There are at least ten different forms of acne, two of which are extremely important: acne vulgaris (meaning "common," not "vulgar") and acne rosacea (adult acne). The former is the subject of this chapter.
Acne vulgaris is a skin disorder that plagues most teenagers and young adults. It starts in puberty and can persist into young adult life. Some 80 percent of us develop the pimples and bumps of acne vulgaris some time or another while we're growing up. In most cases, the pimples (often referred to as zits) and their variantsblackheads, whiteheads, pustules, and cystsas a rule clear up by the mid to late twenties, but they can last longer. They are not usually severe, but can have a serious impact on physical or emotional health when they recur and persist in large numbers on the face, the shoulders, the neck, and the upper back.
Acne vulgaris runs in families; if any of your close family members have it, chances are you do, or will, too. More young men are affected than women, but the ratio changes when acne continues into adult life.
Despite great progress in its treatment, the most important advance in dealing with acne has been the debunking of the many myths that have for so long surrounded it. The following beliefs were inviolable until fairly recently and are unfortunately still held by many:
Myth: Acne is due to poor personal hygienedirt and skin oil that haven't been washed away often enough.
Fact: There is no evidence that acne is caused by dirt or an excess of skin surface oils. In fact, you can worsen matters by scrubbing the skin too vigorously. Gentle washing with normal soap is all you need; don't waste your money on expensive "cleansers." Also, keep your fingers away from your pimples. Squeeze your sweet-heart, not your zits. Use oil-free "non-comedogenic" cosmetics.
Myth: The wrong diet causes acnetoo many French fries, too much chocolate, pizza, and junk food.
Fact: No connection has ever been established between diet and acne. Vitamins don't help either. Strangely enough, many patients insist that their skin breaks out after they eat a particular food, usually chocolate. In such cases my advice is to avoid that food even though there is no scientific study linking diet to acne. But whenever a patient does make such an association, I sneakily take the opportunity to promote a balanced diet with lots of grains, fruits, vegetables, and fish. It won't necessarily help the acne, but it will reduce the risk of heart disease and cancer!
Myth: Acne is the result of unhealthful sexual habits, including masturbation and "tainted" sex partners.
Fact: "Loose" living, as it used to be called, can give you AIDS and sexually transmitted disease, but not acne. Nor will masturbation!
Myth: Stress causes acne.
Fact: Actually, the opposite is true. Acne causes stress; stress per se does not result in acne, although lack of sleep and chronic tension do increase androgen production in some people and may lead to a breakout. More important, picking, squeezing, and rubbing your pimples when you're nervous aggravates them. So if you're under stress, keep your hands in your pockets.
Myth: Acne should be left untreated and allowed to run its course because it's a normal cosmetic problem.
Fact: This is a good tack for insurers to avoid paying for doctors' visits. The physical and emotional fallout from acne can be devastating. Prompt and continuing treatment can prevent outbreaks and reduce the likelihood of developing permanent scars.
Myth: Acne vulgaris always clears up after adolescence.
Fact: One adult in nine, aged twenty-five to forty-five, continues to have acne.
How Acne Develops
Why does acne begin at puberty? Why does it affect younger men more commonly than women? Why does it usually clear up as we get older? The answers lie in our hormones. In adult life each gender has some of the other's hormone. (Thankfully, men have lots of androgenstestosteroneand only nominal amounts of estrogen, and vice versa for females. That's why I shave and my wife doesn't.) But when the body first produces its sex hormones at puberty it makes large amounts of both in boys and girls, in order to ensure adequate bone growth and sexual maturation. The high concentration of male hormones in both causes acne in both genders. Here's why:
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