Clear Skin

Possible help for severe acne

For many adolescents, the first blemish signals one of life's more distressing rites of passage to adulthood. But fortunately for most youngsters, acne is temporary and can be relieved, if not entirely cured, with special soaps and lotions Yet in about 2% of all cases the skin disorder is severe; large pus-filled nodules appear on the face and often on the back and chest as well. Antibiotics and other treatments work for some patients but others are often left permanently scarred.

Last week dermatologists had encouraging news in the battle against acne. Dr Gary L. Peck and his colleagues at the National Cancer Institute reported that they had successfully treated eight men and six women with severe acne, none of whom had responded to ordinary therapy. That feat was achieved with a new oral drug, 13-cis-retinoic acid, which is a synthetic version of all-trans-retinoic acid, a naturally occurring derivative of vitamin A. Applied to the skin, the natural acid has helped relieve common acne. But vitamin A, which is given orally, has been of little use. For severe acne, it is totally inappropriate because the high doses that would be required could damage the liver, bones and nerves.

Of Peck's patients, the youngest was 16, the oldest a man of 46 who had been plagued with acne since age 13. For four months, they took several capsules of the drug each day. By the end of that period, the acne had vanished in nine patients. The skin of four others cleared two to ten months later. Even in the one "uncured" case, there was a 75% improvement. Better yet, write Peck and his colleagues in the New England Journal of Medicine, side effects were minimal and temporary: some chapped lips, skin dryness, minor nosebleeds and slight irritation of the eyes.

Surprisingly, the patients remained free of acne, except for an occasional surface pimple, as long as 16 to 24 months after the test ended. Exactly how the drug achieves that miracle remains somewhat speculative, but studies by Dr. John S. Strauss and colleagues at the University of Iowa indicate that it inhibits oily secretions from the skin's sebaceous glands.

The investigators are elated by the results, but they caution that questions remain. For one thing, does the drug have any untoward side effects after prolonged use? It is known that kindred chemicals can produce birth defects in animals. Thus the drug faces at least two or three years of careful testing before it can be marketed. Still, for those with recurring severe acne, that may not be too long a wait to be spared a lifetime of misery. qed

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