- The Washington Times - Monday, August 22, 2005

Kimberly Miller of Alexandria thought she was finished with acne, but when she was 33 years old, she had a flare-up.

“I felt awkward,” she says. “You think you’ve aged out of it, but you haven’t. That’s the lesson — it can come on at any time.”

Ms. Miller, who is now 39, contacted her dermatologist, Dr. Paula Bourelly, director of Olney Dermatology Associates in Olney.

In 2000, Dr. Bourelly put Ms. Miller on a months-long course of Accutane, an oral medication used to treat severe acne. In April of this year, Ms. Miller returned to Dr. Bourelly for a series of glycolic acid peels, following bridal magazine advice for dead skin removal and exfoliation.

“Now, my skin is wedding perfect,” says Ms. Miller, who plans to marry in October. “My skin is smoother, and it has a nice glow.”

Acne is the most common skin disorder in America, affecting 17 million people and nearly 80 percent of 11- to 30-year-olds, according to the American Academy of Dermatology in Schaumburg, Ill.

“Acne is not a serious physiological disease,” says Lydia Preston, author of “Breaking Out: A Woman’s Guide to Coping With Acne at Any Age.”

But those with acne may feel embarrassed or experience social drawbacks, says Ms. Preston of Alexandria.

“If you’re a woman with acne, you’re not alone,” she says. “It’s very common for adult women to have acne to some degree.”

Ms. Preston and a few dermatologists in the metro area provide suggestions for treating acne and explain some of the causes.

The common form of acne, acne vulgaris, is experienced by both adolescents and adults, while acne rosacea, which causes a flushing and blushing reaction, is seen only in adults.

Acne vulgaris, which affects more than a third of women and a fourth of men, typically does not extend beyond the 40s, says Dr. Alan Moshell, skin diseases branch chief for the extramural program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda.

Acne, Dr. Moshell says, is not caused by dirt on the face, as commonly believed.

“Excessive rubbing and scrubbing can make it worse,” he says.

Acne is an inflammatory condition involving the face, chest, back and arms, the areas of the body that are richly supplied with sebaceous, or oil, glands, says Dr. Bourelly, assistant clinical professor at Georgetown University Hospital in Northwest.

Each sebaceous gland is connected to a follicle, which contains a fine hair, that together form a pilosebaceous unit. The sebaceous gland produces an oily substance called sebum to protect the skin and keep it lubricated. The sebum reaches the skin’s surface through the opening of the follicle, or pore.

“There’s not one cause of acne,” says Dr. Maithily Nandedkar, a dermatologist at Dermatology Associates of Northern Virginia, which has offices in Sterling and Centreville. “Clearly, hormones play a large role in altering the hair follicle, such that the ducts that allow the sebaceous oils that come to the surface of the skin to become blocked. Once that occurs, bacteria and other debris can collect within the follicular structure.”

The androgen hormones, which control sebaceous gland activity, stimulate the glands to produce more than normal amounts of sebum, Dr. Nandedkar says. Sebum acts as a food for Propionibacterium, or P.acnes, which lives within hair follicles under the skin, she says.

The hair follicles become clogged and the immune system overreacts to the overgrowth of bacteria, causing an inflammatory response, says Dr. Anthony Gaspari, professor of dermatology and department chairman at the University of Maryland School of Medicine in Baltimore.

“When the levels of sex hormones increase in blood, that’s when the hair follicles trigger oil gland secretion and other things in the pathogenesis of acne,” Dr. Gaspari says.

Acne can result from the use of oil-based cosmetic, skin care and hair products and certain medications, such as androgens and lithium. Hormonal changes can cause acne, such as from a pregnancy. And genetics can come into play.

“We haven’t found a clear link to foods, like greasy foods or chocolate,” Dr. Bourelly says.

However, diet can play a role in acne rosacea, which causes overactive sebaceous glands, dilated blood vessels in the face, and papules and pustules. Caffeine, alcohol, spicy foods and foods hot in temperature can have an influence, Dr. Gaspari says.

Stress, which does not cause acne, can exacerbate symptoms of acne.

“Stress definitely causes change in hormonal levels in the body. That’s how it can affect acne,” says Dr. Valerie Callender, a dermatologist and director of the Callender Skin and Laser Center in Mitchellville.

Acne takes several forms. Comedonal acne is the result of an enlarged, plugged hair follicle.

If the comedo stays beneath the skin, it produces a white bump called a whitehead. A blackhead is an enlarged comedo that pushes up through the surface of the skin, taking on a dark appearance from oil and skin-cell buildup and the skin’s pigment, or melanin, Dr. Callender says.

Inflammatory acne causes papules, or pink, tender bumps, and pustules, which are pus-filled papules that can be red at the base. A more severe type of acne, nodulocystic acne, has nodules, or large lesions that are deep in the skin, and cysts, or deep, pus-filled lesions.

Acne can be treated in a few ways. Mild topical treatments, such as benzyl peroxide, which kills bacteria, and salicylic acid, which unclogs pores, can be purchased over the counter. Other options require seeing a dermatologist or doctor.

Oral antibiotics, for example, provide an antibacterial function, act as an anti-inflammatory agent and get rid of some of the redness and tenderness from acne lesions. Accutane, the generic name of which is isotretinoin, inhibits oil gland secretion and inflammation and loosens up clogged follicles, but can have side effects, including depression. Chemical peels exfoliate the skin and help diminish scars. And laser treatments, which are used to treat both acne vulgaris and acne rosacea, shrink the sebaceous glands and kill bacteria.

“Any amount of acne you have is worth treating,” Dr. Bourelly says.

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