Acne: Fighting Zits Gently but Thoroughly

Acne is a problem affecting many millions of individuals from all walks of life. Most commonly, the problem starts in the teen years with a second peak in young woman from the early twenties to the late thirties/early forties. Hormonal factors are a primary contributing factor. Stress often seems a factor in acne, with its impact likely mediated through the body's hormone system. Diet has not been substantiated as a contributing factor despite abundant rumors.

Acne starts with a plugging of the hair follicle or pores causing comedones, commonly known as blackheads or whiteheads. Skin cells which line the inside of the hair follicle tend to stick together in clumps, and sebaceous glands which surround the base of every hair follicle increase production of oil or sebum due to hormonal stimulation. The increased oil combined with clumping of skin cells tends to form plugs. Once a pore is clogged, bacteria within hair follicles or pores break down the oily skin cell debris into more inflammatory components causing red, inflamed papules and/or pustules, commonly known as pimples, zits, honkers, etc. Teen acne tends to start with comedones, whereas adult acne tends to be more inflammatory with deeper knots and bumps with few or no comedones.

Many acne patients make the mistake of over-aggressively cleansing acne-affected skin.This results in excessively dry or irritated skin, which patients subsequently try to soothe with moisturizing creams or lotions. Unfortunately, such moisturizing creams or lotions can plug pores and make skin cells stick together even more, thereby aggravating a root cause of acne.

I recommend cleansing the skin gently twice daily with a product that cleanses the skin adequately without causing excessive dryness or irritation. I advise avoiding moisturizing creams and lotions unless absolutely necessary and even then, I recommend using only a select few which do not tend to clog pores. Alpha hydroxy acid (AHA)-containing moisturizers are less likely to clog pores but can sometimes be irritating to some skin types. Lacticare is a milder AHA moisturizing lotion available without a prescription.

Salicylic acid cleansers, such as SalAc, Aveeno acne bar or wash, Neutrogena or Phisoderm acne cleanser, are generally not too drying and can help to loosen attachments between skin cells within hair follicles and decrease clogging of pores. For very sensitive skin, I recommend either Cetaphil liquid cleanser or Cetaphil antibacterial bar. When cleansing your skin, it is best to use a soft wash cloth and rinse with lukewarm water. A common tendency of acne sufferers is to rub, scrub or pick their blemishes. Rubbing and scrubbing is irritating, and picking of acne causes more inflammation and increases the potential for scarring and pitting, which can be permanent.

Another common mistake is the understandable desire to conceal pimples which causes many patients, usually young women, to use concealing makeups which likewise contribute to clogged pores and acne. Many products which state "oil-free acne-formulation" or "non-comedogenic" may still clog pores in some acne patients. I never advise a young woman not to wear makeup, but it is important that she understand the potential contribution of makeup to acne and the general rule of thumb that "less is better," especially with foundations, bases, or heavier, more concealing products. I recommend Liquimat, Rezamid, or Neutrogena salicylic-acid-containing acne concealer, which can be purchased without a prescription.

It is important that regular follow-up appointments be made with your doctor to maintain control of acne. I consistently advise my patients to give their cleansers and medicines time to work. This can take from six to eight weeks or longer, so patience is not only desirable, but essential.

For more information on acne, go to:

http://www.aad.org/pamphlets/acnepamp.html

http://www.aad.org/pamphlets_spanish/acne.html (in Spanish)

Or go to:

http://www.aafp.org/afp/20000115/20000115a.html

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