All About Acne

Acne, the scourge of adolescence, is more than skin deep. There are few skin ailments that cause as much physical and psycholog­ical anguish as this complex chemical mystery.

And there are no quick, magical cures for it.

By far the most common teenage skin disorder, acne usually begins at puberty, at a time when oil glands in the skin enlarge and increase the production of skin oil (sebum). Ranging from simple pimples to angry boils, these unsightly blemishes that fall under the general heading of acne, will plague nine out of ten pubertal youngsters; an age when physical attractiveness becomes .so im­portant. And no one wants to be Number One on the "zit parade."

Acne appears most frequently in the mid-teens but can appear as early as the ninth year. It usually continues into the twenties. It may appear transiently in the newborn and is often seen in women in their mid-thirties. The condition appears earlier in girls but is more frequent and more severe in boys. Overall, blacks and Asians tend to have fewer and less severe acne prob­lems.

There is a great deal of controversy concerning the causes of acne, but most dermatologists agree that the basic problem is an overproduction of the skin oil by enlarged oil glands. This condi­tion is characteristic of the internal chemical changes that occur at puberty when the skin is adjusting to a greatly increased output of hormones.

These hormonal factors play a significant role in the onset of acne, and since oil gland activity and sebum production are under the control of androgens (male-type hormones), the role of these hormones is crucial. In men the testes are the primary source of androgenic hormones, whereas in women they are produced both by the ovaries and the adrenal glands. Acne seems to be the result of the oil gland's sensitivity to these androgens or their derivatives.

Acne also can be hereditary. Parents who had severe acne during their teenage years often have children who develop severe acne.

Acne occurs on areas of the body where oil glands are the largest, most numerous, and most active: the face, chest, and back. Simply stated, these enlarged and overactive oil glands become clogged with oil and sticky skin cells, thus forming blackheads and whiteheads. (When a skin pore is closed and oil can't escape, the swelling is called a whitehead; when the skin pore isn't closed but is simply plugged up with dead cells and oil, it's called a black­head. The dark color of the blackhead is not due to dirt: it is a result of pigment cells- melanin-in the upper layers of the skin.) The glands continue to manufacture oil which is unable to escape.

Bacteria, which are always on the skin in "friendly" and harmless numbers, set up housekeeping and begin to thrive in these trapped secretions. They then become "unfriendly" and harmful, causing infected pimples, or zits. These zits may lead to cysts (little sacs filled with fluid or cheesy material), which then break down to form scars.

Many external factors can aggravate acne. Anything that prevents the oily secretions from flowing freely out of the oversized oil gland, such as infrequent washing, long hair (particularly bangs), hairspray, mousses and greasy hair dressing, and moistur­izers. Other cosmetics containing lanolin can further plug up the already clogged oil gland opening to produce new lesions. Young­sters working at gas stations or fast food restaurants, who are constantly exposed to greases and oils, are especially prone to acne flare-ups.

Another type of acne-acne mechanica-is an aftermath of physical irritation to specific areas of the body, either resulting in or aggravating prior acne. A common example of this process is the development of acne over the forehead, chin and back in teenage football players as a result of wearing football helmets, chin straps, and shoulder pads. These sources of friction, combined with heavy perspiration, may cause acne lesions over the affected pressure areas. "

Other factors that can aggravate acne include hormonal dis­orders and taking drugs such as cortisone, iodides, lithium, vita­min B12, and anti-epilepsy medications. Young men who are taking anabolic steroids for body-building are prone to the severe cystic type of acne that doesn't respond to conventional anti-acne medications. Young women often experience acne eruptions just before their menstrual periods. The "low-dose" birth control pills also are responsible for acne in women who never had the problem as adolescents. Many women note a worsening-even an onset--of acne after stopping their oral contraceptive. This phenomenon can last as long as two years.

There also is some indication that acne around the mouth is aggravated by fluoridated toothpastes. Persistent localized acne over the temples and forehead may be caused by excessive brush­ing with a hair brush or hair dryer attachment.

Acne usually lasts for several years and abates in the early twenties. The conflicts and tensions that may arise along the way can lead to feelings of inferiority, insecurity, and inadequacy, which undermine self-confidence. After acne has burned itself out, it may leave permanent scars on the psyche as well as on the skin. Both subside with time, but if the skin scars are severe, they may benefit from further treatment in the form of dermabrasion, chemical peel, punch grafting, or collagen injections.

While there is no easy cure for acne, you can control it to lessen its severity and to prevent the pitting and scarring that arise from neglect and self-medication.

The key to acne therapy is to control the overactivity of the oil glands, shrink them if possible, and destroy the bacteria that are responsible for the infection. And the earlier you treat your acne, the better.