ACNE UNDER CONTROL; DERMATOLOGY HOLDS ADVANTAGE IN SKIN BATTLE.

Byline: Phil Davis Staff Writer

Scratch this off your list of millennial worries: mutant acne.

As recently as 1996, some doctors noticed forms of the bacteria that cause acne were developing the ability to shrug off oral and topical antibiotics such as tetracycline and erythromycin. The predictions were grim.

``By the year 2000, dermatologists worldwide may have few, if any, anti-microbial agents to rely on to treat their acne patients,'' British Dr. William J. Cunliffe pronounced at a medical conference three years ago.

But as the millennium approaches, local dermatologists say antibiotic-resistant acne is still more sci-fi threat than medical fact.

In fact, instead of facing a so-called ``superbug,'' dermatologists say the fight against acne especially cystic acne, which can leave scars - is going well.

``You don't see people walking around with the bad cystic acne anymore,'' said Dr. Ronald Moy, a professor of dermatology at the University of California, Los Angeles. ``We cure those cases.''

That's not to say antibiotic-resistant bacteria isn't a crisis in other fields, Moy said. Overuse of antibiotics over the last few decades has created some strains of bacteria that can shrug off the most powerful antibiotic drugs.

For example, strains of staphylococcus bacteria - staph infections - which used to be destroyed by a simple shot of penicillin, now survive even the most powerful antibiotic available, vancomycin. Several people have died because there were no antibiotics capable of stopping the raging bacterial infection.

Only a week ago did the Food and Drug Administration approve a new antibiotic - Synercid - for use against bacteria that can survive vancomycin. And while the FDA has imposed no specific restrictions on use of Synercid, physicians will be cautioned to use it only as a last resort.

Fortunately for acne sufferers, pimples aren't caused by bacteria alone - and therefore, the problem isn't treated with antibiotics alone.

Acne usually kicks in during puberty, when the body starts producing hormones called androgens, which enlarge oil-producing sebaceous glands in hair follicles. Sometimes androgens overstimulate the glands, causing an excess of a natural oily secretion called sebum, which can lead to acne.

Acne lesions break out when the excess sebum gets trapped in a clogged hair follicle. The oil picks up normal skin bacteria (called Propionibacterium acnes, or P. acnes) and dead skin cells, and together they form pimples on the surface of the skin. More sebum means more pimples.

There are two kinds of pimples: comedones, also known as blackheads, and other more unpleasant inflammations called papules, pustules or nodules, which range from a typical red pimple to a painful, pus-filled zit.

So while antibiotics, which fight bacteria, are useful against infections caused by P. acnes, doctors also can use a host of other powerful non-antibiotic drugs that either cleanse skin or unclog pores and reduce oil output in the follicle. One of the most popular birth control pills on the market today is Ortho Tri-cyclen, which claims to have the beneficial side effect of controlling the hormonal imbalances that can cause acne. And for men and women with less serious cases of acne, there also are over-the-counter topical drying agents such as benzoyl peroxide and salicylic acid that help decrease the amount of oil on the skin's surface.

``Because we have a number of different drugs that work by different mechanisms, (drug resistance) seems not to be a problem,'' Moy said. ``I think in theory it could be a concern - maybe down the road further. We are curing acne better than when I started in dermatology in 1981. We have more drugs and, with really bad acne, we have Accutane.''

Accutane is a powerful vitamin A derivative (called a retinoid) that shrinks oil glands and helps hair follicles and pores shed dead cells more efficiently, which clears up infections and stops acne before it has a chance to get infected and turn into a skin blemish.

``All the follicles and pores get cleansed and the oil glands shrink and the acne goes away,'' said Dr. Wendy Hoffman, an Agoura Hills dermatologist. ``The reason we don't use it all the time is because it has a lot of side effects.''

The drug causes birth defects, so any woman who takes it must also take birth control pills. It also can harm the liver or boost unhealthy levels of fat in the blood. And it makes skin sensitive to the sun.

Lianne Noddle of Woodland Hills said she had to stop taking Accutane for a persistent case of adult acne after only six weeks because of troublesome side effects such as nose bleeds, joint pain and other discomforts.

``My dermatologist didn't tell me any of the side effects,'' Noddle said. ``He didn't tell me about not going out in the sun and I broke out.''

Noddle switched dermatologists and is now back on a half-dose of the drug. She said the side effects, which this time were explained to her, are minor.

``In terms of my acne, it has been great,'' Noddle said.

Noddle hasn't experienced trouble with traditional antibiotics, but her new dermatologist, Dr. Lisa Benest of Burbank, prefers to use a combination of drugs to treat acne.

``There are clearly some people who don't respond to antibiotics,'' Benest said. ``I prefer to use them more as a short-term blast and then move on to something else. I do think using a lot of antibiotics does breed resistance in the population as a whole. It's a problem in the hospitals.''

The good news is that antibiotics such as tetracycline aren't used to treat other bacterial infections, so doctors are not being forced to ration the drug.

But acne is - and always has been - tough. Just about everyone gets pimples sometime between their teens and age 40. Most people can wash away the trouble by regularly cleaning affected areas with soap and water.

``Acne therapy takes a long time,'' Hoffman said. ``It also takes diligence on the patient's part because it's not just taking antibiotics. When you come in with acne, you usually leave with a bag full of stuff. It takes a combination of therapy to make it better. It's a real routine and a chore.''

Misconceptions cleared up

Understanding acne can lead to a clearer complexion:

It's not just a cosmetic problem or vanity concern. Acne can leave permanent scars - both physical and mental. Doctors say the disease can cause incalculable damage to a person's self-esteem.

Acne is not caused by poor hygiene, eating too much chocolate or stress. It's a hormonal condition that has more to do with genetics than with dirt or food. That includes pizza and french fries.

Acne is hereditary. It's not clear exactly why, but teens whose parents or older siblings had bad acne are likely to have similar problems.

Make-up can cause acne. Look for products that are ``noncomedogenic,'' which means they won't clog pores. Clogged pores cause acne.

Too much face washing can cause acne. It does help to stay clean, but experts say washing your face more than three times a day can irritate skin and create conditions that are ideal for acne.

Over-the-counter products can help fight acne. Look for products that contain benzoyl peroxide - ``oxy'' products - or salicylic acid. Stick with it. The problem will start again if you stop using the products. Avoid alcohol and hydrogen peroxide, which dry out skin and do nothing for acne.

See a dermatologist if acne lesions are dark and painful, interfere with your enjoyment of life, cause scars or are not responding to non-prescription acne products.

Sources: American Academy of Dermatology; staff research.

CAPTION(S):

2 Photo, box

PHOTO (1 -- cover -- color) Facing Acne - New treatment quell fears of antibiotic-resistance menace.

(2) Dr. Lisa Benest prefers to use a combination of drugs to treat acne because antibiotics don't work for everyone.

John McCoy/Staff Photographer

Box: Misconception cleared up (see text)