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Acne

Acne

ACNE

“Zits”, pimples, blackheads, sores…- what doctors call “acne vulgaris” – can make the awkward age of adolescence even more awkward. At the first sign of a tell tale spot on your face, you fear the worst – your looks will be ruined, you’ll be scarred for life, and no one will ever go out with you. Over 80% of teenagers develop some acne. Fortunately, most acne is mild and self-limiting without scarring and there is now treatment available to keep acne under control until this tendency is outgrown, usually by age 20 to 25.

CAUSE:

Everyone’s skin is covered with little hairs (“peachfuzz”). Attached to the wall of the hair root under the skin is an oil gland. During adolescence, hormones stimulate the oil glands to secrete more oil. For some unknown reason, the pores for the hair and oil glands tend to become plugged. This plugging results in swollen, plugged oil glands which you see as blackheads, and white heads. If this plugged gland then ruptures, the result is inflammation (redness) under the skin, causing pimples.
Bacteria live on everyone’s skin and normally cause no problems. However, one type of bacteria converts bland normal oil to an irritating oil, and when these bacteria are trapped under the plugged pore, it worsens the imflammation in the skin. Thus, the treatment of acne involves keeping the “pores” open and reducing the number of bacteria on the skin.

ACNE FACTS:

  1. Diet does not affect acne. Studies done with chocolate, cola, nuts, or fried foods have failed to show that these or other foods worsen acne.
  2. Masturbation or sexual activity do not affect acne. Birth control pills sometimes improve acne but other times may make it worse.
  3. Acne is not caused by dirt, nor from not washing enough.
  4. Sunlight may improve acne.
  5. Tension and anxiety may occasionally worsen acne.
  6. While eating oily foods does not cause acne, getting oil or grease directly on the face may worsen acne. This may happen to teens who work with cars or machinery, or to those who work in a fast food restaurant with the deep fryer.
  7. While some girls tolerate cosmetics, others may not. If make-up is important to you, it may take some experimentation to find cosmetics that won’t worsen your complexion. Try the “hypoallergenic” or water-based non-oily ones (e.g. Clinique Pore Minimizer, Almay Fresh Look Oil Free Make Up, Helena Rubinstein’s Bioclear).

TREATMENT:

  1. Shower or bathe daily and wash your face twice a day using a mild soap such as Dove, Camay, or Neutragena. Using stronger soaps, or more frequent washing may dry the skin too much so that it becomes difficult to use the presribed acne medications.
  2. Shampoo hair daily.
  3. Try to avoid picking or squeezing pimples, as this tends to increase scarring. However, if you feel that you can’t live without “popping zits”, please follow these suggestions:
    1. Wash hands and face first.
    2. Only squeeze pimples that have a “pus head” and squeeze gently. You may need to carefully open the pimple with a sterile needle. You can sterilize the needle by wiping it with alcohol or heating it in a flame. Squeezing red pimples, or squeezing too hard may cause it to rupture under the skin, thereby “spreading” the acne.
    3. You may buy a blackhead extractor at most drugstores for about a dollar. Place the hole in the end of the small metal spoon directly over the blackhead and apply pressure. If the blackhead does not come out, it can be opened carefully with a sterile needle before pressing again.
  4. Use the medications that your doctor has prescribed:
    1. Oral antibiotics (e.g. tetracycline, erythromycin): These are both very safe even if taken for years. However, tetracycline may make you more prone to sunburn and vaginal yeast infections, and should not be taken during pregnancy.
    2. Antibiotic lotions (e.g. Cleocin T): Apply to the face in the morning and before bed.
    3. Benzoyl Peroxide: This is available in 2 1/2%, 5%, and 10% as a lotion, cream, or gel. Your doctor may start with a mild preparation and increase the strength and/or frequency of application as you skin becomes accustomed to it. It’s more irritating on moist skin, so wait 15 to 30 minutes after washing to apply it. It may cause peeling at first, but don’t stop using it unless your face becomes painful.
    4. Retin-A: This is also available in various strengths. It can usually be applied only once a day, or, if you have very sensitive skin, every other day. It should be applied 30 minutes after washing and very sparingly (i.e. 3 pea-sized dabs should cover the entire face.) It may also increase your tendency to sunburn. Do not apply Retin-A together with benzoyl peroxide; if both are prescribed, use the benzoyl peroxide in the morning, and the Retin-A before bed.

PROGNOSIS:

Acne treatment does not generally have any effect on pimples that are already present, but will help prevent new ones. This is why you may not see any improvement for the first 4 to 8 weeks. Don’t give up if you don’t look better at first. It may turn out that you will need “stronger” medicine than originally prescribed, so be sure to keep your next appointment. There is no magic cure for acne; it may be necessary to continue treatment for several years to keep it controlled.