WHEN TO SEE YOUR DOCTOR
* Over-the-counter acne medicines aren't helping.
* Your pimples are forming scars after they heal.
What Your Symptom Is Telling You
Remember when just one pimple was enough to ruin your week? Your family complained that you never came out of the bathroom. But it wasn't vanity that kept you glued to the mirror—it was desperation.
Acne usually begins in adolescence, when hormones start to rage. Along with producing major bodily changes like the appearance of a beard or breasts, those hormones can also produce enough oil to keep J. R. Ewing in business for life. With the extra, thicker oil supply, the tiny ducts leading from the oil glands to the surface of the skin can become narrowed or clogged.
Sometimes, oil gets caught at a pore's opening, and when it hits the air, it oxidizes and turns dark, forming a blackhead. Those irritating dark spots are not from inadequate cleansing, dermatologists say. You could wash your face six times a day and still be prone to blackheads. When oil can't escape a plugged-up pore, a small white cyst, known as a whitehead, may form. Either a blackhead or a whitehead can become infected, producing the inflammation and redness of an acne pimple.
But the raging hormones of youth aren't the only cause of problem complexion. External oils on your skin—greasy cleansers, hair products or cosmetics, or even oils you encounter at work—may cause pimples. Stress plays a part, too. Some researchers say that chemicals released by the skin during stress can worsen inflammation.
Acne in adults is essentially the same as the plague of adolescents. Older skin tends to react a little differently, producing deeper lesions and fewer whiteheads and blackheads.
Another kind of acne is unique to adults. It's called rosacea or "the curse of the Celts." This is a skin condition common among rosy-cheeked people of Scotch-Irish descent. These people have a tendency to flush easily, and the increased blood flow to the skin overstimulates oil glands. Over time, this condition can produce acnelike pimples. (For information on how to deal with rosacea, see Nose Redness on page 400.)
There's a lot you can do on your own to clear up pimples.
Use the right OTCs. Over-the-counter preparations can be a big help with acne, if you know which ones to use, dermatologists say. Oxy-5, Oxy-10 and Clearasil contain benzoyl peroxide, which fights infection and promotes drying, says Ralph Coskey, M.D., a clinical professor of dermatology at Wayne State University School of Medicine in Detroit.
Clearasil contains salicylic acid and sulfur to both cover and dry up the pimple, says Tor Shwayder, M.D., a pediatric dermatologist at Henry Ford Hospital in Detroit.
Handle with care. Gentle cleaning is the watchword for acne. Twice a day, cleanse your skin with an antibacterial soap like Dial or Safeguard and an ordinary washcloth, says Stephen Webster, M.D., a dermatologist in Lacrosse, Wisconsin. "Don't use abrasive scrubs," says Dr. Coskey. "They can make acne worse."
Also avoid astringents, advises Thomas D. Griffin, M.D., a dermatologist at the Graduate Hospital in Philadelphia. Astringents can be irritating, causing the follicles to swell and leading to further breakouts.
Soak, but don't pick. Warm compresses can ease acne inflammation, says. Dr. Shwayder. Dip a washcloth in warm water, wring it out and apply it to the affected area for 20 minutes twice a day. Avoid the temptation to pick at the lesions, which can cause scarring.
Use nonclogging makeup. Use only cosmetics labeled "noncomedogenic," which won't clog pores, advises Dr. Griffin.
Soothe your stress. Removing the sources of stress from your life—along with daily relaxation techniques and exercise—will ease the stress that can aggravate acne, says George Murphy, M.D., a dermatologist at the University of Pennsylvania School of Medicine in Philadelphia. "Studies show that stress may be part of your skin problem," he advises.
Don't touch. Touching your face frequently only encourages inflammation, says Dr. Griffin. Try to become aware of it and leave this nervous habit behind.
Help from the Doctor
Fortunately, even the worst case of acne can be temporary. Here's how your dermatologist can help.
Open the pores. A form of vitamin A called tretinoin (Retin-A) has gotten a lot of press for its ability to reduce wrinkles. But the primary mission of Retin-A is to treat acne by peeling away the buildup of skin in clogged pores. Your doctor can prescribe Retin-A for as long as you're troubled with acne. At first your skin may be irritated, but your doctor can adjust the dose to the concentration that's right for you.
Another side effect of Retin-A is increased sensitivity to the sun, says Dr. Webster. If you're using Retin-A, apply a nongreasy sunscreen with an SPF (sun protection factor) of 30 every time you go outdoors, he says. "Check labels. You should look for a gel-type sunscreen that contains alcohol."
Kill bacteria. For persistent acne, dermatologists often prescribe benzoyl peroxide medicines to be applied to the skin. Benzoyl peroxide cuts down bacterial activity in the pores, and also produces a mild amount of peeling, says Dr. Webster.
Ask about antibiotics. Your doctor may also prescribe antibiotic creams or lotions to cut down on skin bacteria, says Dr. Webster. The normal bacteria in your skin break oil down into fatty acids, which may cause inflammation. For more severe lesions, your doctor may prescribe oral antibiotics, he says.
Peel pimples away. Fruit acids called alpha-hydroxy acids are effective new weapons in the acne-fighting arsenal, says Dr. Griffin. "A light chemical peel gives fairly quick control over acne," he says. "It may take two or three light peels, repeated monthly."
Your dermatologist will apply a diluted solution of glycolic acid in the office, he says. You will feel stinging and burning for about 30 minutes and experience some initial redness and swelling. If you have the peel done on a Friday, by Monday you'll have only mild flaking, which makeup can cover.
Zap them with zinc. Prescription zinc creams, sometimes mixed with an antibiotic such as erythromycin, may slow the inflammatory process and aid in healing, says Dr. Shwayder.
Approach Accutane with caution. Accutane is a powerful prescription drug for severe cystic acne that doesn't respond to any other treatment, says Dr. Coskey. But Accutane can cause birth defects and must be used with extreme caution in women of child-bearing age. If you're a woman using Accutane, your doctor will require that you use a reliable method of birth control and that you be tested regularly for pregnancy. Other side effects often associated with Accutane are extremely dry skin, nosebleeds, dry eyes, muscle aches and elevated triglycerides and cholesterol.
Accutane therapy lasts for 16 to 20 weeks, and is 80 percent effective for severe acne, says Dr. Coskey.