Two views: How to treat adult acne

TRADITIONAL: Dr. Victoria Taraska, dermatologist in Winnipeg

Acne, from blackheads to large lesions, is caused by four things: bacteria, too much oil, hormonal changes or too little exfoliation. I often try different therapies before one works; most people see results in six to eight weeks. For mild to moderate acne, I start with drugstore cleansers with salicylic acid or benzoyl peroxide, which is antibacterial.

I also suggest moisturizers that are non-comedogenic or oil-free, because those don’t clog pores. If that doesn’t work, the next steps are antibiotics or prescription topical therapies that contain benzoyl peroxide, alpha-hydroxy acid or retinoids.

If the acne is hormonal, birth-control pills work for 70 to 80 percent of people. (The Pill lowers testosterone, which increases oil production in the body.) For severe acne, I prescribe Accutane, the only therapy that can result in remission. Serious side effects are rare: Out of thousands of patients I’ve treated with Accutane, only two had serious mood changes.

I don’t discourage natural therapies, but I’d like to see them go through the rigorous testing everything I prescribe does: double-blind studies involving hundreds of people that prove the remedies are more effective than a placebo.

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ALTERNATIVE: Maryam Mahanian, traditional Chinese medicine practitioner in Vancouver

First, I ask about medical history, stress levels, menstrual cycles, bowel movements and eating habits. Then, I check blood pressure and pulse, and look at the tongue. Using all of that information, I prescribe herbs or acupuncture; commonly, I combine the two.

Cystic acne [severe] is caused by damp heat, which is a heavy, sticky substance in the body that’s the result of a bad diet or damage to the digestive system. Milder acne is caused by dry heat. I offer herbs that promote urination and sweating, like long dan cao (gentian root) or pi pa ye (loquat leaf), which patients take two or three times a day in a tea.

Acupuncture stimulates circulation, eliminates blockages and brings energy and blood to the organs. For acne, helpful points are on the lower legs and arms, abdomen and feet. With herbs, acupuncture, and diet and lifestyle changes, most patients improve within a week; for hormonal acne, it takes about three menstrual cycles. Most people come to me after trying Western medicine, like Accutane, which can cause liver damage and fetal malformation - it’s that strong. Chinese medicine treats the root causes, instead of just the symptoms.