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Acne: it isn't just for kids anymore.

We've all agonized with our teenagers going through the acne stage, but many women again face the problem themselves in later life. The pimples of adolescence often reappear during pregnancy--and with alarming frequency during menopause.

The precipitating factors in acne are not as well understood as the actual cause of the condition, although hormonal influences certainly seem to play a role. Mild acne (just blackheads or white-heads) begins in a hair follicle with its attached sebaceous gland, which produces the clear, oily sebum that lubricates the skin. At home in this cozy environment is the bacterium P. acnes, which breaks down sebum into fatty acids. As cells within the hair follicle die and mix with these fatty acids, this ensuing debris may block the opening of the follicle's pore, and the bacterial proliferate. The result is a blackhead or whitehead.

If the pressure of the debris in the follicle becomes too great, it will rupture, producing inflammation in the surrounding skin. As the body's immune system attempts to deal with the problem, further damage occurs--with scarring if the damage is severe.

Treatment is therefore directed at the bacteria themselves, slowing cellular turnover in the follicle and reducing sebum production. Nonprescription lotions, etc., for treating mild acne contain sulfur, salicylic acid or resorcinol, which help dry up the whiteheads and blackheads. More effective, however, is benzoyl peroxide (Benzamycin lotion or gel), also a nonprescription item--although it can irritate the skin and should therefore be used in graduated strengths.

Tetracycline, doxycycline, and minocycline are the preferred oral antibiotics for moderate acne. Retin-A and topical antibiotic preparations, available by prescription, are also useful. Severe acne that has not responded to high doses of antibiotics usually responds to treatment with Accutane--which must be used under the careful supervision of a physician because of its common side effects and its having been linked to birth defects.

Whatever the stage of acne, do not--repeat, do not--squeeze, press, or otherwise attempt to extract the contents of a comedo (the medical term for blackheads and whiteheads), either with the fingers or an instrument designed for that purpose. Also, don't allow a nonmedical person, such as a cosmetologist, do so as part of a professional facial. If scarring has occurred, consult a dermatologist, who may be able to help with collagen injection, chemical peels, or dermabrasion.

Although not guaranteed to prevent acne, the following procedures may help:

* Wash only once or twice a day with a mild soap recommended by a dermatologist, and avoid abrasive cleansers and masks.

* Use only makeup clearly labeled as noncomedogenic.

* Eat a balanced diet, avoiding foods that seem to worsen the condition or trigger outhreaks.

* Avoid excessive exposure to sun--and all such exposure if taking Retin--a or Accutane.
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Author:Brown, Edwin W.
Publication:Medical Update
Date:May 1, 1995
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