Acne is usually thought of as an adolescent problem, but dermatologists have been treating adults with blemishes for years. The technical term for such outbreaks of pimples is acne vulgaris. Common skin bacteria (mostly Propionibac-ter-ium acnes), the production of oils by the skin, and even the impact of hormones all seem to play a role in determining who gets acne and how severe it will be. When an oil-producing hair follicle becomes plugged up and the bacteria go to work feasting on the fatty acids trapped inside it, the body often reacts with inflammation. That’s what makes the pimple so sore and red.
Based on this scenario, there are four ways to tackle the problem of acne: discourage the bacteria, reduce the production of oil, control the hormones, or lower the level of inflammation. In practice, dermatologists mostly focus on bacteria and oil production. But perhaps trying to lower the level of inflammation is more practical than they think.
Blemishes are a common part of adolescence, but they also trouble many people well into adulthood. Changes in hormone levels seem to aggravate acne. Most treatments are aimed at killing or slowing down bacteria that are commonly present on and in the skin, and this usually works well until or unless the bacteria develop resistance. Stress seems to make acne worse (which is why college students have more zits during the week of final exams), but given the fact that stress is so hard to avoid, almost no treatments focus on controlling it. There are many approaches to acne treatment; if self-care does not prove effective, a dermatologist should be able to prescribe a therapy that will help.
- Change your diet. A low-glycemic-index diet with very little sugar and other refined carbohydrates might improve skin significantly, and it will have other health benefits as well. Other things to avoid: milk and trans fatty acids, which are found in margarine and shortening. A study of dairy products and acne is currently under way.
- Facial masks of clay may remove excess oil and help clear the skin. Other topical treatments include nutmeg mixed with milk or honey to make a paste for pimples. A tea tree oil gel (5 percent) is worth trying.
- Wash morning and evening with a gentle nonsoap cleanser. Using a harsh or abrasive product may aggravate acne.
- Ask your doctor about applying a topical antibiotic such as clindamycin or erythromycin. They can be helpful, but skin bacteria are developing resistance to these drugs.
- Check with your doctor regarding a prescription for Retin-A. Be vigilant about protecting your skin from the sun or any other source of ultraviolet radiation while you are using this medicine.
- Ask about Nicomide-T gel or cream. This vitamin-based topical medicine can reduce inflammation and may be almost as effective as some topical antibiotics.
- Oral antibiotics may work even when topical antibiotics do not. Be sure to ask your doctor about side effects and interactions, and follow the dosing instructions carefully.
- Women may benefit from birth control pills. Sometimes the diuretic spironolactone provides additional anti-acne power.
- For severe acne that has not responded to other treatments, isotretinoin (Accutane, Sot-ret, etc.) is an option. Discuss the risks and benefits thoroughly with your dermatologist before starting on a 5-month course of these pills. Because isotretinoin causes birth defects, women are required by the manufacturer to verify before taking any of this medication that they are not pregnant, and to confirm it again each month during treatment. They must also use two effective forms of contraception during the course of treatment.
- Ask your dermatologist if Dusa Blue Light (photodynamic therapy) is appropriate for you. It should be administered by a dermatologist or plastic surgeon experienced with its use.