M ost agree that it begins silently and asymptomatically as the microcomedone — a medically innocuous series of cellular events lead to this precursor lesion that once clinically expressed, can irrevocably change lives and fuel multi-million dollar over-the-counter (OTC) and prescription industries. Our understanding of the pathogenesis of acne continues to evolve. Sophisticated models and in vitro studies have expanded the acne lexicon to include retinoid and toll-like receptors, cortisol receptors, cytokines, interleukins, etc. We have well-controlled clinical data to support our contention that these laboratory studies have translated to bedside efficacy. It’s a fact that prescription acne medications clearly outperform the plethora of available OTC products in the treatment of both comedonal and inflammatory acne. Further, public awareness of acne as a treatable entity has never been greater. Direct-to-consumer (DTC) advertising from pharmaceutical companies, legitimate medical Web sites and readily available access to medical programs and articles provide accurate information to potential consumers about the true pathogenesis of acne and availability of efficacious products that can be obtained from physicians. This all sounds great so far for science and traditional medicine. A Looming Problem Now for the kicker, despite the availability of “better than ever” medical therapies, recent data suggest a decline in new prescriptions being filled for acne. Since we know that the occurrence of acne is certainly not decreasing, the obvious interpretation is that medicine is losing these patients to other treatment sources. Spas, salons, pharmacies, non-dermatologists, such as plastic surgeons, telemarketers and magazine marketers, are all competing for this ever-growing and revenue rich “alternative” market. Why are these non-dermatologic sources so successful at attracting even the most educated patients? Several bothersome and potentially frightening explanations can be offered. The legitimate and scientifically validated information provided to consumers must be assimilated in the context of the massive advertising campaigns from OTC sources claiming overnight miraculous cures. Unfounded, speculative and, at times outlandish, suppositions regarding etiologies of acne lead consumers to buy numerous products that lack efficacy and have potential for adverse effects. These sources are bound by no requirement to substantiate their claims and no regulatory agency monitors their outcomes. How is legitimate science, which is held accountable to legal sanctions and peer review to compete with unregulated, exaggerated and fictitious claims of success? The integrity and viability of legitimate medical therapies are being threatened by this pervasive trend in our society. The indoctrination of the public by non-medical sources has led to a distrust regarding the intentions and medications provided by physicians and pharmaceutical companies. There are allegations that pharmaceutical companies withhold effective treatments from patients for monetary gain. Further, critics of our traditional scientific method suggest that our current system presents researchers from “thinking outside the box.” With honest reflection and introspection, is the movement away from traditional medicine an indictment of our competence and efficacy? Is it a testament to the outstanding success and effectiveness of non-medical treatments? I think not. Big Business Acne is big business. In 2003, acne sales from eight different brands reached $1 billion, with $600 million for a telemarketed treatment system alone.1 This product, a topical benzoyl peroxide agent, which lacks peer-reviewed proof of efficacy, commandeered the treatment patterns of the American public because of brilliant marketing. Is this a beginning of a trend that will further delay acne patients from receiving efficacious therapy? I fear the answer may be yes. There is a critical threshold beyond which acne causes irreparable scarring of the integument and the psyche. The data are robust regarding the short- and long-term detrimental effects of acne. The intrapsychic impact is often lifelong and can be severe. The functional impact can substantially effect scholastic, social, vocational and sexual functioning. Fighting for Legitimate Science The time has come for us as a society to demand regulation and substantiation of the legitimacy of claims made by marketers of “health and beauty products.” One-hour wrinkle removers, anatomical enhancers, vitality boosters promising boundless energy and sexual prowess, memory enhancers, psoriasis cures, all-you-can-eat diets and anti-aging miracles all represent the symptoms of a societal delusion that magical elixirs can mitigate all unpleasant aspects of aging, illness and dissatisfaction with our personal reality. A sucker is born every minute — PT Barnum knew it, so do the modern-day purveyors of elixirs of youth, beauty and immortality. In final contemplation, the comedone can be conceptualized as the poster child representing the larger issue facing the medical community. Legitimate, validated and efficacious medical treatments lengthen and improve the quality of people’s lives. I preach these proven facts all too often to a deaf-eared choir as I rush from room to room during my busy day of clinical practice. Struggling with the realities of modern medicine, there are some days this weary clinician can’t help but wonder . . . shall I write another prescription for a product whose efficacy is substantiated by controlled studies? Or, should I compound some benzoyl peroxide/salicylic acid and make a really cool infomercial?
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Contemplating the Comedone
M ost agree that it begins silently and asymptomatically as the microcomedone — a medically innocuous series of cellular events lead to this precursor lesion that once clinically expressed, can irrevocably change lives and fuel multi-million dollar over-the-counter (OTC) and prescription industries. Our understanding of the pathogenesis of acne continues to evolve. Sophisticated models and in vitro studies have expanded the acne lexicon to include retinoid and toll-like receptors, cortisol receptors, cytokines, interleukins, etc. We have well-controlled clinical data to support our contention that these laboratory studies have translated to bedside efficacy. It’s a fact that prescription acne medications clearly outperform the plethora of available OTC products in the treatment of both comedonal and inflammatory acne. Further, public awareness of acne as a treatable entity has never been greater. Direct-to-consumer (DTC) advertising from pharmaceutical companies, legitimate medical Web sites and readily available access to medical programs and articles provide accurate information to potential consumers about the true pathogenesis of acne and availability of efficacious products that can be obtained from physicians. This all sounds great so far for science and traditional medicine. A Looming Problem Now for the kicker, despite the availability of “better than ever” medical therapies, recent data suggest a decline in new prescriptions being filled for acne. Since we know that the occurrence of acne is certainly not decreasing, the obvious interpretation is that medicine is losing these patients to other treatment sources. Spas, salons, pharmacies, non-dermatologists, such as plastic surgeons, telemarketers and magazine marketers, are all competing for this ever-growing and revenue rich “alternative” market. Why are these non-dermatologic sources so successful at attracting even the most educated patients? Several bothersome and potentially frightening explanations can be offered. The legitimate and scientifically validated information provided to consumers must be assimilated in the context of the massive advertising campaigns from OTC sources claiming overnight miraculous cures. Unfounded, speculative and, at times outlandish, suppositions regarding etiologies of acne lead consumers to buy numerous products that lack efficacy and have potential for adverse effects. These sources are bound by no requirement to substantiate their claims and no regulatory agency monitors their outcomes. How is legitimate science, which is held accountable to legal sanctions and peer review to compete with unregulated, exaggerated and fictitious claims of success? The integrity and viability of legitimate medical therapies are being threatened by this pervasive trend in our society. The indoctrination of the public by non-medical sources has led to a distrust regarding the intentions and medications provided by physicians and pharmaceutical companies. There are allegations that pharmaceutical companies withhold effective treatments from patients for monetary gain. Further, critics of our traditional scientific method suggest that our current system presents researchers from “thinking outside the box.” With honest reflection and introspection, is the movement away from traditional medicine an indictment of our competence and efficacy? Is it a testament to the outstanding success and effectiveness of non-medical treatments? I think not. Big Business Acne is big business. In 2003, acne sales from eight different brands reached $1 billion, with $600 million for a telemarketed treatment system alone.1 This product, a topical benzoyl peroxide agent, which lacks peer-reviewed proof of efficacy, commandeered the treatment patterns of the American public because of brilliant marketing. Is this a beginning of a trend that will further delay acne patients from receiving efficacious therapy? I fear the answer may be yes. There is a critical threshold beyond which acne causes irreparable scarring of the integument and the psyche. The data are robust regarding the short- and long-term detrimental effects of acne. The intrapsychic impact is often lifelong and can be severe. The functional impact can substantially effect scholastic, social, vocational and sexual functioning. Fighting for Legitimate Science The time has come for us as a society to demand regulation and substantiation of the legitimacy of claims made by marketers of “health and beauty products.” One-hour wrinkle removers, anatomical enhancers, vitality boosters promising boundless energy and sexual prowess, memory enhancers, psoriasis cures, all-you-can-eat diets and anti-aging miracles all represent the symptoms of a societal delusion that magical elixirs can mitigate all unpleasant aspects of aging, illness and dissatisfaction with our personal reality. A sucker is born every minute — PT Barnum knew it, so do the modern-day purveyors of elixirs of youth, beauty and immortality. In final contemplation, the comedone can be conceptualized as the poster child representing the larger issue facing the medical community. Legitimate, validated and efficacious medical treatments lengthen and improve the quality of people’s lives. I preach these proven facts all too often to a deaf-eared choir as I rush from room to room during my busy day of clinical practice. Struggling with the realities of modern medicine, there are some days this weary clinician can’t help but wonder . . . shall I write another prescription for a product whose efficacy is substantiated by controlled studies? Or, should I compound some benzoyl peroxide/salicylic acid and make a really cool infomercial?
M ost agree that it begins silently and asymptomatically as the microcomedone — a medically innocuous series of cellular events lead to this precursor lesion that once clinically expressed, can irrevocably change lives and fuel multi-million dollar over-the-counter (OTC) and prescription industries. Our understanding of the pathogenesis of acne continues to evolve. Sophisticated models and in vitro studies have expanded the acne lexicon to include retinoid and toll-like receptors, cortisol receptors, cytokines, interleukins, etc. We have well-controlled clinical data to support our contention that these laboratory studies have translated to bedside efficacy. It’s a fact that prescription acne medications clearly outperform the plethora of available OTC products in the treatment of both comedonal and inflammatory acne. Further, public awareness of acne as a treatable entity has never been greater. Direct-to-consumer (DTC) advertising from pharmaceutical companies, legitimate medical Web sites and readily available access to medical programs and articles provide accurate information to potential consumers about the true pathogenesis of acne and availability of efficacious products that can be obtained from physicians. This all sounds great so far for science and traditional medicine. A Looming Problem Now for the kicker, despite the availability of “better than ever” medical therapies, recent data suggest a decline in new prescriptions being filled for acne. Since we know that the occurrence of acne is certainly not decreasing, the obvious interpretation is that medicine is losing these patients to other treatment sources. Spas, salons, pharmacies, non-dermatologists, such as plastic surgeons, telemarketers and magazine marketers, are all competing for this ever-growing and revenue rich “alternative” market. Why are these non-dermatologic sources so successful at attracting even the most educated patients? Several bothersome and potentially frightening explanations can be offered. The legitimate and scientifically validated information provided to consumers must be assimilated in the context of the massive advertising campaigns from OTC sources claiming overnight miraculous cures. Unfounded, speculative and, at times outlandish, suppositions regarding etiologies of acne lead consumers to buy numerous products that lack efficacy and have potential for adverse effects. These sources are bound by no requirement to substantiate their claims and no regulatory agency monitors their outcomes. How is legitimate science, which is held accountable to legal sanctions and peer review to compete with unregulated, exaggerated and fictitious claims of success? The integrity and viability of legitimate medical therapies are being threatened by this pervasive trend in our society. The indoctrination of the public by non-medical sources has led to a distrust regarding the intentions and medications provided by physicians and pharmaceutical companies. There are allegations that pharmaceutical companies withhold effective treatments from patients for monetary gain. Further, critics of our traditional scientific method suggest that our current system presents researchers from “thinking outside the box.” With honest reflection and introspection, is the movement away from traditional medicine an indictment of our competence and efficacy? Is it a testament to the outstanding success and effectiveness of non-medical treatments? I think not. Big Business Acne is big business. In 2003, acne sales from eight different brands reached $1 billion, with $600 million for a telemarketed treatment system alone.1 This product, a topical benzoyl peroxide agent, which lacks peer-reviewed proof of efficacy, commandeered the treatment patterns of the American public because of brilliant marketing. Is this a beginning of a trend that will further delay acne patients from receiving efficacious therapy? I fear the answer may be yes. There is a critical threshold beyond which acne causes irreparable scarring of the integument and the psyche. The data are robust regarding the short- and long-term detrimental effects of acne. The intrapsychic impact is often lifelong and can be severe. The functional impact can substantially effect scholastic, social, vocational and sexual functioning. Fighting for Legitimate Science The time has come for us as a society to demand regulation and substantiation of the legitimacy of claims made by marketers of “health and beauty products.” One-hour wrinkle removers, anatomical enhancers, vitality boosters promising boundless energy and sexual prowess, memory enhancers, psoriasis cures, all-you-can-eat diets and anti-aging miracles all represent the symptoms of a societal delusion that magical elixirs can mitigate all unpleasant aspects of aging, illness and dissatisfaction with our personal reality. A sucker is born every minute — PT Barnum knew it, so do the modern-day purveyors of elixirs of youth, beauty and immortality. In final contemplation, the comedone can be conceptualized as the poster child representing the larger issue facing the medical community. Legitimate, validated and efficacious medical treatments lengthen and improve the quality of people’s lives. I preach these proven facts all too often to a deaf-eared choir as I rush from room to room during my busy day of clinical practice. Struggling with the realities of modern medicine, there are some days this weary clinician can’t help but wonder . . . shall I write another prescription for a product whose efficacy is substantiated by controlled studies? Or, should I compound some benzoyl peroxide/salicylic acid and make a really cool infomercial?
