Illustration by Kathy Hagedorn / Akron Beacon Journal

What a difference a generation makes.

From hand-held zit zappers to high-powered laser beams and prescription and over-the-counter miracle creams, teenagers today have many more options to treat acne than their parents had at their age.

As both a dermatologist and someone who's wrestled with acne since third grade, Dr. Susan J. Kucirka of Family Dermatology of the Lehigh Valley, Schnecksville, Pa., has seen and experienced the changes firsthand.

"I went to see a dermatologist for years and years. I had such bad acne, I wanted to put a paper bag over my head," said Kucirka, who's now in her mid-50s and still gets an occasional breakout.

Scientific advancements in the understanding of the skin disease that affects an estimated 17 million people, most younger than 30, and new technology and medicines have greatly improved treatment options, especially in the past 10 years.

"We now have more choices from which to draw upon," said Dr. Bruce Brod, a spokesman for the American Academy of Dermatology and clinical associate in the department of dermatology at the University of Pennsylvania.

Retin-A, a powerful derivative of vitamin A, was a major breakthrough in acne treatment when it became available in the 1970s. Retinoids, the family of vitamin A derivatives, are still used in the frontline defense, but other topical medications that are less harsh, prescription and over-the-counter, are increasingly coming onto the market.

Michelle Yondura, 21, of Tamaqua, Pa., who has been battling cystic acne and blackheads for eight years, had been using a product that contained salicylic acid but was not seeing results, and Retin-A caused some minor peeling. But Yondura knew there were many more weapons in the arsenal.

A better understanding

"Even within the last few couple months, they've come out with new and different products and they seem to be working very well," she said.

Brod said treatment options for mild to moderate acne have broadened because scientists have a better understanding of the hormonal and microbiological aspects of acne, and that requires different methods of attack. For example, the birth control pill Yaz has been prescribed to women because it blocks androgen receptors that can cause acne.

Dr. David Vasily, president of Lehigh Valley Dermatology Associates in Bethlehem, said he can offer patients newer forms of retinoids, such as adapalene and tazarotene, that offer the same benefits but cause less irritation, which can include redness or dry, flaky skin.

In addition, Vasily said new treatments that combine two drugs in one agent are particularly effective, such as Ziana, a new gel that is a combination of Retin-A and clindamycin, an antibiotic that helps kill p.acnes, the bacteria that causes acne. And, because one gel is easier to apply than two or more, patients are more likely to use them, he said.

Yondura is now using Differin and Duac gels, both combination ointments.

"They seem to be working pretty well," she said.

Oral antibiotics such as doxycycline and minocin have traditionally been part of a dermatologist's arsenal to kill the bacteria. While these antibiotics are still effective, doctors are more reluctant to prescribe them because they can cause strains of resistant bacteria. But new compounds that combine benzoyl peroxide and clindamycin prevent bacteria from becoming resistant to antibiotics, Vasily said.

And new low-dose antibiotics, such as Oracea for rosacea, that control the papules and pustules of inflammatory acne have also shown to create less resistant bacteria.

Beyond antibiotics and retinoids, acne sufferers have been turning to chemical peels of glycolic or salicylic acids to control their pimples.

"I think we've come to realize that acne has a multifactoral aspect to it," said Robin Ashinoff, an AAD spokeswoman.

"Different people may have different types of acne that predominate," Ashinoff explained.

When topical retinoids and antibiotics don't work, "then we move up the scale," she said.

"Some people may add ancillary things like chemical peels and microdermabrasion to exfoliate and open up the pores and a variety of different lasers to try to treat acne and acne scarring," she added.

Vasily, who is the director of Aesthetica Cosmetic and Laser Center in Bethlehem, Pa., advocates laser therapy when traditional treatments have failed. Lasers emit various wavelengths of light that are aimed on a hair follicle. There they destroy acne-causing bacteria or inhibit the sebaceous gland's oil-producing capacity.

Some instruments emit one wavelength that targets sebum. Others, such as the Star Lux V, are intense pulsed lights that emit multiple wavelengths.

The problem is that lasers have been "overhyped," said Vasily, who has conducted research on the Cool Touch laser and written the white paper on the StarLux V laser.

Lasers are useful adjuncts for treating acne, but not a panacea, he said.

Operating along the same principles of laser is Zeno, the first of several small, hand-held pimple-destroying devices that are available in stores without a prescription. Zeno was approved by the Food and Drug Association and became available in 2005. Zeno MD is the newest version and retails for about $225.

Both instruments, which are about the size of a cell phone, emit a low level of heat to destroy bacteria in pimples and reduce the blemish in about two days.

ThermaClear by Therative, another hand-held device, became available in September and retails for about $150. Clear-u by Phototherapeutics, which employs light-emitting diodes that kill acne bacteria and stimulate collagen production, is expected to be available in 2008.

One of the latest forms of light therapy is photodynamic therapy or PDT and used in conjunction with a topical treatment called porphyrin.

'Jury is still out'

Brod of the American Academy of Dermatology said PDT is promising, but added, "The jury is still out on its effectiveness and on the right wave of light to activate the porphyrin derivative."

Like other lasers, PDT would not be a first-line therapy for acne, but may be an option for people who wish to avoid oral medications, Brod said.

Accutane, the brand name for isotretinoin, a powerful oral retinoid drug that has been available since the 1980s, is still reserved as the heaviest artillery to fight the most severe forms of cystic or nodule acne, but women have to be highly monitored because it can cause birth defects.

"In the right setting, it's the closest thing to a miracle drug we have in dermatology," Brod said.

— Distributed by McClatchy-Tribune Information Services.