End that spot of bother

TEENAGE DISTRESS: Acne can damage more than a young person's skin, so get it seen to, writes Kathryn Holmquist.

Any parent with acne scars will want to make sure the same thing doesn't happen to their children. Many parents are seeing children as young as eight develop acne - part of a trend that has children becoming "teenagers" earlier than ever before. Remember back to your own youth; if you were like 50 per cent of your peers, you had acne and all the self-consciousness that went with it. One prominent "zit" was enough to make you stare in the mirror, feeling like a freak.

Imagine the vulnerability of teenagers with severe cystic acne - "severe" being defined as 12 or more spots on their faces.

Teenagers with acne have twice as many emotional and behavioural problems as teens with clear skin. Even mild acne can lead to psychological distress and even suicidal thoughts, the American Journal of Clinical Dermatology reports.

Prevention of acne can eliminate emotional and psychological scarring, yet two-thirds of parents fail to seek treatment for their children, according to the British Journal of Dermatology. Many parents see acne as a part of adolescence and assume it will clear up on its own. Acne may clear up eventually, but it may leave permanent physical and emotional scars. Even small bumpy acne can leave marks. You may think that cosmetic surgery can fix anything these days. In fact, laser skin-resurfacing merely reduces scarring by 40 per cent on the face (the back and chest cannot be lasered).

When your child first develops acne (blackheads are often the first sign), you should respond initially by encouraging your child to cleanse the skin twice daily with dedicated product, advises Dr Rosemary Coleman, a dermatologist and acne specialist. After cleansing, a product containing benzoil peroxide should be applied to the area, not just the spot. Watch carefully for scarring, since even small "zits" can leave marks on the face.

If the cleansing regime is not enough, and scars are developing, then see your GP. Antibiotics may clear up the acne, but they are not without side-effects - inflammation of the liver, hypersensitivity of the skin, vertigo, dizziness and fatigue. Tetracycline, for example, must not be used for more than two years. A female on tetracycline for more than two years may develop auto-immune disorders, such as lupus and chronic hepatitis.

Patients on the drug need regular blood tests to check for liver damage.

Girls have an edge on boys, because the contraceptive pill on its own can be an effective cure for acne, though parents may resist this treatment.

Coleman recalls a patient who had been through all five antibiotics and was developing acne scarring, yet her mother would not allow her to take the pill for fear that her daughter would become "less careful" sexually.

After the first-line options - antibiotics for boys and antibiotics and/or the pill for girls - there is one last resort, and that's Roaccutane, which will cure acne and prevent scarring by drying the skin.

Coleman, who prescribes Roaccutane for severe acne (never mild acne), says that 19 out of 20 parents she sees are fearful of it due to publicity about teenagers who have committed suicide while taking the drug. Mark Rogers of Roche Products says that prescriptions in the State for Roaccutane fell by 30 per cent 18 months ago after negative publicity, but have since returned to former levels.

Depression is listed as one of many possible side-effects on the patient information leaflet that comes with the drug. However, there is no scientific proof that depression and suicide are linked to Roaccutane, despite many studies.

Scare stories, rather than science, are putting some parents off a drug that could save their child emotional pain and physical disfigurement, says Coleman. For example, a US Congressman, Republican Bart Stupak, has mounted an anti-Roaccutane campaign in the US because he has linked his 17-year-old son's suicide to Roaccutane.

"I have no vested interest and I don't own shares in Roche," says Coleman. "Roaccutane is not the cause of our suicide rates." She recalls a teenage boy who told her he spent "90 per cent of his time in his room" because of his acne. Antibiotic treatment had failed and the only alternative left was Roaccutane, but his parents refused to allow him to use it.

Coleman, who has only had one patient (a 42-year-old woman) experience depression as a result of Roaccutane use, stresses that Roaccutane has to be prescribed carefully. Before prescribing the drug, she checks patients for signs of depression and refers them to a psychiatrist for treatment if they are distressed. Patients sign consent forms in which they agree to alert the doctor if signs of depression develop and parents - presumably - keep a careful eye to their children's moods. If depression develops, the child should stop taking the drug and mood will return to normal within two weeks.

Girls taking Roaccutane must be on the pill because Roaccutane can cause serious birth defects should they become pregnant.

The information in this column is not an endorsement of Roaccutane. Only parents can balance the emotional and physical risks of acne against the possible side-effects of a drug. If only someone would invent a side-effect-free treatment for acne, we would all be a lot happier.