Given the psychological damage caused to so many, it should be obvious that everyone affected should always use the best medication. Except that the most effective, Accutane, has some unfortunate side effects. So it should not be used until all the other remedies have been tried and failed. That means people should do whatever they can to avoid making their acne worse.

The first and most obvious thing is to leave the pimples and zits alone. There’s a terrible temptation when this eruption comes up filled with pus. It’s so easy to squeeze and get that mess of infection out of the way. You can talk to yourself and say how much better your skin will be without all that poison inside. Once the spot is popped, the temptation continues. Why not pick at what is left of the pimple? It’s often unsightly. A quick excavation with fingernails can smooth the skin and make the remains of the spot less obvious. Unfortunately, breaking the skin prematurely is likely to spread the infection and, more importantly, cause scarring. If possible, you must resist these temptations and let the body deal with the situation at its own speed.

Now we come to one of the ironies. Getting acne is probably going to expose you to stress. As a teenager, you’re likely to become a target for abuse. Yet there’s a well-established link between stress and acne. Medical research shows that people in stressful situations are significantly more likely to experience eruptions of acne, or to find their acne grows worse. The precise reason for this link is not understand but its reality is not contested. Thus, no matter what the provocation you receive from those around you, staying calm is going to prevent your acne from worsening.

Then there are drug side effects and interactions. Acne is caused by an excess of androgens in the body, most commonly progesterone. Some women use an oral contraceptive with too much progesterone. If you are taking an oral contraceptive, check with your physician to ensure your medication is not causing the acne. Similarly, some of the medications taken to control seizures and steroid creams used to treat eczema can make your acne worse. So try these strategies to get your acne problem under control before resorting to Accutane. It may be the best medication to treat acne, but it should come last.

The FDA has struggled with this issue and some families will also find difficulty in accepting the limitations on use. Under normal circumstances, a drug that causes such severe side effects will be pulled from the market. But Accutane is a highly effective medication. Thus, if all the other treatments have been tried and failed, it is appropriate to fall back on this drug so long as adequate precautions are in place.

It’s important to be honest about this. The treatment with Accutane usually lasts between four and five months. This is a long time. During this time, there must be no risk that the female patient can become pregnant. Ignoring situations of involuntary sexual intercourse through rape, the FDA does not consider it sufficient to rely on women to abstain from sexual activity. There is very clear research evidence that abstinence programs among the young do not work. Only contraceptives represent sufficient levels of security. In some Christian families, this will pose a dilemma. But the issue must be confronted head on. Which is more important? That a teenaged girl who is being victimized because of her acne gets relief so that parents can begin to rebuild self-confidence, or that she gets relief from the acne together with the trauma of a miscarriage or a deformed baby? Older women are no less vulnerable and their self-esteem should also be protected. Morality and conscience must sometimes bend to accommodate family needs.

The iPledge Program requires you to use two approved contraceptives together before, during and after treatment. You will also have to have regular pregnancy tests in an approved Laboratory. To make sure you comply, you will only be given one month prescriptions. The supply of the drug is also limited to those pharmacies participating in the iPledge Program. Unless you step outside the FDA system by not consulting with your local physician and buying through one of the online pharmacies, the Federal Government is determined to protect female patients who propose to take Accutane.

As parents, this can create several quite different headaches. The first is keeping your child safe. It can sometimes be difficult to decide whether your child is being affected. Some seem to to be almost completely oblivious to the bullying. Others fall apart when the glances they dread come their way. They have seen it happen to others and their anticipation and fear magnifies the mild reality into a crisis. Emotional support is part of the job-description of being a parent. But how far should you go on the medical front? The options are to:
• ignore the medical side and wait for the hormones to settle down;
• use over-the-counter (OTC) products;
• refer to your local healthcare provider; or
• consult a dermatologist.

The more your child’s self-esteem is under threat, the more you need to do even though the actual level of acne may be mild. Obviously, what you do will depend on whether you have health insurance or savings that can be used to fund treatment. You should also recognize that some children become anxious or depressed in the clinical sense. A very small percentage harm themselves or commit suicide.

OTC products work for mild outbreaks but, if you want access to the most powerful of all the treatments — Accutane — you should first see a dermatologist. The implications, particularly for young girls, need careful thought to balance the risks against the benefits. Acne is a treatable condition but how you maintain the relationship with your children and deal with the various medical issues can be challenging.

If there is too much androgen (those are the male hormones) in your body, the glands can produce too much oil. This confirms your deepest suspicion that all your problems are caused by men. This builds up and blocks the pores. Pimples are the result. If bacteria infect the pores, you get the usual swelling and sometimes painful redness. So here we go with the stark fact. Women do produce androgens but, you will be pleased to know, only in small quantities unless something goes wrong. The first sign of this is facial hair. But this is relatively rare and material for a different article.

A word of reassurance. Acne has nothing to do with poor hygiene or the diet you eat although it does help the skin to heal if you keep your skin clean and eat healthy foods.

Since the theme of this article is hormones in women, we need to talk about the use of oral contraceptives as a treatment for acne. Because the cause of excess oil production is a male hormone, use of a contraceptive which contains cyproterone is ideal because it blocks the effect of androgens in the skin. You should ask our local healthcare provider to recommend which of the oral contraceptives is best for this purpose. However, we also need to dispose of another myth. A story is put about (often by those who oppose the use of any contraceptive precautions) that long-term use of an oral contraceptive leads to infertility. This is completely untrue. Although the effect of the pill is to prevent the release of the egg from the ovaries each month, your body will almost immediately return to its normal cycle when you stop. If, for some reason, there is a slow response, there are standard drugs available to prompt your body to ovulate.

Whilst on the subject of pregnancy, we should also remind you not to use Accutane if you could become pregnant. The iPledge system requires you to be on a course of two contraceptives before, during and after you take this drug. Accutane is the ultimately successful medication for the treatment of acne. It is almost always successful although it is not uncommon for the acne to return when you stop the treatment. But this drug is likely to damage a fetus in your womb. You must avoid pregnancy if you propose to use this powerful medication. The removal of acne is not worth the price of deformed children.

One person we tracked down is Michael Krajicek. He is now 18 years old and still living with his parents in Chicago. The acne came when he was just turning 13. Blackheads, whiteheads, nothing would make them go away. Five years on, he is beginning to find more peace of mind. Sitting in his bedroom, he managed a disarming smile, “I think I would be quite a good looking guy if only I didn’t still have all these acne problems.” We asked him about how he came to give up school. “The way I look was giving me low self esteem. The result? I had no real confidence. I never seemed to make any friends. Even the teachers had a down on me. The way people judge you when you have acne. It’s terrible!”

Michael described some quite serious bullying and showed us some of the web chat and forum posts made about him. “About a year ago,” he went on, “I was so upset I secluded myself from the rest of the world. I gave up school and stayed at home. The TV and laptop were my only friends.” He managed another of those shy smiles. “I couldn’t even talk to my parents. It was like I was in solitary confinement.”

Looking at him today, you cannot help but see the acne but Michael assures us that there has been a big improvement recently. He attributes this to gentle washing twice a day with ordinary soap, but most importantly, he has avoided the sunlight during summer. He says he goes out at night on his own. He wants to get used to the idea of being around people again. “I pray I am growing out of it.” He sighed. “Perhaps my life will come together again sometime soon.” We hope so too. He is such a pleasant person to have been victimized in this way. Fortunately, he has not been completely crushed. We hope he will soon be able to give up his seclusion. When we asked the High School for a comment, no-one was available to respond.