The major determining factor in who get acne is genes, according to Albert M. Kligman M.D., PhD., emeritus professor of dermatology at University of Pennsylvania School of Medicine in Philadelphia. Science now finds that acne is caused by a basic change in the body's hormonal system which lead to increased production of an oily substance in the skin glands. Research has suggested that many acne sufferers are deficiency in zinc.
You have thousands of glands in the skin on your face, chest and back that lubricate the skin by producing sebum or oil, explains Alan D. Klien M.D., a member of the feeding staff at Ventura County Medical Center in California and spokesman for The American Academy of Dermatology. The oil from the glands flows through tiny ducts to the skin surface. Sometimes these oil ducts become plugged with sebum, bacteria or dead skin cells that are shed from lining of the duct. The condition often appears during adolescence because of changing hormone levels which enlarge the oil glands and encourage them to produce more oil. Although the process is not well understood, the increase in oil appears to fuel acne, perhaps by stimulating the production of 'sticky' skin cells that, when shed, tend to plug the duct. The situation usually settles down by the end of the teen years or during the early twenties.
More About Acne
The American Academy of Dermatology.
So why do adults develop acne?
'Premenstrual acne is real,' Kligman says. Pregnancy, changes during the menstrual cycle, and birth control pills can cause fluctuations in hormone levels and subsequent fluctuations in acne in women. In some women, low-dose oral contraceptives improve acne, in others they make worse. If you have acne along with menstrual irregularities you may want to see a physician to see if abnormal hormone level are to blame.
Dermatologists agree that high levels of stress can effect hormone levels.
Wearing heavy, oily makeup may clog pores and cause acne.
If you're a mechanic or you're standing over the deep-fat fryer at the local fast-food joint, your face may be getting assaulted by oils, some of which may cause acne. Numerous chemical in workplace can also cause acne.
Some drugs, such as Dilantin (which is used in the treatment of epilepsy), can cause acne, says Alan N. Moshell, M.D., Director of The Skin Diseases Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
No matter what's causing your acne, there are steps you can take to help clear up your skin.
EAT PLENTY OF
Shellfish, nuts, poultry and lean meat, for zinc.
Fresh fruit and vegetables for vitamin C.
CUT DOWN ON
Chocolate and sweets.
Highly salted snacks.
DO NO HARM.
In other words, don't pick, press, rub, or otherwise manipulate those pimples, warns Kligman. "You risk spreading the bacteria and increasing the chances for scarring," explains Klien. Vincent A. DeLeo, M.D., assistant professor of dermatology at Columbia-Presbyterian Medical Center in New York, gets even more descriptive: The plug at the top of the pore is like a balloon. You can pop it, but below the surface, the sebum, bacteria, and skin cells may leak into the surrounding tissue, causing inflammation.
USE BENZOYL PEROXIDE.
A number of over-the-counter products contain this ingredient, which helps break up the plug of dead skin cells, bacteria, and oil in pores and cuts down on bacteria as well. Start with the lowest concentration, and work your way up, especially if you have sensitive skin, because the higher the concentration, the more irritating it may be. Use it once or twice a day. If it dries the skin too much, Kligman suggests applying a mild moisturizer.
GIVE ONE OF THE OTHER OVER-THE-COUNTER PRODUCTS A SHOT.
Other acne products contain sulfur or resorcinol, which help unplug oil glands by irritating the skin, Klien says. Most dermatologists, however, believe that benzoyl peroxide is the most effective over-the-counter ingredient for acne.
APPLY OVER-THE-COUNTER PRODUCTS FOR PREVENTION.
"Don't just spot the product on existing acne," DeLeo says. "Put it on acne-prone areas," That can include your entire face (avoiding the lips and eyes, however), back and chest.
GO EASY ON YOUR FACE.
"Kids with oily skin use hot water, a washcloth, and a drying soap and think they can wash their acne away," Kligman says, "But they can't," DeLeo points out, "You can wash your face ten times a day and still have acne. It has nothing to do with cleanliness," Washing removes oils from the surface of the skin, not from plugged ducts. And adults can certainly suffer from both acne and dry skin, says Klien. In fact, if you're too aggressive in your quest for cleanliness, you may very well end up drying out or irritating the sensitive skin on your face.
How do you do that? Use a mild soap. DeLeo recommends Dove Unscented, Tone, Basic, or Neutrogena. Rub lightly with your fingertips and warm water. Do not use a washcloth. If your skin is oily, use a soap with benzoyl peroxide for it's drying properties, suggests Klien. And wash once or twice daily.
That refers to removing the top layer of dead skin cells. Some dermatologists using a rough washcloth or special design product to do just that. "But your skin is already irritated if you have acne," says Kligman. Don't use brushes, rough sponges, cleansers with granules or walnut hulls, or anything else of that nature on the delicate facial skin, says Klien. For the back and chest, where skin less sensitive, you can try one of the acne scrub pads along with soap that contains benzoyl peroxide, he adds.
WATCH OUT FOR OILY PRODUCTS.
That goes on oily pomades on your hair, heavy oil-based mostouirisers, and even oily cleanser. "The classic that I hear from women is that they use only cold cream on their face," says DeLeo. "They think they're removing avoiding wrinkles, but dry skin doesn't cause the skin to age, exposure to sun does."
USE WATER-BASED MAKEUP.
If you're not sure---and DeLeo says some cosmetic label are misleading---set the bottle of makeup on the counter. If it separates into water and powder, it's water-based, he says. If it doesn't, it contains oil. He also advises that you opt for powder blushes and loose powders. Eye makeup and lipstick are OK because you don't generally get acne in those areas.
FOREGO THE FACIAL.
DeLeo warns that most people giving facials aren't trained to treat acne-prone skin properly and may end up doing more harm than good.
DON'T REST YOUR CHIN ON YOUR HANDS.
Try not to constantly touch your face. "People who do a lot of telephone work will get chin-line acne," DeLeo says. It cause trauma to acne, just like picking the pimples does. Tight sweatbands and chin straps from sports equipment can have the same effect.
SOAK UP THE OIL.
Some cosmetic companies make a paper product that can pressed onto the skin to soak oil, says Kligman. "It's very simple procedure," he says. "It doesn't help the acne, but it helps relieve the oiliness, which is disagreeable,"
SCREEN OUT THE SUN.
At one time, sun exposure was believed to help acne, says Klien. However, too much sun can lead to skin cancer and premature aging, making the risks outweigh the benefits. He suggests protecting the skin with a sunscreen that has sun protection factor (SPF) of 15 or higher. "Look for one that's oil-free or noncomedogenic," he says. Unfortunately, many waterproof products are too likely to clog oil glands to use on face, so you'll need to be diligent about reapplying the sunscreen often.
DON'T WORRY ABOUT DIET.
Chocolate, french fries, and other foods have not been proven to have anything at all to do with causing teenage acne. "It doesn't matter what you eat," says Kligman. Eating chocolate, nuts, or greasy foods is not to blame when it comes to the zits on your face. On the other hand, if you notice a correlation between something you eat and you face breaking out, most dermatologists agree that you should avoid the offending food. "Maybe one out of 100 or even 1,000 patients will have some relationship of acne to certain foods," says Moshell.
WATCH OUT FOR IODINE.
This still somewhat controlversial, but some doctors believe that high levels of iodine, found in some multiple vitamins and in iodized salt, may encourage acne.
If you're over 40 and suddenly develop severe acne, you could be suffering from acne rosacea, which is a different disease from acne vulgaris, the medical name for garden variety of acne.
How can you tell the difference?
Acne rosacea is characterized by redness, inflammation (swelling), and dilated blood vessels. Further clues: You don't have any blackheads, the acne is located mainly on the central part of your face (your nose and cheeks), and you have a lot of pustules (pus containing pimples). You're more likely to suffer from this type of acne if you're light skinned.
Unfortunately, there's not much you can do on your own for acne rosacea, says Vincent A. DeLeo M.D., although you should be especially careful about avoiding the sun, since sun exposure can worsen the condition. Acne rosacea can, however, be treated by a dermatologist.
What Does A Doctor Do For Acne
With today's drugs, there's no reason for to put up with serious acne, says Albert M. Kligman, M.D., Ph.D.
"Persistent acne can effect self-esteem and confidence," Kligman says. "The psychological, social, and sexual effects of acne are very, very prominent, and the social consequences can be severe." He suggests the children be treated fairly young if they start showing signs of acne, especially if their parents suffered from severe acne.
When you should you see a dermatologist for your acne? Most dermatologists answer that by saying "when it bothers you." Severity is in the eye of the beholder in this case.
Vincent A. DeLeo, M.D., gives some additional guidelines for when professional treatment is called for. See a dermatologist if you:
Use benzoyl peroxide products for six to eight weeks and still have problems.
Have pustules larger than a match head.
Have nodules the size of the end of your little finger.
Have any scarring from your acne.
It's extremely important to see a dermatologist before scarring occurs.
Today's arsenal of treatments includes topical and oral antibiotics and a class of medications called retinoids. It's the latter that have "revolutionized" acne treatment, says Alan D. Klien M.D. Tretinoin (Retin-A) is applied to the skin, while isotretinoin (Accutane) is taken orally: Pregnant women should not take isotretinoin; it has been shown to cause birth defects. It's considered a last-ditch treatment, but it's especially effective for cystic acne. One course of this treatment generally is enough, says Alan N. Moshell, M.D.