By James Fulton
WebMD Live Events
Transcript

Event_Moderator Welcome to WebMD Live. Today we will be discussing "The Prevention & Treatment of Teen Acne," with James Fulton, M.D., Ph.D.

James Fulton, M.D., Ph.D., is based in Newport Beach where he is the founder and leading research scientist at the Acne Research Institute and the medical director at the Fulton Skin Institute. Fulton is a current editor for both the Journal of Dermatological Surgery and the International Journal of Aesthetic and Restorative Surgery. He is active in numerous professional societies, including the American Academy of Dermatology and the Skin Cancer Foundation, and his scientific research in skin care has led to several U.S. patented treatments. Fulton has published his research in several scientific journals, and he is the author of two specialized acne treatment books, "Farewell to Pimples" and "Dr. Fulton's Step-by-Step Program for Clearing Acne."

Dr_Fulton I'm James E. Fulton, Jr. of Newport Beach, CA. I had acne as an infant and again as a teenager, and have dedicated my life to the understanding and treatment of acne. In 1969, I developed Retin A. In 1972, I developed benzoyl peroxide lotion in 1975 I developed the antibiotic lotions called E-gel. Since that time, I have been Research Director of the Fulton Skin Institute in Newport Beach, California, where we treat acne every day.

Event_Moderator What is acne?

Dr_Fulton Acne is basically a genetic disease. If mom and dad had it, three of the four children will have it. You don't see it until the hormones begin to circulate age 10 and 12. The oils begin to flow. The pores become impacted if you have the disease process in your family.

Event_Moderator What causes acne?

Dr_Fulton The increased oil around the age of 10 or 12 irritate the pores in those certain families. The cells that line the pore begin to stick and thousands of cells build up in the pore and you see that as a whitehead. The wall breaks down and it becomes red and inflamed and we call that the pustule.

Event_Moderator Do greasy foods contribute to acne?

Dr_Fulton Not really. Basically it's your own oil in certain families that cause the problem and diet has little to do with it. Years ago, diet was considered a major factor, but our research has shown that it's one of the myths of acne.

Event_Moderator What are some other myths about acne?

Dr_Fulton We have series of myths we want to dispel. One is that acne is dirty skin. The truth is that acne is below the surface and you can wash your face 20 times a day and still have a problem.

Event_Moderator What are some preventative measures to avoid developing acne?

Dr_Fulton You really can't prevent it. It's like you inherit diabetes and all of a sudden it comes on. They're aggravating factors that you can be careful with, but you can't prevent it.

Event_Moderator What are some of these aggravating factors?

Dr_Fulton There's a whole list and stress is the number one aggravating factor. If you're not getting a good night's sleep, acne gets aggravated. Another aggravating factor is certain cosmetics. Another aggravating factor is pressure like a headband or a backpack or the shoulder pads of an athlete, all those block the pore and can aggravate the condition. test test test

Dr_Fulton We're back and ready to talk some more about aggravating factors of acne. One drug called Lithium which can aggravate the acne problem.

Event_Moderator How is acne treated?

Dr_Fulton There's some old treatments which I had with my complexion problem. For example, I was taking an antibiotic called tetracycline. I took it for five years. As I look back on it, it didn't do me any good. There were also special diets. They don't really affect acne. More recent treatments have been the Retin A that I developed in 1969 with Dr. Kligman. That's a topical ointment of vitamin A and that peels out the impacted cells of the pores. After that, we developed the benzyl peroxide that we mentioned before which went down the pore and kills all the bacteria. The ones that contain the benzyl peroxide are Oxy 5 or Oxy 10. They're good products.

Event_Moderator Are the over-the-counter "medicated pads" or ointments useful?

Dr_Fulton Some of the other things like alcohol pads don't do much good.

Event_Moderator Are there natural treatments for acne?

Dr_Fulton There's the holistic component. I think you need the vitamin A and the benzyl peroxide. Holistically speaking, you need 8 hours sleep a night. Going without sleep is an aggravating factor. You also need balanced diet with fresh fruits and vegetables. If you're just having empty calories like French fries, it's a stress. Any of those stresses can aggravate the complexion.

josuechan_WebMD What would happen to skin if sebaceous glands stop working?

Dr_Fulton Probably nothing. When we were hairy like earlier on, the oil lubricate the hair like it does on the scalp. On the face, there's no hair so there's no reason for the oil glands. They're just left over as we evolved and lost hair. They don't really have any function. They just get in the way and cause impacted pores.

Event_Moderator Why are teens more likely to have acne?

Dr_Fulton You inherit it. It runs in your family, but the hormones that begin to circulate in the teen years aggravate the problem. After all the pores have been destroyed that are affected, the problem burns out. By the time you're 22, maybe you're over it. That's why it's a teenage problem although now we have acne in the adult woman, which is an epidemic problem.

Event_Moderator Why is that occurring in adult women?

Dr_Fulton Women in general don't have such high level of hormones as men so they might have a minor problem as a teenager and not go through the whole thing.

sgb120_WebMD With all the technology we have why is their no cure or is there?

Dr_Fulton As they're older, when they have hormone changes like pregnancy or birth control pills or stress, it can become a big problem in the 20's and 30's as opposed to the teenage years. It's like diabetes. We know that diabetes is due to an insulin problem and you have to take insulin. There's no cure. Same thing with acne. There's no cure. You have to use your vitamin A to keep the pores open. The closest thing we have to a cure is the vitamin A you take in the pill called accutane. That reduces the oil and in some people leads to a cure.

Event_Moderator Isn't accutane a very dangerous drug?

Dr_Fulton There are some side effects but compared to having acne scars for life, most of the side effects are minor.

Event_Moderator What side effects would there be?

Dr_Fulton Normally since there's less oil, your skin gets dry. Also the nose gets dry and the eyes become dry and you may have nose bleeds and can't wear contacts. Those are minor problems. Any form of vitamin A like accutane can cause more migraine headaches and side effects such as those. The only serious side effect is women is if they get pregnant, the fetus may have birth defects. You have to take some preventive measures while you're taking accutane, like birth control pills.

Event_Moderator Can environmental factors cause acne?

Dr_Fulton The climates can aggravate it, like a wet humid climate blocks the pores. A dry climate, high in mountains opens the pores and acne is less of a problem in colder, dry climate.

Event_Moderator What is glycolic acid?

Dr_Fulton We've talked about vitamin A and benzoyl peroxide. A newer treatment is the alpha hydroxy acids which are acids that cause the skin cells, the dead skin cells, to come off more freely. Now we know acne is the impacted pores, the dead cells stick and glycolic acid reverses that and improves acne.

Dr_Fulton Often we use the glycolic acid in the morning and the vitamin A at night. Glycolic takes off the dead skin cells and the vitamin A produces new skin cells that don't stick in the pore.

Event_Moderator How can a teen cope with the embarrassing stigma of acne?

Dr_Fulton It's a difficult situation. A four letter word, acne, is the teenager's worst word. It's an emotional problem. The best advice I have is to really get on a good program for therapy and clear it up. Some people are not bothered by acne, but my own case, it was devastating to me and for many of your listeners it's devastating also. So the important thing is to understand acne and to treat it aggressively with the products we've talked about so it is controlled.

Event_Moderator How does one find a good dermatologist to treat acne?

Dr_Fulton The yellow pages is your first start. You should interview the receptionist and make sure the dermatologist likes to treat acne. Many dermatologists like to treat skin cancer. You need to find somebody who loves to treat acne. If the doctor doesn't, ask the receptionist who does in their area. Contact me and I'll give a doctor in the area if I happen to know one who devotes his career to acne.

Event_Moderator Why are boys more prone to developing acne than girls?

Dr_Fulton Because they have a higher level of the male hormone. Everybody has male hormones, but men have a level ten times higher so they get it bad as a teenager. Women have like 10% of the level and they may have problems as teenagers, but they also may have problems later on with hormone changes.

Event_Moderator I've heard that sexual activity reduces acne. Is that true?

Dr_Fulton That's another myth. We talked about dirty skin, diet, and sexual frustration. The acne as we discussed, tends to burn out when you're around 22, which is about the time you get married and grandmother says, "he got married and the acne got better." It's really a burn-out and not due to sex.

Event_Moderator With some people, acne doesn't burn out. Why not?

Dr_Fulton Normally it comes across the face like a wave. When you're 12 it's on the nose. When you're 14, it's on the cheek. When you're 18, it's on the jaw line and when you're 22 it's on the neck. There are some pores left over in adult women and they can smolder on for years.

josuechan_WebMD If we produce a drug that stop oil glands secretions, would it cure acne?

Dr_Fulton Yes. That's really how accutane works. It turns off the oil and the acne goes away.

Event_Moderator What are you currently researching?

Dr_Fulton We're doing two types of research. One is looking for vitamin A lotions that will improve acne without being irritating and drying to the skin. We're researching how to improve the acne scars. Many people come to us too late. We're looking at new lasers to smooth the complexion after the acne is gone.

josuechan_WebMD Where can I get accutane, I live in Panama?

Dr_Fulton As far as I know, accutane is available around the world and should be available in Panama. It may be called something different. If not, a lot of people from Panama pass through Miami and it can be picked up in Miami.

Event_Moderator Why do some people respond to certain treatments for acne while others do not?

Dr_Fulton Basically, if you irritate the skin with the vitamin A lotions that we've talked about and the benzyl peroxide and do it diligently, most respond. A few people are resistant to that. Today if they are good patients and put on their lotions or take their accutane, almost everybody has cleared up.

Event_Moderator Is touching your face a contributing factor to acne? Why?

Dr_Fulton There's aggravating factors. The fingernail is an aggravating factor. If you pick the lesion before it's ready to be extracted you can force the impaction deeper and cause more scarring.

josuechan_WebMD Since I started lifting weights I have acne in my back and chest, does it have anything to do?

Dr_Fulton Acne progresses across the face and onto the back and chest so it may just be doing that naturally. The athletes who do a lot of work on mats like wrestlers, get a flare up of acne from the pressure of the--it's like the pack on the back, or the shoulder pads, the sweating and the pressure break the pore and aggravate it.

Event_Moderator How does stress cause acne?

Dr_Fulton Acne basically is a disease. And any disease is worse with stress. If you go without sleep, your diabetes is worse. If you go without sleep, the acne flares up. There is acute stress. If you're in chronic stress like going to college or something like that, chronic stress aggravates the hormones which aggravate the acne. There's acute stress like no sleep and there's chronic stress around chronic stress such as homework.

josuechan_WebMD What can I do to treat my back acne?

Dr_Fulton It's more difficult on the back because the pores there are deeper than on the face. You have to use stronger vitamin A lotions and stronger benzyl peroxide lotions. If the guest will email me, I'll email them back some stronger formulations.

Event_Moderator Is there anything else you would like to discuss, that we haven't covered, Dr. Fulton?

Dr_Fulton It runs in certain families and if it's in your family, you need to understand that it's not due to the myths. You need to avoid the aggravating factors and to put on a skin care program that causes some peeling so you can peel out the impactions. To realize that it's not a social disgrace, it's just a disease like any other disease. We want to bring acne out of the closet so that everybody understands it.

Event_Moderator Where do you see acne treatment 10 years from now?

Dr_Fulton We've been since 1969 -- been using vitamin A, and then from 1979, we had accutane and I don't see a lot of new developments. There are new types of vitamin A and new types of benzyl peroxide but I don't see the treatment changing. I'd like to educate the public, the sufferers, that there are good treatments available. I think there are 60 million Americans with acne. It's one of the most frequent diseases in certain populations.

It's not a problem in China, where it may be a problem in the Philippines or hot humid climates but as populations become more fluent or more Westernized and eat more junk foods, they tend to aggravate the problem. We try to worldwide understand acne and avoid the aggravating factors and use good treatments. One of the aggravating factors is your favorite cosmetics. We have to be careful about the oil in cosmetics.

josuechan_WebMD Is there any other chemical that can be more effective that accutane or benzyl peroxide?

Dr_Fulton Not at the moment. We combine the treatments, the alpha hydroxy, the vitamin A and the benzyl peroxide. Those are the three that we use currently and some mixture of those will clear your complexion. There is nothing new as effective as those.

Event_Moderator Thank you for joining us, Dr. Fulton. Join us again Monday, December 20 at 1:00 p.m. EST in the Mind Matters Auditorium when we will discuss "Mental Health In An Aging Society" with Marvin Shachter.

Dr_Fulton It's been great.

Event_Moderator James Fulton, M.D., Ph.D., is based in Newport Beach where he is the founder and leading research scientist at the Acne Research Institute and the medical director at the Fulton Skin Institute. Fulton is a current editor for both the Journal of Dermatological Surgery and the International Journal of Aesthetic and Restorative Surgery. He is active in numerous professional societies, including the American Academy of Dermatology and the Skin Cancer Foundation, and his scientific research in skin care has led to several U.S. patented treatments. Fulton has published his research in several scientific journals, and he is the author of two specialized acne treatment books, "Farewell to Pimples" and "Dr. Fulton's Step-by-Step Program for Clearing Acne."