Acne
You probably call them pimples, blackheads, and whiteheads; we doctors
call them acne vulgaris. This condition is so characteristic of youth
that I can't help wondering who coined the slogan, "Keep that schoolgirl
complexion." As boys and girls approach maturity, their glandular
activity increases, including that of the sebaceous glands of the skin.
In girls this may become pronounced at the time of their menstrual
periods.. Certain foods increase the activity of the sebaceous among the
worst offenders being chocolate, nuts, sharp cheeses, and fat or greasy
food. If the pore opening is small or clogged by dirt or heavy
cosmetics, the fatty material made by the sebaceous gland accumulates,
and a "bump" appears under the skin or perhaps a whitehead or a
blackhead . Blackheads are not due to dirt, but to the discoloring
effect of air on the fatty material in the clogged pore. If this
substance becomes infected, as it often does, a pimple results. The
temptation to squeeze the unsightly pimple should be resisted. A hard
push, and the membrane around the pimple is broken, so that the
infection spreads to the surrounding tissue; it also spreads on the
surface unless it is carefully washed off. The result more pimples, and
sear tissue or pits.
Pimples develop when oil glands attempt to push the thick, buttery oil
through tiny pore openings. The oil contains irritating substances that
backfire into the surrounding tissue creating a mosaic of papules (red
bumps), pustules, cysts, and blackheads. Subsequent scarring may ensue
from damage to the skin's underlying architectural framework. Damage
from severe acne to the architectural building blocks of the skin may
actually make the skin susceptible to premature biological aging. For
example, deep creases may appear between the nose and the comer of the
mouth in the early twenties rather than in the forties.
Active acne can be devastating. In its aftermath, the acne prone person
may be left physically and psychologically scarred. The key is
prevention and early intervention through the help of a skin specialist.
A variety of topical medications, which are applied directly to the skin
may suffice for mild acne. More aggressive acne, however, may require
systemic medications such as Minocin (minocycline), a potent yet low
risk antibiotic. This is taken by mouth in the form of a capsule. Such
medications may be combined with regular treatments of ultraviolet light
therapy, cortisone injections, and liquid nitrogen sprays. When acne is
resistant to all other forms of treatment, a medication known as
Accutane (isotretinoin) may be required. This derivative of vitamin A is
a very potent medication which has some side effects, so the decision to
use it is weighed carefully by the doctor in consultation with the
patient.
Once acne scarring has occurred, a variety of resurfacing techniques, as
well as collagen implant therapy, can be used to improve the appearance
of the damaged skin.