Acne

Zits are the Pitt's. What makes Jolie not Jolly?

When international mega stars Brad Pitt and Angelina Jolie first paired, the tabloids cheered: Grocery store headlines followed for years!  Part of the draw was the beauty projected by the delicious duo. Yet there was trouble from the start, at least on the surface. Specifically, skin problems.  Brangelina tormented by acne? Comprehend that one of the most common conditions confronting those curing cutaneous complexities is comedones. Congested pores, that is. And one of the biggest misconceptions is that acne happens only to teenagers. The reality is that almost all adults experience some form of acne. These flares range from the rare deep cyst and closed pore to severe inflamed nodules. Acne lesions can be painful or itchy, and recurrent crops can be embarrassing and depressing. Fortunately, there are a multitude of treatments for acne. Sometimes it helps just to know you are not alone. So look at your screen, oh brave but pimply web surfer. Look upon the visages of two of the most glam stars on our tiny planet. Though they are no longer an item, the bonding they shared, coping with adult acne, is something that the Fleet Street press can never take away.

Certainly, teens are, per square inch of skin, more likely to have closed pores, white heads, black heads and cysts than those in their early twenties. Check out this teen image of heartthrob actor Leonardo DiCaprio. Note the full gamut of acne lesions. Beginning with closed pores and ending with markedly inflamed cysts, his was adolescent acne in bloom. Most teenagers can be treated with a topical Vitamin A cream, such as Retin-A, Differin or Tazorac.  Until recently, these products required a prescription in the US, but like DiCaprio’s roles over the years, that is changing.  In 2017, a form of Differin (adapalene) became available over the counter.  Care must be taken to avoid dryness or Leo’s face might become as irritated as it was in “The Revenant.” We are sure there is some joke herein of Titanic proportions, but we are not going to go there.

Cinematic acne is not alone. The music industry is also a breeding ground for blemishes.  Teen dream Katy Perry is a pop diva prone to pimples.  Deep to closed pores, bacteria collect, causing Fireworks-style pustules and inflamed cysts. 

There are times when topical options are just not enough.  There may be no bigger movie star than Will Smith for sheer blockbuster bucks.  Yet even Smith was for years plagued with adult acne.  As seen here, the Man in Black was also the Man with Blackheads. Here are punched up cystic lesions seen in the boxing biopic “Ali.” Even with Smith’s wealth, access to the finest chefs was not enough. Despite reams of internet info to the contrary, diet does not play a major role in non-rosacea acne flares. We aren’t privy to Smiths treatment regimen, but some benefit from courses of antibiotics, either topically, or taken by mouth.  The pills that best work clear inflammation even as they zap bacteria.  Usually a treatment like Retin-A cream can be a helpful sparring partner.

Hormones can also contribute to problem pores. In 2016, Star Wars hero Daisy Ridley came clean about her complexion issues. Like a large number of young women, Ridley has polycystic ovary syndrome (PCOS).  This may sound like a villain from the Dark Side, but instead represents a non-contagious condition usually featuring abnormal menstruation, facial hair and acne.

Note the many congested pores on Ridley's forehead, like so many movie fans swarming to attend the latest flick in the galaxy-spanning franchise. Not seen here, women may also have increased facial fur. Facial hair is only mildly increased, so Chewbacca’s Wookie job security is not threatened. Treatment usually involves estrogen-based birth control pills or Spironolactone, a blood pressure medicine that doubles as a hormone balancer.  This pill limits the hormonal shifts, resulting in skin as smooth as the planet Tatooine is dry.

A pill form of vitamin A, dermatologists have long seen the beneficial effects of Accutane to normalize pores and shrink oil glands, improving the skin of millions of patients. There are well documented side effects to Accutane. No woman should become pregnant while taking the pill because of the risk of birth defects. Other problems, such as dry skin, sun sensitivity, and possible emotional effects, are temporary and can be minimized under a doctor's care. Accutane can clear severe forms of acne for months or years.

After having her acne cleared by Accutane, Simpson went on to become a well-paid endorser of Proactiv, a heavily hyped over-the-counter option. In my experience as a dermatologist, the beneficial results from Accutane for cases of persistent cystic acne are clear. Proactiv, on the other hand, might work for mild cases (the ingredients, benzoyl peroxide and glycolic acid, are available over-the-counter at any pharmacy). Whether or not Simpson gives credit to Accutane for clearing her acne, actors such as Matthew McConaughey and Emma Stone have come forward with Pro-Accutane stories.  Though not for everyone, Accutane can be a game-changer in the battle against blemishes.

Actress Michelle Rodriguez is best known to fans of the action franchise, "The Fast and the Furious."  She proves she can drive, seduce and fight as well as any of her male co-stars.

At Skinema.com, Rodriguez' star status is sealed by her star turn in 2003's slick flick "S.W.A.T." Here she proves that she is a dermatologic double threat. No, not necessarily a singer-actor, rather that she displays 2 distinct skin conditions. Like many of her peers she shows adult acne. Note the congested pores on her cheeks.  Topical vitamin A creams would work like a well-oiled engine to speed her to a clear complexion.

Michelle truly stands out with this image, unique in Hollywood. Nearly no other publicity photo shows what she displays on her well-toned arms: Small, pimple-like bumps in the place of hair follicles, a condition known as keratosis pilaris (KP). KP is a genetic tendency to tiny, scaly spots on the arms, legs, and trunk. Though it is very common, it can be as hard to see in photographs as it is to follow the convoluted plots of the endless "Fast/Furious" installments. Unlike facial acne, which is worsened by oiliness, KP flares when the skin is dry. Furiously scrubbing and exfoliation just make the bumps burn as bright red as the tropical island sun. Only hydration can smooth the skin. Avoiding soap and losing the loofah are the key to clearance, along with prescription moisturizers containing lactic acid and urea, gently applied to the wet skin. With a little TLC, Rodriguez can make her arm lesions vanish in time for the next summer sequel.

Sometimes, even the titan of acne treatments, Accutane, can’t help.  Here is an undoctored image from one of actor Kevin Spacey’s early films, “See No Evil, Hear No Evil.”  The bulging cheek bump is not a result of prosthetic makeup.  Its presence predates the routine use of cinematic CGI.  There, literally in the flesh, is an epidermal inclusion cyst (EIC).  The mother of all blackheads, an EIC represents a pore that folds under the skin surface, creating a pocket.  The lining of the pocket acts like the normal epidermis.  Skin cells and keratin, rather than flaking off the surface and making dust, are gradually released into the cyst.  In Spacey’s case, this resembles the bald pate of his eventual Oscar statuette hoping break free from its cutaneous constraints.

Traditional acne creams and pills don’t correct this dermatological defect, surgery is the solution.  Whether draining the cyst and extracting the wall, or cutting out a larger margin and using sutures, EIC’s meet their end in doctor’s offices. We leave posting Youtube vids of cyst-draining to other (extremely popular) websites.

We would rather speculate about whether this cyst helped Spacey’s career.  In the movie, he plays a thug.  As is well documented elsewhere on this site, bad guys are usually shown with bad skin.  Was Spacey cast because his bulging cyst made him stand out during the cattle call?  By his next film, he appears to have cashed his paycheck, used his SAG insurance and had it treated.  With talent and perseverance, Spacey became an Oscar-winning movie and TV star. A small scar remains, a possible testament to the lesion that may have started it all.