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“There is no single disease which causes more psychic trauma, more maladjustments between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic suffering than does acne.”
cne, the scourge of adolescence, is more than skin deep. There are few skin ailments that cause as much physical and psychological anguish as this complex chemical mystery that affects almost 20 million people in the US. The market for prescription and over-the-counter acne medications is well over $1.5 billion dollars a year.
And there are no quick, magical cures for it.
By far the most common teen-age skin disorder, acne usually begins at puberty, at a time when oil glands in the skin enlarge and increase the production of skin oil (sebum). This occurs as a result of rising hormones during adolescence. Ranging from simple pimples to angry boils, these unsightly blemishes that fall under the general heading of acne, will plague 9 out of 10 pubertal youngsters; an age when physical attractiveness becomes so important. And no one wants to be Number One on the “zit* parade” . . .
Acne appears most frequently in the mid-teens when hormone levels increase and kick the skin’s oil gland into overdrive, but can present as early as the ninth year. It usually continues into the twenties. It may appear transiently in the newborn and is often seen in women in their mid-thirties. The incidence of acne in adult women is now more than 50 percent compared to 35 percent in 1979. (Neutrogena recently had an ad campaign with the slogan “Unfortunately, acne stands out even more on an adult.” This is not too comforting to those “thirty- and forty-something” women who are in the workplace.)
The condition appears earlier in girls but is more frequent and more severe in boys. Overall, blacks and Asians tend to have fewer and less severe acne problems.
There is a great deal of controversy concerning the causes of acne, but most dermatologists agree that the basic problem is an overproduction of the skin oil by enlarged oil glands. This condition is characteristic of the internal chemical changes that occur at puberty when the skin is adjusting to a greatly increased output of hormones.
These hormonal factors play significant roles in the onset of acne, and since oil gland activity and sebum production are under the control of androgens (male-type hormones), the role of these hormones is crucial. In men, the testes are the primary source of androgenic hormones, whereas in women they are produced both by the ovaries and the adrenal glands. Acne seems to be the result of the oil gland’s sensitivity to these androgens or their derivatives.
Acne can also be hereditary. Parents who had severe acne during their teen-age years often have children who develop severe acne.
Acne occurs on areas of the body where oil glands are the largest, most numerous, and most active: the face, chest, and back. Simply stated, these enlarged and overactive oil glands become clogged with oil and sticky skin cells, thus forming blackheads and whiteheads. (When a skin pore is closed and oil can’t escape, the swelling is called a whitehead; when the skin pore isn’t closed but is simply plugged up with dead cells and oil, it’s called a blackhead. The dark color of the blackhead is not due to dirt: it is a result of pigment cells - melanin - in the upper layers of the skin.) The glands continue to manufacture oil that is unable to escape.
Bacteria, which are always on the skin in “friendly” and harmless numbers, set up housekeeping and begin to thrive in these trapped secretions. They then become “unfriendly” and harmful, causing infected pimples, or “zits.” These zits may lead to cysts (little sacs filled with fluid or cheesy material), which then break down to form scars.
Many external factors can aggravate acne. Anything that prevents the oily secretions from flowing freely out of the oversized oil gland, such as infrequent washing, long hair (particularly bangs), hairspray, mousses, gels and greasy hair dressings, moisturizers, and other cosmetics containing lanolin can further plug up the already clogged oil gland opening to produce new lesions. Youngsters working at gas stations or fast food restaurants, who are constantly exposed to greases and oils, are especially prone to acne flare-ups.
Another type of acne – acne mechanica – is an aftermath of physical irritation to specific areas of the body, either resulting in or aggravating prior acne. A common example of this process is the development of acne over the forehead, chin and back in teen-age football players as a result of wearing football helmets, chin straps and shoulder pads. These sources of friction, combined with heavy perspiration, block the oil gland openings and often give rise to acne lesions over the affected pressure areas. The so-called “hippie acne” of a previous era, refers to the acne that occurs under headbands. A new entity – “cell phone acne” – is a result of keeping cell phones virtually glued to one ear, preventing the oil glands over the cheek from discharging its oily secretions.
Other factors that can aggravate acne include hormonal disorders as well as taking drugs such as cortisone, iodides, lithium, vitamin B12, and anti-epilepsy medications. Young men who are taking anabolic steroids for bodybuilding are prone to the severe cystic type of acne that doesn’t respond to conventional anti-acne medications. Young women often experience acne eruptions just before their menstrual periods. The “low-dose” birth control pills also are responsible for acne in women who never had the problem as adolescents. Many women note a worsening – even an onset – of acne two or three months after having discontinued their oral contraceptive. This phenomenon can last as long as two years. Excessive brushing with a hairbrush or hair dryer attachment may cause persistent localized acne over the temples and forehead.
Acne usually lasts for several years and abates in the early 20s. The conflicts and tensions that may arise along the way can lead to feelings of inferiority, insecurity, and inadequacy that undermine self-confidence. Acne has been shown to be associated with impaired academic and social functioning; it also affects employment status. After acne has burned itself out, it may leave permanent scars on the psyche as well as on the skin. Both subside with time, but if the skin scars are severe, they may benefit from further treatment in the form of dermabrasion, chemical peels, punch grafting, laser treatments, or collagen injections. Some of the well-known actors who have facial scars from acne are Bill Murray and E. Murray Abraham.
While there is no easy cure for acne, you can control it to lessen its severity and to prevent the pitting and scarring that arise from neglect and self-medication.
The key to acne therapy is to control the overactivity of the oil glands, shrink them if possible, and destroy the bacteria that are responsible for the infection. And the earlier you treat your acne, the better.
Here are a few general principles that can help prevent or control acne:
For some of the larger bumps – cysts – that do not resolve with oral and surface means, your dermatologist may choose to inject a cortisone-like material directly into the cyst to help them disappear more promptly.
No therapy really “cures” acne. New lesions can occur despite good management. It can be controlled, however, to lessen its severity and to prevent the scarring that may result. Don’t be discouraged if your progress is slow. If you are diligent, conscientious, and faithful with your treatment, you will reap the benefit of a clearer complexion.
It is especially important that parents try to understand their teenagers’ plight. By offering encouragement and helping your teenager maintain his or her self-esteem, you can help lessen the mental anguish and psychological scars that so often accompany acne.
Every day brings promise of a new magical cure. The best-heralded treatment for acne is an oral drug of the vitamin A family, isotretinoin. Sold under the name Accutane, this prescription medication works by shrinking the oil glands to reduce the output of skin oil. The Food and Drug Administration has approved Accutane for only the very severe and stubborn form of cystic acne that generally doesn’t respond well to conventional forms of medication.
Accutane has many drawbacks. Pregnant women should not take Accutane because of the possibility of defects in the newborn. And women of childbearing age must show proof that they are not pregnant when they begin a course of Accutane treatments.
Accutane may also cause various undesirable side effects, including chapped lips, dry nose, dry mouth, dry skin, nosebleeds, and generalized itching. Other adverse reactions include muscular aches and pains, fatigue, headaches, conjunctivitis, blurred vision, and hair loss. These side effects are all temporary, and disappear when the drug is discontinued.
Also, during Accutane therapy, blood tests must be taken every few weeks to determine the level of certain fatty substances – triglycerides – that often become elevated during therapy. Frequent follow-ups by your dermatologist are essential to monitor any side effects.
A relatively new oral contraceptive – birth control pill – Ortho Tri-Cyclen has been given the stamp of approval as being the only birth control pill that helps acne. Most all the others, the so-called “low-dose” pills, aggravate or actually trigger acne eruptions.
If your acne is stubborn, persistent, and disfiguring, consult your dermatologist. Waiting to “outgrow” acne can be a serious mistake; permanent scarring can result if acne is left untreated. A dermatologist can prescribe internal and topical medications to eliminate or lighten this cross that almost all teenagers have to bear.
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For further information about acne, log on to www.aad.org or phone: 1-888-462-DERM x22 Acne Support Groups www.m2w3.com/acne www.familydoctor.org/healthfacts/001 |
Myth #1: Acne is a disease of adolescence.While it is true that acne usually appears during puberty, this is not always the case. Many people, particularly women, don’t develop acne until their twenties or thirties, and it can afflict both men and women well into their forties.
Myth #2: Acne is more common in girls.Young women are more likely to see a dermatologist about their acne problems because, as a rule, they are more conscious of their appearance. However, acne affects both sexes equally. As a matter of fact, the severe cystic form of acne of the back is more common in men.
Myth #3: Acne is due to improper hygiene.In reality, acne patients generally are more fastidious and conscientious about cleanliness than other teenagers. Blackheads, the primary hallmark of acne, do not result from dirt but from pigment (melanin) in the oil glands.
Myth #4: Masturbation causes or aggravates acne.The only link between masturbation and acne is that both are often associated with adolescence. Moralists of the 19th century blamed many diseases on such “sinful” practices. The guilt surrounding masturbation in the minds of many teenagers probably perpetuates this timeworn myth.
Myth #5: Sexual intercourse will cure acne.While this form of therapy sounds appealing, there is no evidence to document that it works. This belief probably stems from an old European myth that marriage cures acne. People often got married in their early 20s, about the same time that acne usually burns itself out.
A zit is a common, colloquial expression that young people often use when referring to an acne “bump,” or pimple. These acne “bumps,” or zits, come in many sizes, and, depending upon how large they are, can go by a variety of other names.
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The following is a list of some of the specific measures and products I recommend to reduce, eliminate, or “mask” zits and other acne lesions. There are countless products available for controlling acne, and new products are being developed all the time. I have limited this list to a few of those over-the-counter products that many dermatologists recommend and that give my patients best results.
One of the mainstays in the treatment of acne is washing. Proper washing gets rid of all the accumulated greases, oils, soot, and debris that all of us are exposed to on a daily basis. Wash your face thoroughly at least three times a day. For mild acne, where there are mainly blackheads and some oiliness, use a Benzoyl Peroxide soap or cleanser.
Benzoyl Peroxide comes in many strengths. For cleansing, I recommend the weakest form of this product, 2.5%. If you are still greasy, up this to 5 or 10%.
A favorite of mine is PanOxyl Bar 5% or 10% (Stiefel)
For mild acne, apply any of the following to the pimples at bedtime:
Acnomel
Rezamid Lotion
Clearasil
For more severe acne, try any of the following acne preparations:
Neutrogena
Clean & Clear
Clearasil
Stridex
Note that Benzoyl Peroxide comes in many forms: soaps and cleansers, creams, lotions, masks, sticks, gels, liquids and even shave creams. *
These preparations should cause slight peeling to help dry up your pimples. If your face gets too dry, use the products less often. If your face begins to itch, burn, or turn red, you may be allergic to one of the ingredients. Stop the medication, and apply cool, wet compresses to your face. Do not use the medication again; use a different or milder preparation.
If your face is very greasy, use the following astringents several times a day to remove the excess oil that accumulates:
Seba-Nil Liquid Cleanser
Shampoo daily, if possible. Patients with acne usually have oily hair. When too much oil collects on the scalp and hair, it gets onto your face and further plugs up the already clogged oil glands. An interesting phenomenon is that young women (and men) with unusually long hair -- no matter how they style it -- very often have acne on their backs.
For exceptionally oily hair, use either of the following:
DHS Clear Shampoo
DHS Shampoo
Keep your hair off your face, eliminate bangs, and avoid hair-sprays, mousses, gels and greasy hair dressings. Use creme rinses in moderation.
Avoid greasy cosmetics. An oil-free, water-based cosmetic cover-up is the best type of make-up even for those who do not have acne problems.
Note: If you have acne on one cheek only, or more on one cheek, you may have the habit of being (figuratively) glued to your cell phone! In addition, resting that cheek on your palm while talking on the telephone or while asleep will prevent the oils in your skin from escaping, thus causing a plugging up of the oil follicle. Try to break the habit.
As a disclaimer, note that any acne preparation can cause burning, stinging, itching, and peeling. If this happens, discontinue the culprit at once.
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