Lifestyle Choices

Sometimes dermatologists use the antibiotic tetracycline, usually administered in doses of 250 milligrams twice a day. In many cases this has dramatically reduced the acne probably by altering the chemistry of fatty acids in the skin so that the sebaceous glands are rendered less active, as well as acting on the infection itself. But there are disadvantages to antibiotic treatment, too, particularly in growing teenagers, for it does inhibit protein synthesis in mammalian cells. It can also stain the teeth when used over a long period of time and of course disrupts the natural intestinal flora, which produce many of the body’s B-complex vitamins.

Sometimes a dermatologist will lance a cyst in order to release the trapped infection in it and help it heal. Resorcinol, a white crystalline antiseptic substance that is soluble in water, alcohol, and oils, is often useful and prescribed along with vitamin A acid. It is antiseptic and antifungal.

An outmoded treatment for acne, X-ray therapy, will slow down the activity of the oil glands by destroying their very active cells, but it is also dangerous since X rays are destructive to skin in general. Indeed, X rays used for acne treatment have been linked with the occurrence of skin cancer later. Like X-ray therapy, sun exposure for acne is also controversial. It does seem to help temporarily in some cases. The trouble is that although it is beneficial while you are in the sun and although tanning makes the appearance of acne less offensive, the condition often becomes much worse after periods of sun exposure. Sunlight, either “sun lamps” or the real thing, should be used only if you have certain proof from past experience that it is helpful to you in the long run. Because of the stress aspects of acne, both regular exercise and meditation or deep relaxation can be helpful too.

Treatment of Scars

The treatment of acne scars is a different matter altogether. It should only be attempted after the acne has completely cleared up. There are three methods: dermabrasion, chemical peels, and plastic surgery.

A smoothing operation to minimize the pits and wrinkles on the skin, dermabrasion demands great skill in the hands of the dermatologist, who uses a motor-driven wire brush, rather like a dentist’s high-speed drill, to take off the epidermis. The skin is first sprayed with a refrigerant—often ethyl chloride—to eliminate pain. Then the imperfections are abraded using a variety of brushes, or fraises, finishing off with a very smooth disk called a diamond fraise. Planing away the skin’s surface like this makes the acne pits seem shallower. It also makes the follicles shorter and thicker by taking off the top layers, so one can hope the oil secreted by the glands can more easily reach the surface of the skin and they won’t become so easily blocked in the future. After dermabrasion, the patient is sent home with pain-killers for a few days while a crusty surface develops on the top of the skin. This is shed in a week or so, leaving the reddish new surface which gradually returns in color to normal.

Chemical peeling aims at much the same thing, but instead of using a physical abrader it relies on a caustic substance such as trichloracetic acid or phenol to do the job. It can be difficult to control the depth to which the burning takes place, but this is terribly important, for if the chemical peeling goes too deep, only scar tissue will grow back all over the face. This is why much peeling that is done nowadays is done with milder chemicals that limit the amount of peeling and drying of the skin. In the case of mild peeling, the edema that develops helps temporarily at least to smooth over irregularities of the skin.

With a deeper peeling, the patient is given an anesthetic; then the chemical peeler is applied. In a few minutes the skin turns grayish white. Then, later, a brown crust appears, which falls off after three to five days. Alternatively the dermatologist can cover your face with occlusive surgical tape to get a deeper penetration. A day or two afterward, the tape is removed to leave an oozy, reddish-brown mask that looks a little like a very bad sunburn; then, in a week to ten days, the crust falls off and the new, pinkish skin appears beneath it.

Chemical peeling for acne scars is expensive and has many possible side effects. It can cause scarring and occasionally serious infection if proper sterilization procedures are not carried out. It makes the skin extremely sensitive to sunlight, so that it often develops brown splotches.

Cosmetic surgery can sometimes help scarred skin simply because the pulling up of the skin smooths it out and lessens the depth of pits and scars. Some surgeons will cut out raised scars and then later treat the flattened scar area that remains by dermabrasion. Often, treatment for acne scars employs a combination of these methods.

One more treatment for acne needs to be mentioned, although it is little known in some countries, particularly the United States. This is the use of pulsed high-frequency (PHF) waves directly on the surface of the skin. Electromagnetic medicine has long been used in the hands of physiotherapists to treat athletic injuries. It can also be an effective treatment for acne, eczema, psoriasis, and other skin problems, probably because of the ability of PHF to stimulate rapid healing of tissue and to minimize scarring. The practitioner directs the pulsed radio waves from a machine to the troubled area for half an hour and then treats the liver and the adrenal area (the pulsed waves enter the body to a depth of 6 inches) to encourage total body healing. PHF treatment is also useful after cosmetic surgery and dermabrasion, to speed healing and minimize scarring.

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