How to save your skin

A Californian doctor claims that his methods can cure acne in 95 per cent of cases, using simple, over-the-counter products. Is this too good to be true? Clint Witchalls investigates

There are a lot of myths about the causes of acne. First, there is the food theory: that eating chocolate, sugar, shellfish, tomatoes or oily foods causes acne. Not true, although iodide (which is found in desalinated drinking water) can cause spots. Second, that not washing your face often enough causes acne. Again, not true. Human skin is quite efficient at cleaning itself, and you can actually aggravate acne by washing your skin with harsh soap. Third, that masturbation causes acne... Does anyone still believe this?

There are a few myths about cures, too. Camphor won't clear up your acne and neither will spending time in the sun. Also, there is no proof that essential oils, such as lavender and tea tree, will cure your spots. Acne is a genetic disease. If both your parents had acne (or still have it), the odds are that you'll get it too. You'll probably even get it in the same body area as your parents. But that it's a genetic disease doesn't make it untreatable.

Of course, most people know that changes in the level of testosterone during puberty (in both boys and girls) causes acne outbreaks, but acne isn't a disease that just affects teenagers. For some people, outbreaks will continue into middle age and beyond. It is the most common skin disease in the world, affecting 100 per cent of men and 90 per cent of women at some point in their lives. If anyone could find a cure, there would be a huge market to tap into. And, of course, there are many people who say they've found a treatment that works. The American dermatologist Dr Nicholas Perricone, for one, has written a book called The Acne Prescription: the Perricone Program for Clear and Healthy Skin at Every Age. But the Perricone range of products - which can be bought at stores such as Liberty - are proprietary and beyond the pockets of most teenagers. Now, Brenda Adderly (co-author of The New York Times No 1 bestseller The Arthritis Cure), has teamed up with a Californian plastic surgeon, Dr Terry Dubrow, to write a book called The Acne Cure. The book is being heavily hyped and is set to be a big seller, at least in the United States. This is the authors' claim: "Using the techniques outlined in this book, acne can be completely eliminated in 95 per cent of cases - even the most severe ones - in six weeks or less. These techniques start to work in 24 hours." The authors give short shrift to acne support groups and other specialists who, they think, treat acne sufferers as helpless victims. Dr Dubrow believes that acne is eminently curable.

All the anti-acne products needed for the programme can be bought over the counter at high street pharmacies, with the exception of glycolic acid, which needs to be bought over the internet or at a big department store. The full range of products costs about £80. It's not cheap, but is certainly cheaper than visiting a private dermatologist. Also, unlike with the popular anti-acne medicine, Roaccutane, there are no unpleasant side effects.

There are several different types of acne. By far the most common type is acne vulgaris (affecting 95 per cent of sufferers), and it's this that The Acne Cure programme is most adept at curing. Acne occurs when sebum (the substance that lubricates your skin and keeps it healthy) combines with dead skin cells and blocks further sebum from emerging from your pores. The pore continues to produce sebum, but it is trapped below the skin's surface, ballooning into a moist, warm environment that is welcoming to bacteria. To rid the body of these bacteria (called propionibacterium acnes), the skin becomes inflamed. But the body's evolved defence doesn't always work, and the inflammation can inadvertently help spread the condition.

Dr Dubrow's programme is complex and detailed, but the following is a summary. There are four steps to the cure. First, excess dead skin must be cleaned away, and any bacteria that are lurking on the skin's surface eradicated. This step uses salicylic acid, found in a range of over-the-counter skin products such as Neutrogena's Oil-Free Acne Wash. This only cleans up the surface of the skin, which is why step two requires something that can "dig down" and get rid of the plugs of sebum that are jammed in the pores. To do this, you need glycolic acid. Not only does glycolic acid root out the plugs of sebum, it also has antioxidant powers which help reduce inflammation. Step three gets rid of any remaining bacteria that may still be hiding deep in the follicular canals, preventing the condition from flaring up a few weeks after the other products have been used. You need benzoyl peroxide (BP) for this deep-cleansing step. Dr Dubrow's innovation is to use an ice pack before applying cold BP, straight from the fridge. This opens up the pores and ensures that the BP does its job more effectively. Finally, you protect your skin with an oil-free moisturiser that has an SPF of 15. This is because UV rays weaken the skin's resistance to bacterial attack.

Research has proved that each of these products is effective on its own in counter-acting acne. What Dr Dubrow has done is to put them all together in a programme that tackles each stage of acne. But does it work? I asked Joycellyn Akuffo, a 24-year-old woman who has had acne since her early teens, to try the cure. "The Acne Cure programme was an intense one - the more so because it had four stages," she says. "Within the first few days, I had a breakout, and I thought that this might be due to using new products or because of hormonal connections (time of the month), but the spots that came were quite painful and took longer than usual to clear. My skin settled, but then there were still spots appearing weeks down the line, so I knew that this programme wasn't the one for me."

Joycellyn has suffered from persistent acne since her early teens, so she may fall into the five per cent of Dr Dubrow's group that doesn't respond to the programme. However, she had other concerns about the programme, namely the application of ice packs to the face. "Luckily for me, my breakouts are on my cheeks, so using the ice for 10 minutes was OK," she says. "I can't imagine how anyone who has acne all over their face would manage, because they'd end up with a headache or migraine with all that coldness."

I asked Alison Dudley, head of the Acne Support Group (a network of more than 6,000 acne sufferers worldwide), what she thought of the Dr Dubrow's regimen. "I'm very worried with the wording 'cure'," she says. "I think it's misleading to think that any treatment can actually cure your skin. I think the basics of it are very good, and I don't see why it wouldn't work for some people. But they're only recommending treatments that we - and dermatologists - have been recommending for years."

But Dr Dubrow says that he's had wonderful results at his Acne Clinic in Newport Beach. "The reason for those results is because of the synergistic effect of attacking the multiple causes of acne simultaneously," he says. "It works in theory and it works in practice. Has everyone who had severe acne ended up with 'model perfect' skin afterwards? Of course not, nor do we promise such a result in the book. But, nearly all people will see noticeable results, often beginning as soon as 24 hours from the first day of treatment."

Dudley remains sceptical, however. She says that if the 95 per cent cure rate is ever substantiated by a statistical study, she'll quit the Acne Support Group and start selling Dr Dubrow's book.

'The Acne Cure' by Dr Terry Dubrow and Brenda Adderly, published by Rodale on 19 September, £10.99; the Acne Support Group (0870-870 2263; www.stopspots.org)

TRADITIONAL ACNE TREATMENTS

There are about 100 acne treatments available over the counter and on prescription. These treatments help to prevent spots in three main ways: some unblock pores, others eliminate the bacteria which infect the blocked pores, and still others reduce the amount of sebum which is produced by the skin.

Which treatment is suitable for you will depend upon the severity of your acne and how it responds to treatment. It is important to keep trying until you have found one that works.

* Mild acne can often be successfully treated by topical, over-the-counter treatments containing benzoyl peroxide or salicylic acid. These work by clearing the blocked pores which lead to spots.

* For moderate acne, or for mild acne which has not responded to treatment, a topically applied gel called Nicam gel may be beneficial.

* If neither of these treatments work then visit your doctor, who may prescribe antibiotic treatments. These eliminate the bacteria which cause spots, and are either taken internally - in the case of treatments such as oxytetracycline - or applied topically - as with treatments like Zineryt.

* For severe acne, a doctor may prescribe Roaccutane. This"switches off" sebaceous glands. A single course lasts about four months. However, it is linked to birth defects so should not be taken by pregnant women or women trying to become pregnant.