THE BLEMISH BATTLE ADULT ACNE SUFFERERS SEEK RELIEF - AND ANSWERS.

Byline: Mariko Thompson Staff Writer

When we said goodbye to the awkward teenage years, those of us with bad skin had hoped to see the last of benzoyl peroxide tubes, cover-up sticks and all the other indignities that come with unsightly acne outbreaks.

No doubt some moved to flawless pastures and left their blemishes behind. The rest of us continued our love-hate relationship with the dermatologist. For most people, acne subsides in the early 20s. But dermatologists say the battle of the blemish can continue into the 40s and even beyond.

Acne in adulthood affects both sexes about equally, though women are more likely to be concerned about it, said Dr. Michael Lin, a dermatologist at Encino-Tarzana Regional Medical Center.

``I'd say 90 percent of people have acne at some point in their lives,'' Lin said. ``The difference is in the severity.''

Sheri Keith never had problems with acne as a teen. Then she turned 30 and the break-outs started. Over the past three years, she's tried all kinds of over-the-counter remedies. Now she's working with Lin to find a prescription medication that will clear up her skin.

``I've done everything and nothing works,'' said Keith, a Palmdale resident. ``I've spent a lot of money.''

Forget the myths that say poor washing habits or eating chocolate leads to acne. Often those finicky hormones are to blame. A change in hormone levels can cause blemishes to flare. In women, progesterone can make acne worse. In men, higher levels of testosterone can be the culprit.

How do hormones cause acne? According to the American Academy of Dermatology, hormones stimulate the oil glands in the skin into producing more oil. The oil mixes with a build-up of skin cells in the lining of the hair follicle, causing the duct to become plugged. If normal skin bacteria then multiplies in the clogged follicle, inflammation can occur. This process isn't limited to the face. Acne can also emerge on the neck, back, chest and shoulders.

When adults complain of acne, Dr. Jeff Ashley, a dermatologist at Providence St. Joseph Medical Center in Burbank, considers several factors. Female patients who slather on the moisturizer simply may need to switch to a brand that doesn't block the pores. He recommends they use brands that say non-comedogenic or oil free. Sunscreens also can clog the pores, he said.

``Women can be overzealous in wanting to prevent wrinkles and they end up with pimples,'' Ashley said.

In women who didn't have acne as teens, an outbreak can be a sign of a more serious hormonal imbalance, also marked by irregular menstrual cycles, excessive facial hair and a lowered voice, Ashley said.

And sometimes what looks like acne is actually a condition called rosacea, where excessive circulation creates a ruddy appearance. In addition to redness and pimples, rosacea sufferers may experience dryness or a grainy feeling in their eyes, Ashley said.

Once the dermatologist determines that the problem is old-fashioned acne, numerous treatments are available. To choose the most effective method, dermatologists consider the patient's skin and type of acne, said Dr. Jonathan Carp, a dermatologist at Kaiser Permanente in Panorama City.

The most common prescription medications applied to the skin are retinoid creams such as Retin-A and topical antibiotics such as erythromycin. Medications that are ingested include antibiotics such as tetracycline. Taking birth control pills with estrogen also can be effective for some women.

Dermatologists will prescribe Accutane for severe cases. Accutane has been at the center of controversy in recent years. In 2000, Michigan Rep. Bart Stupak's son committed suicide while on Accutane. Stupak called for a study on Accutane and the risk of depression and suicide.

``We give it as a last resort if everything else has failed,'' Lin said. ``In general, it's a safe medication.''

Laser treatments have become trendy in recent years. The patient goes in for several quick laser sessions each month. But Carp said laser treatment is pricey and not necessarily more effective than acne medications.

``I don't think the verdict is out on that,'' Carp said.

Tea tree oil is sold in many health food stores as a natural remedy for acne. But Lin is skeptical that the oil, touted for antiseptic and antibacterial properties, clears up blemishes.

``There are no good clinical trials showing that it works,'' Lin said.

Though acne isn't a threat to a physical health, dermatologists say it can have a profound effect on a person's self-esteem and confidence. For Keith, the battle with acne has been distressing.

``The first thing you look at is a person's face,'' she said.

The path to clear skin

Acne isn't just for teens. The American Academy of Dermatology Boffers tips on skin care for people with acne:

-- Wash the skin gently twice a day using water and mild soap. Alcohol- based cleansers and vigorous scrubbing will irritate the skin and make acne worse.

-- Look for non-comedogenic or oil-free cosmetics and toiletries on the label. Avoid heavy foundation makeup.

-- Don't pick or squeeze acne lesions. This can increase inflammation and raise the risk of scarring.

-- Eliminating chocolate and fried foods is good for your waistline, but it won't clear up acne.

-- There's no evidence that sunlight improves acne. Since many acne treatments increase the skin's sensitivity to ultraviolet rays, people who take them should exercise caution when outdoors.

- M.K.

CAPTION(S):

2 photos, box

Photo:

(1 -- cover -- color) Facing up to acne

For some, the skin problem doesn't go away

John Lazar/Staff Photographer

(2) Nurse Nora Puyot, right, examines 14-year-old Jacey Simon at Kaiser Permanente's dermatology clinic in Panorama City. Acne, the bane of teenagers, sometimes affects adults in their 40s and older.

Gus Ruelas/Staff Photographer

Box:

The path to clear skin (see text)