It’s hard enough being a teenager without having to cope with the problem of acne as well. Acne is so common as to be almost a normal part of growing up.
The real problem is due to an overproduction of the fatty material in the sebaceous or oil glands of the skin near the hair follicles. This overproduction is due to too much androgen, or male hormone, circulating in the blood. Or it is due to the sebaceous glands being too sensitive to these hormones.
Male hormones are produced in the female, and vice versa. Normally the hormone of the opposite sex plays little part in the body’s function, but if there is an imbalance in the amounts of the hormones, then we can expect some trouble.
Because androgens play a leading role in acne, it is more common in boys than girls. It usually starts at the age of 12 or 14. which is around puberty and has cleared in most cases by the age of 18 or 20. Unfortunately for some, it may persist through the 20s or even 30s. It may affect not only the face but also the chest, back, and sometimes the limbs as well.
Apart from the basic hormone imbalance, there are several other factors that can influence the onset and course of acne. Diet may play a part. Fatty foods, such as chocolate and all derivatives of the cocoa bean are best avoided. Nuts and an excess of dairy products should also go on the banned list. Emotional factors, poor skin hygiene, local irritation, and even some drugs are causes in some people.
There has been some doubt about infection in acne. In the acne pustule, a germ, the acne bacillus, is present. Control of this acne bacillus, either by antibiotics or the use of a local gel which releases oxygen, can improve the condition.
Blackheads are usually associated with the pimples or pustules of acne. These should be removed by gently squeezing or using a special extractor. Heating the skin with hot water or steam before doing this makes it easier by softening the plug.
Epidermal cysts, milia or “white acne” may be present as well, or occur on their own. There is no point in trying to squeeze these, as there is no opening or weak spot for the contents to come out.
If they are small and not noticeable, then they are best left alone. The larger ones can be opened with the point of a sterile needle and then the contents squeezed out. This is best left to the doctor or else infection or scarring may occur.
One of the great problems with acne is its tendency to leave scars, especially if the person is in the habit of squeezing the pimples.
Scars that persist after the acne has settled down can be removed, or at least reduced, by the technique of dermabrasion. This is a little like rubbing the skin with rough sandpaper. The superficial skin, including the scars, is removed, leaving a raw bleeding surface, such as when one falls and grazes one’s knees. The skin heals usually without the scar.
In the past, to reduce the influence of the androgens, the female hormone estrogen was used. If used in a dose sufficient to rid a male of acne, it usually had the side effects of stopping a sexual drive and causing enlargement of the breasts. If used in females, it was likely to interfere with the periods.
Those women on the contraceptive pill often find an improvement in their acne. But some forms of the pill, where the progesterone part breaks down to form androgens, can actually make acne worse.
Local applications for acne should be used sparingly and with care, if at all. Most teenagers spend a small fortune at the chemist trying the many different local applications and special soaps available. The simplest treatment is often the most effective.
Firstly, care of the skin by frequent washing with soap and hot water is a must. Ordinary soap is enough, it does not need to be medicated or contain antiseptics. Friction by using a washer or rough towel is also useful.
Sunshine is cheap and very effective. Most acne sufferers find that their condition improves in the summer. In the winter months a sun lamp can be used but going out in the fresh air and having the wind on the face may do just as much good.
Diet may be more important for some but not for others. Sugar doesn’t seem to matter (it may still rot your teeth) but it is wise to avoid fatty foods and especially chocolate. In fact, avoid any food which you think makes your acne worse.
Most local applications contain sulfur as an astringent. Sulfur and calamine lotion is a well-tried old-timer, but recently there is evidence that sulfur in some people may make the acne worse.
Lotions are better than creams and ointments and cosmetics should be used sparingly. A cream that contains granules so as to abrade the face gently and, by friction, loosen the fatty material plugging up the opening of the glands, may help some people.
The best results for severe acne have been obtained by using antibiotics in a small dose over several months.
There are complications with any form of treatment in medicine and this applies in acne as well. Hormone therapy may give good results in some cases but may lead to undesirable side effects.
Local applications may irritate the skin and lead to contact dermatitis. Antibiotics may, in women, and particularly those on the pill, lead to the condition of vaginal moniliasis (thrush).
Acne, like most medical conditions, may be mild or severe. In mild cases, it usually requires no treatment. The more severe cases certainly require treatment and the emotional problems associated with the self-image of insecure teenagers demand that the doctor take seriously his young patients’ worries.
Although acne is so common, it requires all the skills that modern medicine can bring to bear. Nobody should be fobbed off with the comment “Don’t worry! It’s only acne, you will grow out of it.”