NEW YORK, Oct. 29 /PRNewswire/

-Vitamins have been increasingly used to prevent and treat a variety of skin disorders. A new study in the October issue of the Journal of the American Academy of Dermatology suggests that vitamins A, C and E are increasingly important because of their antioxidant capabilities.

Antioxidants have been the center of much media attention in recent years due to their ability to stabilize reactive, potentially-harmful free radicals in the body. Free radicals are thought to be the cause of many diseases from cancers to colds. The free radicals damage a person's DNA, causing unwanted changes in the basic building blocks of cells. This damage can often be prevented, and sometimes reversed, with the healing properties of antioxidants.

The three antioxidants most commonly found in antioxidant supplements are vitamins A, C and E. Each works independently and in conjunction with other vitamins to reduce the effects of free radicals.

"There have been so many conflicting media reports that it is often difficult for the public to understand what the antioxidants can and cannot do to help people maintain good health," said Karen Keller, MD, the lead author of the study. "We did a comprehensive review of the scientific literature to determine how vitamins A, C and E can help dermatologists improve patient care."

Vitamin A is found in many yellow and green vegetables, egg yolk, butter, liver and fish oils. Retinoids, the active ingredient in Vitamin A, are more commonly known as retinol in topical skin creams, lotions and ointments.

Retinoids, whether synthetic or natural, have many important biological effects such as regulating growth and differentiation in cells, diminishing malignant cell growth and strengthening the immune system. Most retinoid research has focused on acne treatments, the main treatment use of the compound since 1971.

Recently, multiple controlled studies have shown that retinoids can reduce and prevent wrinkles, brown spots and actinic keratoses. Patients reported noticeable improvement in skin texture and tone after starting a retinoic acid treatment program. The positive results can be reversed, however, if the patient discontinues topical application of the retinol products. At one time, retinoids were only available in prescription treatments. Now, many retinoids are available in over-the-counter preparations.

Vitamin A was also found to have positive results when used as a treatment for stretch marks, psoriasis and lichen planus.

One study found that regular supplements of both vitamins A and E were associated with a 70% reduced risk for basal cell carcinomas. In addition, an increase in dietary vitamin C has been shown to reduce UV-induced tumors in mice.

Wound healing is an important indicator of skin health. To enhance wound healing, it is important that patients receive adequate amounts of each vitamin. Patients whose bodies are vitamin A deficient experience diminished wound healing, which is correctable by vitamin A supplementation. Vitamin C is considered critical in wound healing because it acts as a cofactor for several enzymes, which stabilize collagen. Through its antioxidant and anti-inflammatory effects, topical vitamin E may enhance wound healing, although the benefits remain controversial. More research is needed to determine if and how vitamin E supports the wound healing process.

While it is important that everyone receives the recommended daily allowances of vitamins and minerals, there is no research to suggest that mega-doses of vitamins A, C and E provide enhanced benefits. In fact, mega-doses of vitamins A and E, as well as beta carotene, build up in the body and may cause serious adverse reactions ranging from headaches to birth defects to altered immunity at high levels. "It is important that people eat a variety of foods every day to receive the needed antioxidants," advised Dr. Keller.

The American Academy of Dermatology is the largest and most influential society representing physicians who specialize in treating skin, hair, and nail conditions.

REFERENCE NOTES:
Keller, K.L., M.D.; Fenske, N.A., M.D.; "Uses of Vitamins A, C, and E and Related Compounds in Dermatology: A Review," Journal of the American Academy of Dermatology, October 1998, pp.611-625.

SOURCE: American Academy of Dermatology

By ED SUSMAN UPI Science News

TORONTO, Sept. 29 (UPI)
-British researchers say long-term use of antibiotics to treat acne not only may not work, but apparently create skin bacteria resistant to several powerful drugs.

Scientists in Toronto, at an infectious disease meeting of the American Society for Microbiology, report that 64 percent of patients with recurrent acne problems harbor bacteria that are resistant to medications.

Trish Coates, a researcher at University of Leeds, says, "The resistant bacteria can also be passed on to others through contact, which means that even people who haven't received antibiotics treatments for acne will develop resistant bacteria to the antibiotics used in treating acne."

Coates says that people are treated with antibiotics typically for 8 to 12 years.

Marilyn Roberts, professor in pathobiology at the University of Washington School of Public Health and Community Medicine, Seattle, says, "Long-term treatment with antibiotics is insane. That's the best way to develop bacterial resistance."

Coates says, in her study she found that the bacterium, Propionibacteria acnes, had developed resistance to widely-used antibiotics erythromycin, tetracycline, and clindamycin; several colonies of resistant bacteria could be found in each patient.

P. acnes causes the redness around acne lesions. Roberts says doctors and patients need to be educated further that long-term use of antibiotics for treating acne can cause more difficult problems down the road by creating P.acnes populations that can't be treated.

by AJ Cooper

Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW. Medical Journal of Australia 1998 Sep 7;169(5):259-61

OBJECTIVE: To document changes in the prevalence of resistance of Propionibacterium acnes to antibiotics used for treating acne.

DATA SOURCES: MEDLINE and EMBASE were searched for publications on P. acnes resistance to systemic antibiotics. The search strategy mapped "acne" or "acne vulgaris" with the terms "antibiotic resistance" or "drug resistance, microbial". Only papers published in English during 1976 to 1997 were included in the search.

STUDY SELECTION: 53 publications met the search criteria. The search output was refined by selecting papers that specifically addressed P. acnes resistance patterns. Additional studies (not included in the search output) were identified from review articles and references of the retrieved articles. Twelve articles were reviewed.

DATA EXTRACTION: Data on the prevalence of antibiotic-resistant propionibacteria, the incidence of individual resistance phenotypes, mixed resistance, and correlation between poor therapeutic response and resistant propionibacteria were extracted.

DATA SYNTHESIS: Research since 1978 has suggested an association between poor therapeutic response and antibiotic-resistant propionibacteria. The overall incidence of P. acnes antibiotic resistance has increased from 20% in 1978 to 62% in 1996. Resistance to specific antibiotics varied and was most commonly reported with erythromycin and clindamycin, tetracycline and doxcycline, and trimethoprim. Resistance to minocycline is rare.

CONCLUSIONS: In many patients with acne, continued treatment with antibiotics can be inappropriate or ineffective. It is important to recognize therapeutic failure and alter treatment accordingly. The use of long-term rotational antibiotics is outdated and will only exacerbate antibiotic resistance.

by Judith Levine Willis

This article originally appeared in the July-August 1999 FDA Consumer. This reprint contains revisions made in December 1995 & November 1999.

Tonight's your first date with the person of your dreams. You're standing in front of the mirror, coaxing your hair into a more sophisticated style when there it is--right on the tip of your chin--a big fat zit! You look at your face more closely and see another smaller pimple on your cheek. Lifting your hair, you spot several on your forehead, too.

Why did this have to happen just when you want to look your best? And, while we're at it, why you?

No one knows for sure exactly what causes acne vulgaris, the technical name for the zit attack. But researchers do know that it usually starts in adolescence and that heredity plays a big role. If one of your parents had acne, there's a good chance you'll develop it. If both of them had serious pimple problems, then your chances are even higher.

If you have acne, you have lots of company--about 85 percent of the U.S. population between ages 12 and 25 develops some form of the skin condition. Most teens who get acne have the milder form, called noninflammatory acne, and get just a few blackheads or whiteheads every now and then. But some people suffer from the more severe form, called inflammatory acne, and have a constant outbreak covering the face, and sometimes also the neck, back, chest, and groin. These pus-filled pimples and cysts can cause deep pitting and scarring.

Acne develops when glands that produce an oily substance called sebum begin to work overtime, possibly due to hormone changes that are at their peak in the teen years. One of the jobs of the sebum is to carry cells shed by the glands to the surface of the skin. But because the excess sebum is blocking the openings of the glands, called ducts, both cells and sebum accumulate, forming a plug called a comedo. If the plug stays below the surface of the skin, it is light in color and called a whitehead. If the plug enlarges and pops out, the tip looks dark and it's called a blackhead. This isn't dirt and it won't wash away. The darkness is due to a buildup of melanin, the dark pigment in the skin. If the process continues, a pimple forms.

What Causes Acne?
Acne most often starts at around age 11 for girls and 13 for boys. Scientists think a hormone called androgen plays a role in acne. Among other things, androgen stimulates the sebum-producing glands. After puberty, boys produce 10 times as much androgen as girls, and so it's not surprising that more boys than girls develop severe cases of acne. Also, bacteria called Corynebacterium acnes, which cause skin fats to break down into irritating chemicals, can directly contribute to an outbreak.

Other things that can cause acne, or make it worse, are certain drugs, such as those used to treat epilepsy or tuberculosis; exposure to industrial oils, grease, and chemicals; and stress and strong emotions (which may account for the big date breakout). Some oily cosmetics and shampoos can, on rare occasions, trigger acne in people who are prone to get it.

The American Academy of Dermatology says it's a good idea for acne sufferers to check with a dermatologist to ensure the skin condition really is acne. Rashes from other sources, such as make-up and oral medicine, can create acne-like symptoms.

Many young women notice that they get more pimples around the time of their menstrual periods. In fact, some studies have shown that up to 70 percent of women notice their acne worsening the week before their periods.

You may have heard that certain foods, such as chocolate, nuts, cola drinks, potato chips, french fries, and other "junk food" cause acne or make it worse. But there's no scientific evidence to back up these claims. Still, if you notice that outbreaks increase after you eat certain foods, it makes sense to eat as little of them as possible.

Oily skin and hair don't actually cause acne, experts say. Although there is an association between the severity of acne and the amount of oil a person's skin produces, not all people with oily skin have acne. And some people with dry skin do!

Does Anything Help? In one Swedish study, most people's acne improved after exposure to the sun. But not all doctors agree that sunlight is helpful. Some say it may just be relaxing in the sun that makes the pimples vanish. At any rate, the idea that the sun improves acne by drying out greasy skin doesn't hold water; sun and heat increase oil production.

Mild acne can often be cleared up simply by washing your face once or twice daily and avoiding any food or drink you think triggers an outbreak. If these measures alone don't work, you may want to try one of the acne medicines that you apply directly to the skin and that are sold without a prescription. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid, all of which the Food and Drug Administration has found effective for treating mild acne.

All of these drugs are "peeling agents," which cause irritation and drying that help the body loosen plugs and shed dead cells. The drugs also can keep bacteria from forming, which reduces the fatty acids that contribute to acne.

(FDA officials are concerned about what happens when skin treated with benzoyl peroxide is exposed to sun. Research done so far hasn't shown the combination to be harmful. But the agency plans to review other studies currently in progress to ensure the safety of benzoyl peroxide products.)

What won't work is (popping) picking at pimples . This can injure skin and underlying tissues. If you have acne that won't clear up with home treatment, see a dermatologist, a doctor who specializes in treating skin problems.

Sometimes dermatologists use instruments called comedo extractors to remove blackheads. They may also surgically drain large pustules or abscesses.

There are also drugs that can be prescribed for more severe cases. These include both topical and oral antibiotics such as tetracycline and erythromycin, and Retin-A (tretinoin), a derivative of vitamin A that comes in cream, gel or liquid. Another acne drug, Accutane (isotretinoin), is also derived from vitamin A. But this medication, taken by mouth, has serious side effects and isn't for everybody.

In very rare instances, where these measures don't work or haven't been used before the acne causes permanent skin damage, plastic surgery can be used to smoothe over deeply pitted and scarred skin.

Acne may be an inevitable companion of the teen years. But today, with proper measures, it can usually be controlled before it becomes totally unsightly. And if pimples pop up for that big evening, don't let it get you down--your date will probably have a few, too.

Judith Levine Willis is a member of FDA's Public Affairs staff. Sharon Snider, an FDA press officer, also contributed to this article.

by Judith Levine Willis

There is one medication for acne that teenage girls should be particularly cautious of. The name of the drug is Accutane (isotretinoin). It's a capsule taken by mouth and it's derived from vitamin A, which has for some time been known to cause birth defects.

Accutane is approved by FDA for treating severe cystic acne for people whose skin condition does not sufficiently improve with other treatments, including antibiotics taken by mouth. Accutane completely clears acne in many people, but there continues to be concern about its use in young women who may become pregnant.

The instructions that doctors receive for prescribing the drug warn: There is an extremely high risk that a deformed infant will result if pregnancy occurs while taking Accutane, even for short periods.

Accutane is not to be given to a woman of childbearing age (any menstruating female) unless she has "severe disfiguring cystic acne" that does not improve with standard therapies and unless certain precautions are taken.

Before prescribing Accutane to women of childbearing age, the doctor should give the patient an information sheet that includes statements about the drug's ability to cause birth defects. The patient is asked to initial these statements and to sign an authorization for treatment. If the patient is a minor, a parent or guardian's initials and signature are required.

Another acne medication, Retin-A (tretinoin), is also derived from vitamin A, but it is applied to the skin, not taken by mouth, and there have been no reports of birth defects related to its use.

-Publication No. (FDA) 96-97