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Week of 26 September 1997

Vol. I, No. 5

Health Matters

Facing up to adult acne

I had clear skin as an adolescent, but now that I am an adult I am having problems with acne. Why? And what can I do about it?

Acne, technically known as acne vulgaris, is caused by a plug in hair follicles that leads to accumulation of oils, fatty acids, and bacteria underneath the surface of the skin. Acne can plague adults well into their 30s and early 40s, says Candace Lapidus, MD, director of Pediatric and Adolescent Dermatology at Boston Medical Center, and assistant professor of pediatrics and dermatology at Boston University School of Medicine. Treating acne, which is more common in women than men after adolescence, involves the same steps taken in halting the condition in teens: unclogging the plug and eliminating the bacteria.

According to Lapidus, the primary goal of acne treatment is to prevent the formation of new lesions. Starting with standard, over-the-counter topical medications that contain benzoyl peroxide, rub in pea-sized drops at several points on your face twice daily, avoiding the corners of the eyes, the nose, the mouth and any other sensitive areas. If the benzoyl peroxide irritates your skin, apply the ointments once a day instead of twice.

If your skin condition does not improve after four to six weeks, you may need to consult a doctor about stronger treatment. Most prescribe tretinoin to open the plug, an anti-microbial such as erythromycin or clindamycin to kill the bacteria, and possibly stronger benzoyl peroxide preparations. Even with a prescription, successful treatment takes time -- a minimum of six weeks. "Don't give up if your skin doesn't improve immediately," says Lapidus. "Prescriptions are stronger, but it still takes some time for them to work effectively."

Still, more aggressive treatment involves the use of systemic antibiotics, such as tetracycline pills. A very serious drug called acutane can be used if all other therapies fail. Lapidus issues one caveat: whether using over-the-counter or prescription preparations, go to the doctor immediately if you develop pockmarks or signs of scarring on your skin. Some severe acne can cause permanent scarring.

While researchers are not clear why some people's hair follicles become "sticky" and plug up, they have eliminated certain culprits. For instance, dirt accumulation does not cause acne, debunking the myth that repeated face washing will clear up the condition. "People will scrub harder, or they'll use a buff-puff, thinking that it will improve their acne, but it actually makes the situation worse," Lapidus says. Instead, wash your face with water and mild soap twice daily, and pat it dry gently. Eating junk food or chocolates likewise has no effect on acne, so radical changes in your diet are unnecessary.

In some cases, women may develop acne as the result of hormonal imbalances produced either by the adrenal glands or the ovaries. If the acne is accompanied by irregularities in your menstrual cycle, hirsutism (abnormal or excessive hair growth) or male-pattern baldness, check with your doctor. A simple blood test can determine your hormone levels, and the condition can be easily treated unless you are pregnant. Pregnant women cannot undergo nearly all treatments for acne.

If you plan to see your doctor about your acne, make sure to discuss your stress levels (which can make acne flare) and any other factors that you believe may contribute to the problem. With the proper care and patience, you should be able to treat your acne successfully.

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on acne or other health matters, call 638-6767.