Acne generally does not become a problem until adolescence when increased hormone levels cause the skin's oil (sebaceous) glands to work overtime. Normally, these glands produce an oily substance called "sebum." A mixture of fats and waxes, sebum travels through the duct and spreads over the skin, keeping the hair and skin moist. The excess oil causes the openings of the glands to be clogged with sebum and dead cells. If the plug stays below the surface, it is called a whitehead; If it works its way to the surface, oxygen causes it to take on a black color (thus the name "blackhead"). In addition, the plug becomes an excellent environment for the growth of normal skin bacteria resulting in swelling and redness.

Other things that can cause acne, or make it worse, are certain drugs, exposure to industrial oils, grease and chemicals, and stress and strong emotions (which may account for breakouts before the senior prom).

There is no "magic bullet" that will cure this common skin condition. There are many things that teens can do that will reduce their symptoms and make the adolescent’s life more bearable. The following are some general instructions for a teenager with acne:

• Over-The-Counter Medications
  Americans spend $260 million dollars a year on over-the-counter medications that promise to hide, dry and clear pimples. While not all these treatments live up to their billing, the best ones contain Benzoyl peroxide 5 percent lotion or gel. This topical medication available without a prescription should be applied to all areas daily at bedtime. It helps to open pimples and unplugs blackheads and zaps the bacteria that inhabit the pores. An amount the size of a pea is usually enough to cover most of the face. Occasionally, the benzoyl peroxide can make the condition appear worse at first by prodding already-formed pimples to emerge.

• Cleanliness
  Since acne is not the result of poor hygiene, it cannot be washed away. It is OK to wash your face twice a day with a mild soap. Washing more often may remove so much of the protective coating of oil that the skin will become damaged and inflamed. Avoid abrasive scrubs that cause irritation and forget those heavy grease-based deodorant soaps, makeup or moisturizing creams. Do not use moisturizing creams and makeups that contain oil since this can lead to further plugging of the pores (there are oil-free products available).

• Other things you can do:
  
  • Friction from sports equipment chin straps and tight fitting clothes can cause irritation.
  • Even long hours of holding a phone to your cheek can exacerbate inflammation.
  • Avoid measures that increase and collect grease, especially on your face.
  • Hair should be shampooed daily but avoid hair styles that touch your face.
  • Do not spend much too time in the sun. Although it seems that drying of the skin with sunlight would help, the opposite is true since sun and heat increase skin oil production.
  • Boys should shave lightly to avoid nicking pimples.

• Diet
  There is a long-standing myth that certain foods, such as chocolate, nuts and cola drinks cause acne or make it worse. There is no scientific evidence to back up these claims. Some dermatologists, however, do advise limiting caffeine and greasy "junk foods," such as french fries and potato chips. If you notice that outbreaks increase after you eat certain foods, it makes sense to eat as little of them as well.

• Mental Attitude
  Conscientious and regular use of the medication is essential. They will not do any good if not taken regularly. In addition, it is most important to realize that acne must be dealt with, and adjusted to, until the condition runs its course. Try to maintain a positive outlook and not let those little oil glands stop you from doing the things you want to do.

• Picking
  Would you believe that much of the skin damage with acne is self-inflicted? According to dermatologists, nothing is more likely to produce scarring than squeezing the fresh pimple. Resist the temptation to burst the pimple as this will only injure the skin and underlying tissues. If you are not able to control your acne with sensible home care, then head for your physician's office.

• What Your Doctor May Do
  The weapons of choice for moderate acne are topical retinoic acid (Retin-A) and the topical or oral use of antibiotics.
  
  • Retin-A is often considered the gold standard for all other acne treatments. Applying Retin-A helps open clogged pores by lessening cell stickiness is available in gel, cream and liquid forms. It now comes in micro-formulations that are less irritating than previous forms.
  • New topical acne products that your doctor might prescribe include adapalene (Differin) and tazarotene (Tazarac), which are synthetic forms of retinoids, or azelaic acid cream. All are used once or twice daily and help kill bacteria and unblock pores.
  • Benzoyl peroxide works to kill bacteria, dry the skin, and promote the growth of new skins cells. Low doses (1-10%) are available over the counter but higher strengths require a prescription.
  • Topical antibiotics such as clindamycin and erythromycin are now often used in a combination with benzoyl peroxide in patients with mild to moderate inflammatory acne. These combined topical medications are usually quite helpful.
  • In addition, oral antibiotics may be prescribed to help kill surface bacteria that clog the pores and contribute to additional skin inflammation in patients with moderate to severe acne. Tetracycline is the antibiotic most commonly used because of its low cost and freedom from serious side effects, even when given over a long period. Several other oral antibiotics may be used if tetracycline does not help or cannot be tolerated.
  • For severe cystic acne a drug called Accutane, taken orally, is the only available treatment. It not only disrupts plug formation but also shrinks the sebaceous glands. Accutane cures or greatly reduces acne in up to 90 percent of patients. Unfortunately, side effects are common including nosebleeds, eye infections, dry mouth and elevated blood cholesterol. The most dangerous, however, are severe birth defects, including fetal brain deformities, which occur if a woman on the drug becomes pregnant. Under no circumstances should Accutane be used unless directed by a physician.

• New Therapy Options
  
  • Hormonal therapy (oral contraception) may be used in women with acne to decrease the amount of androgens released.
  • Pulsed dye laser therapy and high intensity light therapy (ClearLlight) are new treatment options still being investigated as possible treatment options for acne. We do not yet know how effective or safe they are for treatment of acne. Both are expensive.

With so much of a teenager's self-esteem resting on how they look, acne can be an unwelcome companion for many adolescents. It is ironic that this condition usually occurs at a time with appearance and acceptance into "the group" is so very important. Acne can make this awkward age even more awkward. It is not something to make jokes about- it is a real disease of the skin that can last a long time. Fortunately, with accurate information about the causes of acne and proper care of the skin, the condition can be controlled. And if a blemish problem pops up on your face before that big evening, do not let it get you down. Your date will probably have a few pimples as well!

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