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.

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  1. Bob
    Reply

    half a tea spoon in a small glass of water at first sign of a cold sore. Next morning all gone. I think it is caused by an in balance in the body.

  2. CT
    Reply

    I am prone to acne along my jaw and around my mouth shortly before my period — this is ‘classic’ hormonal acne for women. I found that taking 15mg of zinc every night before bed worked wonders. I still get spots, but they are easily treated with a pimple cream containing sulphur. I stopped eating gluten as well (as Dwight mentions above) and it seems to have helped, although not as dramatically as the zinc.

  3. PD
    Reply

    Should the milk of magnesia for the whole face or just on the acne. Please respond.

  4. Dwight
    Reply

    Eating products with flour in them causes acne. Gluten has an adverse affect to hormones in some people. My son had a chronic of acne for a couple years. We took white flour out of his diet. Acne is gone as long as he doesn’t eat bread, pasta, etc. It took about a month for it to clear up.

  5. momOf2
    Reply

    I also heard on Doctor Radio (SiriusXM) that new studies have shown that there are high levels of pregnancy hormones in cow’s milk that can cause breakouts if teens drink a lot of it. I didn’t want to stop my teens from drinking milk completely but I did have them cut back. I haven’t noticed a difference in the acne either so that may not be true.

  6. AT
    Reply

    Where can I find milk of magnesia, it is oral or how do you use it? Please I have acne too and I tried everything.

  7. Barb
    Reply

    My 16-year-old daughter had terrible acne. She gave up sugar, diary and gluten and started taking natural supplements for other reasons, and her acne disappeared within 6 weeks. She has beautiful skin now.

  8. Vicki
    Reply

    Baking soda has proved effective for my daughter. She washes her face, rinses, and then making a paste with baking soda scrubs her face and then rinses. It worked very well.

  9. marleycassie
    Reply

    I have started using Acne Free from Walmart. It is placed beside the Neutragena. I started off with the strongest and now just use the regular. I still get them sometimes, usually just above and below my jawline. Overall, it is a keeper!
    PEOPLE’S PHARMACY RESPONSE: THIS PRODUCT CONTAINS BENZOYL PEROXIDE, WHICH HAS BEEN SHOWN TO HELP BLEMISHES. BENZOYL PEROXIDE IS AVAILABLE IN MANY OTHER PRODUCTS AS WELL.

  10. Moni
    Reply

    Where can I find milk of magnesia, it is oral or how do you use it? Please I have acne too and I tried everything.
    PEOPLE’S PHARMACY RESPONSE: TO USE MILK OF MAGNESIA FOR ACNE, POUR SOME ONTO A COTTON BALL FROM THE FAMILIAR BLUE BOTTLE OF LAXATIVE. APPLY IT TO THE FACE AND ALLOW IT TO DRY. IT CAN BE LEFT ON OVERNIGHT AND WASHED OFF IN THE MORNING.

  11. acne care center
    Reply

    I don’t know much about acne. thanks for this share.

  12. Richard
    Reply

    How long did your grandson keep the MoM on for?

  13. S.M.
    Reply

    My grandson, age 13, had severe acne. I sent your column about Milk of Magnesia for acne to his mother. The next time I saw him, about a month later, I could hardly believe the improvement, about 90 percent better. He applied M.O.M. morning and evening and was still using it.

  14. Hayward
    Reply

    I also have trouble with my acne. They never seem to disappear; when one vanishes another appears. It’s quite irritating. I have been going to the dermatologist for some time now but the problem is I am not consistent with my treatments. I guess that is the problem…

  15. L.D.
    Reply

    I’ve tried many products over the years to help fight acne, and the only thing that has ever worked reliably without side effects–like redness, dryness, flaking, irritation–is Nicomide-T Cream. Unfortunately, it’s no longer available. Is there any similar product you could recommend?

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