“If you ever want some help with your skin, let me know, there are some good treatments.”

“What do you mean?  What’s wrong with my skin?”  This was one of those awkward conversations in the midst of doing a physical on a young man with obvious rather severe acne.  Either he was in denial or it just seemed normal and no big deal to him.

On the other extreme are the patients, most often female, who ask rather urgently, “Do you have anything that will help my face?”  On inspection of some of the faces of these young ladies I may be able to find less than a handful of little bumps.  Yet in their minds, those little bumps are like giant facial volcanoes erupting and grabbing all the attention of anyone looking their way.

In short, the severity of one’s acne is very much in the eye (and mind) of the acne sufferer.  Likewise, whether we treat it at all, and how aggressively, mostly depends on how much it bothers the person.  At the same time, we will certainly try to influence their level of concern to a realistic place.

Mild or severe, acne (full name, acne vulgaris) is the most common skin disease in the United States.   It is caused by a combination of overproduction of oil (sebum), irregular shedding of dead skin cells that irritate the hair follicles, and the buildup of certain bacteria.  This results in anything from whiteheads and blackheads to inflammatory papules (red bumps), to pustules (white, pus-filled bumps), to nodules and cysts (large solid or pus-filled lumps that can be quite painful and deep).  Nodulocystic acne, the worst form, tends to not only produce large, long-lasting, painful lumps, but usually leaves behind permanent scars as well.

What are the risk-factors for acne?

  • Probably first on the list is genetics; it tends to run in families.
  • Acne most commonly shows itself around puberty since certain hormones, especially male androgens, promote it.
  • High carbohydrate foods (breads, potatoes, chips, etc.) have been shown to worsen acne.  However, when chocolate and greasy foods have been tested in studies they did not routinely worsen acne.
  • Direct skin contact with greasy or oily substances, or to certain cosmetics applied directly to the skin.  Likewise putting your hands or hair against your face, wearing a chin strap (such as with a football helmet) or pressing a cell phone against your face can all worsen acne.
  • Stress can exacerbate acne
  • Vigorous picking at and squeezing of acne can lead to more scarring.

So, what’s the big deal about having a few zits?  The reality for many young people is that it creates a great deal of teasing, self-consciousness and sometimes scarring that can be both physical and psychological.

If you or your child are bothered by their acne, start by avoiding as many of the triggers (mentioned above) as possible.  Cleanse with a mild soap, such as Dove, no more than twice a day.  Vigorous scrubbing and expensive washes have not been found to be helpful.

Beyond that, a trip to your physician can be very helpful.  Mild cases often respond to one or two topical medications.  More serious cases may need oral antibiotics for a time.  For females, oral contraceptives can often help as well.  Finally, for the most severe cases which aren’t responding to these other measures, or involve large scarring nodules and cysts, isotretinoin (Accutane) may be considered.

The key to all of these treatments is consistency and perseverance.  It usually takes 4-6 weeks of consistent use to see substantial improvement.  And then, staying consistent with a maintenance program is vital.  Acne can be effectively treated, but it takes the kind of mature persistence which can be tough to muster in adolescence.  But with a little help and encouragement from mom and dad, success can be achieved.  So, whatever level of acne may be hitting you, if it bothers you, go after it.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835