Acne is that very unwanted collection of "pimples" that appears at adolescence, and is partly a result of the increased production of skin oil at that age. The increased production of skin oil is largely under hormonal influence; it is a side effect of growth and maturing. Acne occurs when excess skin oil dries to a waxy consistency and plugs follicles, which then become inflamed and infected. The condition of acne can be improved by removing excess oil from the skin, preventing the plugging of pores or follicles, and preventing or treating any infection which may develop in the follicle.
Removal of excess oil can be partly accomplished by washing the skin twice daily, using a soap that is especially formulated to remove oil. Examples of soaps that do this especially well are Fostex and Acne-Aid. Many other soaps are touted to be "medicated," but only contain aromatic substances which smell "mediciney," and offer no therapeutic effect. "Moisturizing" soaps should be avoided, as they are formulated to remove less oil, and many even contain oil, thereby compounding the oil problem. Washing more than twice daily has been shown to provide no additional benefit, and may be injurious to the skin, so additional washings should be avoided except in cases of unusual soiling of the skin.
Nature has provided a mechanism to remove excess oil from skin pores, or follicles. This device is hair. Most oil-producing follicles have hairs growing from them. In the beard area of males, these hairs are the "whiskers". In other areas, and in women, these hairs are fine, vellous hairs. Both types of hair serve to wick oil out of the follicle and keep the follicle from becoming plugged. Therefore, where acne is a problem, shaving and plucking of these hairs should not be done. I realize that this means that many young men should forego shaving (sometimes in contradiction to the wishes of their parents, school administrators, and commanding officers.) A letter from their physician should intercede for them with the authorities. In those cases where their physician has the same irrational objection to a beard as do parents, school authorities, and military authorities, the young men can write to me, and I will provide a letter. It is amazing to me sometimes how irrationally parents, school officials, and other adults can behave, and no one has ever accused the military of being rational.
In acne-prone women with unwanted facial hair, this hair should be bleached rather than removed, at least until the woman is older. In young women with both unwanted facial hair and acne, a hormonal evaluation may be warranted. Sometimes hormonal manipulation in the form of oral contraceptives may eliminate acne in women.
Acne which is not controlled by simple measures described above should be evaluated by a physician. Topical and sometimes systemic (oral) antibiotics can frequently make a big difference. In very severe and stubborn cases of acne, a potent drug called isotretinoin (Accutane) may be effective. This drug has potential side effects and should be used as a last resort. Isotretinoin must be avoided in women who are pregnant or who may become pregnant.
It is not necessary to see a specialist in dermatology to be treated for acne. Acne is one of the most common skin conditions known, and most primary-care docs do an excellent job of treating it.
Diet has not been proven to have an appreciable effect on acne, but it is advisable to eat a healthy, balanced diet, and to avoid the excessive fats prevalent in so many American diets. A diet with sufficient fiber is important to health generally, and this is no less important to the acne sufferer.
Copyright 1993, Wm.P. Alford, M.D
Dr. Bill 's Cyber Clinic