. Saturday, January 24, 2009
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The next time the movie camera closes in on your Hollywood heartthrob, ask yourself: Has this guy ever had a pimple?

Actually, many people have acne that disappears without a trace. Others aren’t so lucky, and the deep, craterlike scars can leave a permanent record of the disease. The scars can rarely be eliminated, but they can be improved, says David W. Low, M.D., an assistant professor of plastic and reconstructive surgery at the University of Pennsylvania in Philadelphia.

The easiest technique is dermabrasion, in which your doctor planes the skin smooth with a high-speed brush or wheel. “What you’re doing is sanding the high spots,” Dr. Low explains. The procedure isn’t particularly painful, but there is significant postprocedure crusting and oozing. “Your face can look pretty bad during the first couple of weeks,” he says.

Dermabrasion is effective only for shallow scars, he says. If you have deep, “ice pick” scars, your doctor may decide simply to cut out the scar, then stitch the skin back together. The trick, of course, is making the surgical scar less visible than the acne scar.

A third technique is called punch excision. First the scar is removed, then a plug of skin is taken from another part of the body and inserted in the hole. Once the grafts takes, your doctor may use dermabrasion to make your skin even smoother.

Another option is to fill the scars with collagen, an absorbable gelatin protein. While collagen does improve the appearance of a scar, it will eventually be absorbed by the body. In most cases, the benefits will fade after six months to a year, Dr. Low says.

Regardless of the procedure, timing is important. Ideally, your doctor won’t operate until new scars aren’t being formed. It’s also important to have realistic expectations, Dr. Low adds. “If someone has really severe acne scars, there’s nothing you can do to remove all of the irregularities. You’re not going to make the skin smooth. You’re going to make it less rough.”


Doctors though they had the perfect cure for acne in the early 1980s with the discovery of the drug isotretinoin (Accutane), a synthetic derivative of vitamin A.

Isotretinoin has the ability to eliminate even the most severe cases of acne for months or even years at a time. Unfortunately, there is a rub: untoward side effects. Accutane, while giving you smooth skin, can give you headaches, itching and muscle pain and can even cause your hair to shed. But most alarming, it can cause birth defects if taken by pregnant women.

But there are some researchers in Europe who still believe that Accutane can be the end-all for acne––without the bad side effects. They feel that lower doses of the drug taken for longer periods can produce the same benefits but cause fewer problems.

Doctors in this country disagree, says Alan R. Shalita, M.D., professor and chairman of the Department of Dermatology at State University of New York Health Science Center in Brooklyn. “It is conceivable that one could come up with a low enough dose that wouldn’t cause birth defects, but this would be very difficult to prove,” he says. “Who’s going to take the chance of testing it?”

Another way to make the drug safer would be to simply limit the distance it travels, Dr. Shalita says. Today, isotretinoin is taken orally, which means it can reach––and perhaps cause problems in––many parts of the body. But researchers are investigating topical preparations that could be rubbed directly on the acne, putting the punch only where it’s needed. “it would be safer this way, because the absorption into the body would be minuscule,” he says.


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