"They're feeling more traumatized by social and peer pressure," he says. "If people call them 'pizza face,' they can develop some real problems if they don't get treated."
Although dozens of over-the-counter and prescription preparations are available, the gold standard for treatment of severe acne is Accutane, an oral medication introduced in 1981. A powerful vitamin A derivative, Accutane prevents pimples from forming by shrinking the skin's oil-producing sebaceous glands.
Treatment usually lasts four to six months. Males typically require only one course of therapy. Since menstrual cycles can complicate acne treatment, females often require two or three courses.
In recent months, Accutane, however, has come under fire from critics who worry that it might cause psychological problems. Since 1989, the FDA has fielded 12 reports of suicides among people taking Accutane. Other patients have complained of depression.
To date, about 8 million people worldwide - including 2 million Americans - have been treated with Accutane.
Although researchers have yet to establish a relationship between Accutane and psychological problems, prescriptions must now carry the warning: "Accutane may cause depression, psychosis and rarely, suicidal ideation, suicide attempts and suicide. Discontinuation of Accutane therapy may be insufficient; further evaluation may be necessary."
While dermatologists still insist the drug is safe and effective, they acknowledge that patients need to be monitored more carefully for signs of psychological distress. Patients whose complexions deteriorate after Accutane is discontinued require additional attention.
Since Accutane also produces side effects ranging from chapped lips to birth defects if taken by a pregnant woman, it isn't for everyone. Most dermatologists prefer to start with less .. powerful, over-the-counter and prescription treatments such as drying lotions, topical Retin A and oral antibiotics.
"We look at the treatment of acne as steps on a ladder," says Larry Cole, a dermatologist in Colorado Springs, Colo.
THE LIFE CYCLE OF A ZIT
Although your complexion may seem clear, that doesn't mean a zit isn't forming in your face, chest or back.
The trouble starts with your sebaceous glands, which cling to hair follicles like little sponges. Around puberty, the glands begin squeezing out an oil called sebum. Normally, sebum flows up the hair follicle to the skin's surface and is washed away.
Sometimes, however, the sebaceous glands produce too much sebum, which mixes with dead skin cells, pigment and bacteria to form an embryonic zit called a microcomedo. Like the plug of a volcano, it blocks the flow of sebum, which creates pressure.
Over several weeks, it grows into a baby zit. Typically just before a date, job interview or other important event, it makes its arrival into the world as a whitehead or blackhead.
A whitehead, or closed comedo, is a small bump. A blackhead, or open comedo, is just a pencil prick. Its dark color is caused by oxidized melanin pigment, not dirt.
Pressure builds inside this plugged system until material leaks or bursts into surrounding tissue, causing redness and swelling. You now have an adolescent zit or pimple.
ALL GROWN UP
The body responds by dispatching white blood cells to the scene - the cells produce pus. You now have a fully mature zit or pustule.
In the worst cases, the pustule will live to a ripe old age. It will become so deeply embedded that you develop chronic cystic or nodular acne.
In most cases, however, the pustule will die a natural death in about 10 days. That's assuming, of course, that you don't prolong its life by picking at it.
Your complexion once again will be dewy fresh. Until another sebaceous gland decides to act up.
Because acne cuts across all socio-economic lines, its presence or absence indicates nothing about a person's potential as a friend, date or employee.
Still, people with severe acne often have such an exaggerated fear of social contact that they don't date, go out with friends or participate in sports. Fearing rejection, they shrink from academic and occupational challenges.
Their self-esteem can fall so low they may develop dysmorphophobia (a hatred of the way they look) and depressive symptoms such as spontaneous crying, insomnia, behavioral problems and suicidal thoughts. The result can be lifelong psychological damage.
A recent American Academy of Dermatology survey of 500 teen-agers shows that the stigma against so-called bad skin is deeply embedded. Among the findings:
* 41 percent of teens consider people with acne less desirable.
* 36 percent of girls and 19 percent of boys say acne makes them feel self-conscious.
* 28 percent of boys and 19 percent of girls prefer to date partners without severe acne.
* 13 percent of girls and 6 percent of boys say they like themselves less because of acne.
* To be rid of acne, 33 percent of teens would give up a date with Cindy Crawford or Brad Pitt, and 22 percent would give up a $1,000 prize.
WHAT TO DO
To keep whiteheads, blackheads, pimples and pustules at bay, dermatologists recommend observing these do's and don'ts:
* Wash skin two or three times a day. If you have sensitive skin, try a mild, hypoallergenic nonsoap cleanser.
* Shampoo every day to keep hair oil away from your face.
* Use water-based cosmetics or oil-based brands labeled "non-comedogenic."
* Shave lightly. Men should experiment with blades and electric razors to see which is less irritating.
* See a dermatologist if over-the-counter remedies don't bring improvements.
* Eat foods that seem to cause breakouts. Although greasy foods seldom cause acne, researchers have linked flare-ups with foods high in iodine (shellfish, seaweed, iodized salt) and iodine-containing mineral supplements.
* Don't bake in the sun or use tanning lamps. Ultraviolet light can damage the skin's pores and make acne worse.
* Don't pick your zits. It increases the risk of infection and permanent scarring.
For a free brochure about acne and other skin conditions, plus a listing of area dermatologists, call the American Academy of Dermatology at 888-462-DERM, or visit its Web site (www.aad.org).
Nearly 80 percent of Americans can expect to develop acne at some point in their lives, yet acne myths and misconceptions abound (no doubt kept alive by the lucky 20 percent who have never grown a Mount Vesuvius on their nose).
Among the most stubborn myths are that acne is caused by poor personal hygiene and eating chocolate, pizza and other greasy foods. Researchers rejected this blame-the-victim theory more than 30 years ago.
Acne is nearly always triggered by factors beyond a person's control, such as heredity, stress and hormonal changes associated with puberty.
That doesn't mean hygiene isn't important; over-washing as well as under-washing can make acne worse. Nor does it mean that some foods can't make some people break out. If your acne is always worse after eating Snickers bars, it might be wise to switch to a chocolate-free snack.
Pub Date: 11/01/98