Frequently Asked Questions About Acne

4. Some acne investigators believe that although this understanding is generally correct, there is more yet to be learned about the causes of acne vulgaris. Acne that appears after the age of 25-30 years is (1) a recurrence of acne that cleared up after adolescence, (2) a flare-up of acne after a period of relative quiet-for example, during pregnancy, or (3) acne that occurs for the first time in a person who had never previously had acne. Acne that occurs in adulthood may be difficult to treat if there are multiple recurrences. Some patients with severe recurrent acne have undergone repeated courses of treatment with the potent systemic drug isotretinoin. Acne flares in association with pregnancy or menstruation are due to changes in hormonal patterns. Acne that appears for the first time in adulthood should be investigated for any underlying cause. Drugs that can induce acne include anabolic steroids (sometimes used illegally by athletes to "bulk up"), some anti-epileptic drugs, the anti-tuberculosis drugs isoniazid and rifampin, lithium, and iodine-containing drugs. Chlorinated industrial chemicals may induce the occupational skin disorder known as chloracne. Chronic physical pressure on the skin-for example, by a backpack and its straps, or a violin tucked against the angle of the jaw and chin-may induce so-called acne mechanica. Some metabolic conditions may cause changes in hormonal balance that can induce acne. Some lesions that appear to be acne may be another skin disorder such as folliculitis-infection and inflammation of hair follicles-that require different treatment than acne. Acne that appears for the first time in adulthood should be examined and treated by a dermatologist. 5. My 15-year-old daughter has what I would describe as a very mild case of acne. She has made it much worse by constant picking and squeezing. She looks in the mirror for hours, looking for some blackhead or blemish she can pick or squeeze. Does she need psychological counseling? Excessive picking and squeezing of otherwise mild acne is a condition called excoriated acne, seen most often in young women. A dermatologist may provide effective counseling. The typical person with excoriated acne is a person-often a young women-who is so distressed with her appearance due to acne that she literally tries to "squeeze the acne out of existence." The acne is often very mild, but the person's face may constantly be covered with red marks from squeezing, and open sores where lesions have been picked open. The word excoriate means to scratch or abrade the skin. Excoriated acne is a medically recognized condition that should be discussed with a dermatologist. Occasionally giving in to a temptation to squeeze a blackhead is not defined as excoriated acne. Hours in front of a mirror, squeezing and picking every blemish, is a definition of excoriated acne. A dermatologist may be able to counsel the patient regarding a course of treatment in which the patient can participate, but keep "hands off." 6. Can the rate of secretion or the composition of sebum be altered by diet? If it can, shouldn't alteration of diet be considered a treatment for acne? Diet has never been proven to have a role in the cause or treatment of acne. Dietary manipulation may have a role in the treatment of some scaling diseases of the skin, but not in the treatment of acne. Dietary cause is one of the most persistent myths about acne. Foods, such as chocolate or greasy foods, do not cause acne, but certain foods seem to make some people's acne worse. The following can bring on or worsen it: *Hereditary factors *An increase in male hormones found in both males and females *Menstruation *Emotional stress *Oil and grease from cosmetics, work environment No food has been shown to be effective in preventing or treating acne. A healthy diet is, of course, necessary for good general health. 7. Shouldn't I just try to eliminate sebum from my body? No. When it isn't blocked in your pores, sebum helps keep your skin healthy. 8. Why does acne usually start at puberty? No one knows for certain. What is known is that the sebaceous glands that produce sebum get much larger at puberty than they were before. 9. Why does the skin around a pimple turn red? This redness is caused by the body's inflammatory response. Inflammation is a sign that your immune system is working to fight an infection. However, the inflammatory response doesn't always work perfectly, and can even be the cause of scarring. 10. If my skin turns red, does that mean that I'm going to have scars? Usually, no. Even when there will be no permanent scar, the aftereffects of the inflammatory response can leave the skin red for months, sometimes for more than a year. 11. What are free radicals? Free radicals are byproducts of oxidation in your body. We all need oxidation to occur as part of our life process, but there is concern that the buildup of unrecycled free radicals contributes to many conditions, including skin damage. Antioxidants, including several of the active ingredients in Acuzine, help prevent the buildup of free radicals.