What is Acne? What is the Acne Vaccine? The Acne-Crohn’s and Acne-Autoimmune Connection

I recently saw that there is a new acne vaccine in the works and my interest was piqued.  How on Earth would a vaccine be effective to treat or prevent acne, I wondered?  What does that even mean?  In order to answer that question, “How would a vaccine reasonably be expected to fight what has long been considered an annoying but benign skin condition that most people grow out of?” we first need to know, what is acne?  Don’t we?  I always believed acne was “overactive sebaceous glands” that ruptured the follicles and became inflamed and/or infected and I had reason to know a little bit about it — that’s the medical explanation I was always given and I have suffered from severe cystic acne since I was a teenager.  How any vaccine would be expected to prevent overactive sebaceous glands or resulting inflammation and/or infections was, at first blush, unclear.

In my own case, I have taken every prescription and over the counter acne treatment imaginable including dubious long-term treatment with antibiotics that were supposed to prevent the deep infections (while simultaneously destroying the gut) and the antibiotics worked until they made me so sick I couldn’t take them anymore.  I was 16 when I decided that I didn’t care how bad my skin looked, I just could not and would not tolerate the antibiotics which made me bloated, nauseated, and overall feeling extremely ill.  Of course, as soon as I stopped taking the drugs, the acne came right back.

By the time I had suffered through 2 years of college with this allegedly “cosmetic” condition and what was also, in hindsight, years of moderate to severe chronic pain from essentially being covered in chronic abscesses (boils) I broke down and agreed to take Accutane, an oral tablet which works to treat cystic acne but no one knows why it works, just that it does.  A mystery cure?  Really?  That doesn’t help explain what acne is either.  When I was prescribed Accutane in the 90s it was known at the time to cause hideous side effects like severely dried and cracked mucous membranes, vision problems, and — wait for it — inflammatory bowel disease (IBD) including ulcerative colitis and Crohn’s disease.  How in the world, one might ask, would any medication cause an autoimmune disease like Crohn’s?  How is that even possible?

Back then, I did in fact develop gastrointestinal symptoms (and vision problems and cracked mucous membranes) that coincided with my treatment with Accutane but I just blew it off and that was not just me being flippant about my health.  I was able to easily treat these so-called side effects with what I was told were benign prescription drugs and besides, the only side effect of Accutane my doctors cared about was the 100% likelihood of severe birth defects if a woman has any contact with Accutane while pregnant or in the 3 months before she becomes pregnant.  Yes, for some reason, Accutane is severely toxic to the developing fetus — but, I was told, not to the adult patient.  The known risk of catastrophic fetal side effects was driven into me deeply and I was forced, if I wanted to treat with the only medication known to quickly and permanently cure severe cystic acne, to take oral contraceptives to avoid becoming pregnant.

And in addition to causing inflammatory bowel disease, Accutane is also extremely toxic to the liver and the drug insert probably said that Accutane patients shouldn’t drink, but my dermatologist, the medical literature and the drug inserts severely downplayed known liver and gastrointestinal side effects iatrogenic illness and injury and highlighted the one that they thought was the most important, or the one most likely to get them sued — the baby one.  Doctors prescribing Accutane to young women (apparently!) didn’t bother to tell them to watch out for signs of IBD or not to drink, but did force the women to concurrently take oral contraceptives to prevent pregnancy even if they were virgins or not “sexually active” to cover the doctors’ own asses as my University campus doctor told me, “In case you get raped.”  Of course, oral contraceptives are also known to cause IBD, meaning, ulcerative colitis and Crohn’s.  The plot thickens.

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