Hair follicles in the skin are surrounded by sebaceous glands that make oil that is delivered to the skin surface. The extra amounts of male hormone at puberty increase the production of this oil, and the glut eventually clogs the ducts and their openings on the skin surface. This results in pimples, either blackheads or whiteheads (doctors call them come-dones). Since boys produce more male hormones than do girls, they have more pimplesand more acne.
If you're lucky, the process stops right there, leaving you with only a few pimples. No big deal. Complications set in when "normal" bacteria on the skin surface penetrate and inflame the obstructed, bulging ducts. In order to deal with these bacteria, the immune system mobilizes its warrior white blood cells and sends them in droves to prevent the ducts from becoming infected. An excess of these white blood cells and other debris forms pus, which when added to the sebaceous ducts already choked with oil, make the pimples bigger and bigger. When the engorged ducts can enlarge no more, they burst under the skin, forming bumps of various kinds and sizes. These bumps may be papules (slightly raised and red), pustules (filled with pus), or cysts (larger, inflamed, and painful). When a cyst opens onto the skin, it scars and disfigures it. That's why so many untreated acne patients have unsightly defects.
Acne can have a serious emotional and social impact on adolescents when it mars and scars the skin: withdrawal, depression, loneliness, frustration, and in some cases suicide have all been reported among such youngsters.
Too many doctors and patients view acne as a normal and inevitable phenomenona rite of passage, so to speak. Youngsters are told they must live with it, despite its social consequences. The worst thing parents can do is to make light of their youngster's acne. Insist on the proper medical care to treat it. If the lesions are extensive, see a dermatologist, for, as you will see below, there are measures that can control acne, modify its course, and even cure it! These consist basically of proper skin care, antibiotics to control the bacteria that infect the ducts, hormones in some cases to prevent over-production of sebum (the fatty substance made by the glands), and dermatological procedures to deal with whatever scarring has occurred. The sooner such therapy is begun, the less emotional trauma there will be in the short run, and the fewer permanent disfiguring scars.
Don't rush to the doctor just because you've found a pimple or two. Try some home remedies first. Sun helps, but too much is bad for the skin over the long term. Avoid putting anything greasy on your skin, especially cosmetics, cleansers, and moisturizers. Use water-based makeup and oil-free moisturizers; keep away from heat and humidity whenever possible; use non-oily sunscreens; and never pick or squeeze the pimples.
The first treatment step, one you can start yourself, is benzoyl peroxide (for example, Clearasil). You can get it at the pharmacy without a prescription. It comes in gel, cream, or lotion. I suggest starting with the weakest strength of the lotion, especially if you have sensitive skin. You can then switch to the 2.5 percent gel and increase the strength all the way to 10 percent if necessary. Benzoyl peroxide dries the pimples and prevents infection by reducing the number of bacteria on the skin; it often unplugs the black or white comedones. It's a peeling agent as well. Don't wear expensive clothes when you're using it because it can bleach them. Sometimes benzoyl peroxide is all you need for your acne, but it can also be combined with several of the other therapies described below.
There are other popular over-the-counter preparations you can safely try if the benzoyl doesn't help. I have found the most effective to be products containing salicylic acid (2 percent), glycolic acid, resorcinol, and sulfur (whose anti-inflammatory properties keep the pimples from swelling). They come in a variety of brands, whose names you can check at your cosmetic counter. I have also found benzoyl peroxide combined with erythromycin (marketed as Benzamycin) to be especially effective.
Copyright 2002 by Isadore Rosenfeld, M.D.
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