To Your Health

I know acne is not life-threatening, but it makes my life miserable. I am considering AccutaneTM treatment but I'm open to other suggestions.

Q. I know acne is not life-threatening, but it makes my life miserable. I am considering AccutaneTM treatment but I'm open to other suggestions.

A. The severe cystic acne that isotretinoin (AccutaneTM or ACT for short) is designed to treat can leave physical scars that can last a lifetime, as well as be the most embarrassing chronic condition of teenage or even adult years. However, this is a cure that may be more dangerous than the disease, especially for women of childbearing age. ACT was introduced in 1982, and by 1990 the Food and Drug Association had reported about 1,000 ACT-related birth defects, which led most physicians to require women to take birth control pills before ACT would be prescribed.

Recently the incident in which 15-year-old Charles Bishop crashed his small airplane into a building in Florida has highlighted a long-standing concern of a possible relationship between ACT and seizures, emotional instability, depression, and other psychiatric side effects. Just in the three years of 1998, 1999, and 2000, ACT was linked with at least 160 cases of suicide, attempted suicide, suicidal thoughts, and psychiatric hospitalizations. If there are other options besides ACT, try them first.

The root causes of acne are proving to be increasingly complex and difficult to unravel. There is a complex interaction of hormones, good and bad skin bacteria, and even a weak genetic predisposition to acne that enters the picture. You may not be able to control all these variables, but your skin environment need not be perfect to be sufficiently blemish-free.

Cleanliness should be the first principle of acne therapy but excessive washing to remove dirt may actually interfere with some of your natural defenses against harmful microorganisms. Explicit causes of acne include exposure to certain solvents or chemicals, particularly the chlorinated hydrocarbons in city water, so be cautious in your choice of skin cleansers. Try washing with glycerin soap and charcoal-filtered water to remove these detrimental substances without overly disturbing your skin environment. Some oily cosmetics may actually increase retention of pore-clogging material, and you may need to stop these cosmetics to see if they are to blame.

Many people assume that diet, especially chocolate, is linked to acne, but there isn't much research to support this. Similarly, though a diet high in iodine can create an acne-like rash in a few people, allergy to seafood is rarely the cause of acne. Unless your personal experience points to a specific food, continue to eat a variety of whole (and wholesome) foods while you search for a remedy that does not involve ACT.

Certain food supplements have been tried over the decades, but there is no single magic bullet for clearing acne. In one experiment men and women with moderate to severe acne were treated with a combination of 200 mcg selenium and 10 mg of vitamin E twice daily for a period of 12 weeks. Good improvements were noted, especially in patients with the worst acne. Also, it has been reported that both men and women with acne have lower serum zinc levels than healthy people, and those with severe acne have lower serum zinc levels than individuals with milder cases of acne. Zinc's action in acne is not fully understood, but it may relate to its role in transport and activation of vitamin A.

Vitamin A is not absorbed well when vitamin E is deficient, consequently some cases of acne that do not respond to vitamin A supplements will respond to a combination of vitamin A and vitamin E. Vitamin E may also inhibit the inflammation that is often present in acne lesions. Vitamin B-6 is among the nutrients reported to improve acne that blossoms in women near period time. A single multiple vitamin/mineral capsule with reasonable amounts of all these nutrients should be available at a good health food store.

Severe acne can leave scars on the face, but even worse are the scars left on the soul of a woman who gives birth to a baby with birth defects or the scars on a mother and father living with the knowledge that their child took his own life. Keep seeking alternatives to the ACT option.

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