ACNE:  SOME FACTS
Up to 90 percent of boys and up to 80 percent of girls experience acne, making it the most common skin ailment seen by physicians. At first glance, acne may seem to be a superficial problem that affects only the skin, but this is not true. First, the disease has a wide spectrum, ranging
from just a few transient pimples to large, chronic, painful nodules that scar when healing. Second, the scars caused by acne are not limited to the skin. The psychological effects may not be as visible as the skin lesions, but they can be even more painful and distressing. In fact, it is the
psychological and social effects that motivate the typical acne patient to seek consultation and treatment with a physician. The psychological effects caused by acne fall into several categories:

Decreased Self-Esteem

People who have had acne for a long time report feelings of being unattractive, and believe that the first thing someone notices about them is their skin problem. They feel self-conscious and less attractive to the opposite sex. They feel frustrated because they feel there is no cure, yet
their disease doesn't elicit sympathetic feelings from other people.

Problems with Body Image

Some people with acne feel so self-conscious about their physical appearance that they shun mirrors to avoid having to see their acne scars.
For them, acne represents a lessening of their self-worth and a blow to their self-image.

Embarrassment Leading to Social Withdrawal

Humiliation about having a skin disease causes some people to avoid social interactions. Some feel very embarrassed when they think someone else is noticing their acne. Having acne affects self-esteem, causing young people to avoid dating, parties, or speaking up in front of their classmates.

Depression

When he looked in the mirror, one acne sufferer described seeing his face as physically distorted and "overwhelmingly exaggerated." Others report an inability to continue with normal life activities like going to school, talking with the opposite sex, and interviewing for a job. Significant,
chronic feelings of depression may warrant treatment with an
antidepressant until the acne is well under control. The new
antidepressants called selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in more than half of those treated who have moderate to severe depression.

Anger

Anger is a normal feeling for many people with acne. They feel frustrated and judged, believing that other people assume they don't wash their faces enough, or that they don't care about their appearance. An obsessive concern about how others view them sometimes makes communication difficult and frustrating for family and friends who would
like to relate to them in a different context.

Confusion and Frustration

Some patients feel that they are given misinformation about their acne from the medical community. They feel upset when they use products to improve their acne and fail to see immediate results. They also feel that their acne is not always taken as seriously as they would like by their doctors, or that their doctors don't adequately explain treatment
expectations.

Limitations in Lifestyle

Acne can alter normal life activities dramatically. One teen described feeling very awkward about taking gym class because others would see blood on his clothing from the acne, and think that he had been hurt in football practice. One young lady felt very inhibited shopping at the grocery store, thinking that others would blame her for her acne if they
saw her buying chocolate or chips.

Difficulty with Family Members

Many acne sufferers have difficulty dispelling the myths their parents believe about acne and its causes. Parents can be unsupportive and blame their children for having acne. These parents may believe the acne is due to inadequate hygiene or unhealthy eating habits, neither of which is true.

Acne is the most common skin disease, especially in adolescence.
Education about how it affects the psyche will help to alleviate the distress it creates. Teenagers with acne should know that their skin disease is normal and common, and that help is available. If over-the-counter products have not helped their skin after six to eight weeks, a visit to the physician is warranted. Parents can help their children by accepting acne as a normal part of growing up, and by being supportive of their children during this difficult period. Physicians can help
by treating the acne, explaining what to expect during treatment, and dispelling common acne myths.




How Is Acne Treated?

Severe, extensive, or resistant forms of acne may require systemic therapy (medicine taken orally). For less recalcitrant cases, topical treatments often produce the best results.

Many topical over-the-counter products contain benzoyl peroxide, an effective acne treatment. Topical antibiotics, such as erythromycin and clindamycin, also can be helpful. The combination of a topical antibiotic during the day and tretinoin (Retin-A) at night is often successful.

Retin-A is the most often prescribed treatment to reduce the formation of blackheads and whiteheads. With the help of its active ingredient tretinoin, Retin-A has the ability to penetrate beneath the surface of the skin and work where acne begins. It may prevent further outbreaks by keeping skin cells from sticking together and causing new acne lesions.