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On the Teen Scene Acne Agony PAGE 2 BY JUDITH LEVINE WILLIS What Causes Acne? Acne most often starts at around age 11 for girls and 13 for boys. Scientists think a hormone called androgen plays a role in acne. Among other things, androgen stimulates the sebum-producing glands. After puberty, boys produce 10 times as much androgen as girls, and so it's not surprising that more boys than girls develop severe cases of acne. Also, bacteria called Corynebacterium acnes, which cause skin fats to break down into irritating chemicals, can directly contribute to an outbreak. Other things that can cause acne, or make it worse, are certain drugs, such as those used to treat epilepsy or tuberculosis; exposure to industrial oils, grease, and chemicals; and stress and strong emotions (which may account for the big date breakout). Some oily cosmetics and shampoos can, on rare occasions, trigger acne in people who are prone to get it. The American Academy of Dermatology says it's a good idea for acne sufferers to check with a dermatologist to ensure the skin condition really is acne. Rashes from other sources, such as make-up and oral medicine, can create acne-like symptoms. Many young women notice that they get more pimples around the time of their menstrual periods. In fact, some studies have shown that up to 70 percent of women notice their acne worsening the week before their periods. You may have heard that certain foods, such as chocolate, nuts, cola drinks, potato chips, French fries, and other "junk food" cause acne or make it worse. But there's no scientific evidence to back up these claims. Still, if you notice that outbreaks increase after you eat certain foods, it makes sense to eat as little of them as possible. Oily skin and hair don't actually cause acne, experts say. Although there is an association between the severity of acne and the amount of oil a person's skin produces, not all people with oily skin have acne. And some people with dry skin do! Does Anything Help? In one Swedish study, most people's acne improved after exposure to the sun. But not all doctors agree that sunlight is helpful. Some say it may just be relaxing in the sun that makes the pimples vanish. At any rate, the idea that the sun improves acne by drying out greasy skin doesn't hold water; sun and heat increase oil production. Mild acne can often be cleared up simply by washing your face once or twice daily and avoiding any food or drink you think triggers an outbreak. If these measures alone don't work, you may want to try one of the acne medicines that you apply directly to the skin and that are sold without a prescription. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid, all of which the Food and Drug Administration has found effective for treating mild acne. All of these drugs are "peeling agents," which cause irritation and drying that help the body loosen plugs and shed dead cells. The drugs also can keep bacteria from forming, which reduces the fatty acids that contribute to acne. (FDA officials are concerned about what happens when skin treated with benzoyl peroxide is exposed to sun. Research done so far hasn't shown the combination to be harmful. But the agency is reviewing other studies to ensure the safety of benzoyl peroxide products.) What won't work is picking at pimples. This can injure skin and underlying tissues. If you have acne that won't clear up with home treatment, see a dermatologist, a doctor who specializes in treating skin problems. Sometimes dermatologists use instruments called comedo extractors to remove blackheads. They may also surgically drain large pustules or abscesses. There are also drugs that can be prescribed for more severe cases. These include both topical and oral antibiotics such as tetracycline and erythromycin, and Retin-A (tretinoin), a derivative of vitamin A that comes in cream, gel or liquid. Another acne drug, Accutane (isotretinoin), is also derived from vitamin A. But this medication, taken by mouth, has serious side effects and isn't for everybody (see accompanying article). In very rare instances, where these measures don't work or haven't been used before the acne causes permanent skin damage, plastic surgery can be used to smooth over deeply pitted and scarred skin. Acne may be an inevitable companion of the teen years. But today, with proper measures, it can usually be controlled before it becomes totally unsightly. And if pimples pop up for that big evening, don't let it get you down - your date will probably have a few, too. Judith Levine Willis is a member of FDA's Public Affairs staff. Sharon Snider, an FDA press officer, also contributed to this article. Comments about this article? Send us an e-mail and we'll add your remarks to the feedback page.

One Acne Drug Causes Birth Defects There is one medication for acne that teenage girls should be particularly cautious of. The name of the drug is Accutane (isotretinoin). It's a capsule taken by mouth that is derived from vitamin A, and for some time it has been known to cause birth defects. ACCUTANE UPDATE, OCT. 31, 2001 New rules issued by the FDA now require women who are taking Accutane to take a monthly pregnancy test. Pharmacists should refill prescriptions only if the patient has a yellow "Accutane qualification sticker" indicating she has had a negative pregnancy test. Accutane is approved by FDA for treating severe cystic acne for people whose skin condition does not sufficiently improve with other treatments, including antibiotics taken by mouth. Accutane completely clears acne in many people, but there continues to be concern about its use in young women who may become pregnant. The instructions that doctors receive for prescribing the drug warn: There is an extremely high risk that a deformed infant will result if pregnancy occurs while taking Accutane, even for short periods. Accutane is not to be given to a woman of childbearing age (any menstruating female) unless she has "severe disfiguring cystic acne" that does not improve with standard therapies and unless certain precautions are taken. Before prescribing Accutane to women of childbearing age, the doctor should give the patient an information sheet that includes statements about the drug's ability to cause birth defects. The patient is asked to initial these statements and to sign an authorization for treatment. If the patient is a minor, a parent or guardian's initials and signature are required. Another acne medication, Retin-A (tretinoin), is also derived from vitamin A, but it is applied to the skin, not taken by mouth, and there have been no reports of birth defects related to its use. J.L.W.