Acne, a common but disturbing teenage problem

By Donya Betancourt

SANUR, Bali (JP): Looking in the mirror and seeing a red blemish or a pimple can be both alarming and disheartening.

Acne is one of most common issues in teen years. Facial beauty is a primary focus in determining attractiveness and, unfortunately, it is also a primary focus of sebaceous follicles. At no other time of life is peer acceptance so important for self-esteem.

Acne commonly starts in early puberty, age 12-14 years, when the oil glands in the body start making more sebum (oil). In cases of acne, the oil plugs up the skin's hair follicles, traps bacteria and makes the follicles swell. The results are red bumps. If the follicle wall breaks, these bumps can turn to pimples. Lesions are most commonly located in the area of highest sebaceous gland activity, such as face, chest and upper back.

Some factors that often make acne worse are oil-based makeup, hair gels or sprays, stress, menstruation in girls, or the habit of picking or squeezing pimples. Some factors which do not cause acne are dust, chocolate, sexual activity or masturbation.

Both boys and girls get acne because of the androgen hormone which stimulates the sebaceous glands. Boys, however, are usually more severely affected than girls because they have more skin oil and androgen. But since girls pay more attention to their looks, acne might be a greater concern for them.

The ache affected skin will have a "white head" which is a follicle that is plugged with oil and skin cells, or a "blackhead" which is when the plug reaches the skin's surface and the air touches it, it can turn black. During this process, if the follicle wall breaks near the skin, it will turn to a pimple with a white head. But if it breaks deep in the skin, it can cause a cyst or a lump, called "cystic acne".

It is true that at sometime during puberty, a teenager will be affected by acne or pimples. Not all cases, however, require professional treatment.

When professional treatment is required, the important tip is to accept that it is not effective in a day. The treatment will take around two months before the skin starts to look better. The treatment's goal is to minimize scarring. Therapy is toward correcting abnormal follicular thickening, decreasing bacteria and decreasing sebum production.

In taking care of problem skin, one should gently wash the skin with soap and water; avoid hard scrubbing.

Medication

Your doctor may prescribe topical medication, such as gels, creams or lotions that can be applied over the area where you have acne after washing. Your doctor may also tell you to start it once a day and step up to two times a day.

If you are using any kinds of cream or lotion that irritate your skin, stop using it and get advice from your doctor.

Topical medications are usually:

1. Benzoyl peroxidase, which has both antibacterial and comedolytic properties.

2. Topical tretinoin (Retin-A) acts to decrease the stickiness of cells, allows plugs to expel and prevent formation of comedones.

3. Topical antibiotics may be prescribed by doctors for patients with a significant inflammatory component. The antibiotics can be very effective for acne. If the antibiotic is for external use, be careful not to apply it near the eyes, mouth or area under your nose. At the time of using it, avoid sun exposure or use a strong sunscreen because you can get very bad sunburn. Oral antibiotics are used in patients with severe acne or patients that do not respond to external medication.

Isotretinoin (Accutane) is an oral medication that may be used to treat severe cystic acne that does not respond to other treatments. It should be taken once a day for 15 to 20 weeks.

An important warning concerning Isotretinoin is it can cause serious side-effects, such as birth defects and miscarriages. It should never be taken during pregnancy or even one month before pregnancy. In order to prevent any complications, sexually active girls should use two types of birth control, such as condom and pill or not have sex from the first month before starting using the medication and the first month after stopping it.

Acne, especially cystic acne, can cause scars in some people. You can help reducing scarring by not squeezing or picking at blemishes. Also avoid scrubbing your skin. If you do get scars, there are treatments available that can greatly reduce or remove the signs of scaring.

There is also another type of acne called neonatal acne, which may be present at birth or develop in the newborn. Lesions are mostly superficial and are usually confined to the face and upper trunk. This occurs as a result of maternal and fetal androgen. Complete clearing occurs within one to three months.

Acne rarely develops later on during infancy. But if children are affected with acne, your doctor can prescribe topical gels. In unusual cases where persistent or severe infantile acne is present, you may need to have a complete endocrinological (hormone) check-up.

In closing my advice for those who are affected with pimples and black heads is to understand that it is a part of the passage of youth. The best thing you can do for yourself is to take care of your skin by treating it gently with mild soaps and soft sponges. Avoid the temptation of picking and squeezing the blemishes and be patient with the process of physical maturation.

-- The writer is a pediatrician based in Sanur, Bali. Questions? Contact her at drdonya@hotmail.com or at features@thejakartapost.com