Out, out damn spot: Treating adult acne

By Maria Endah Hulupi

JAKARTA (JP): "Wati" stares at the mirror, surveying the damage. Angry red spots of acne dot her face, with the one on her nose getting bigger by the day and becoming more painful, like the one under her jaw.

She is 35, but acne is still a part of her life.

"I always wonder why people say acne is a problem of teenagers because I cannot remember a time when I didn't have pimples," said the private company employee.

Although there are no firm statistics for Indonesia, acneworld.com reports about 27 percent of the 51 million acne sufferers in the United States are adults, and the majority of them are women.

Adult acne can break out on the face, shoulders, back and neck. People prone to the condition are those with one or more family members with an acne problem, those who lead stressful lives and people who fail to maintain skin cleanliness.

The problem is usually triggered by androgen (male) hormonal irregularity, stress, cosmetics and a high fat diet, said Lily Soepardiman, a dermatologist with state-run Cipto Mangunkusumo General Hospital in Central Jakarta.

Androgen hormonal irregularities and stress will activate sebaceous glands, prompting the glands to produce excessive sebum on the skin -- and pimples.

Middle-aged women are prone to the development of acne rosacea, which usually breaks out in the T-zone area, often accompanied by reddish skin, telangiectasia (the abnormal dilation of capillary vessels and arterioles) and nodular swelling of nasal tissue.

"Women from the age of 30 to 40 are experiencing hormonal changes, which are aggravated by demodex mites which live on the skin. For this problem, they will receive antifungal facial treatment," she said.

People who consume asthmatic medicines or those who use corticosteroids to increase their body weight are also prone to developing acne because of attendant hormonal irregularities.

Lily said it was important to live a healthy life, such as maintaining a low fat diet, avoiding excessive consumption of carbohydrates and spicy food, drinking at least eight glasses of water a day and trying to relax.

And women should not use heavy makeup which may clog the pores.

Using cosmetics which contain acnegenic mineral oils, like isopropyl myristate and myristic myristate, in the form of foundations and moisturizers will alter the condition on the epidermis, the top layer of skin, leading to clogging of the pores.

"What's worse is that here in Indonesia, cosmetics producers never clearly indicate the ingredients in their products, so the consumers will never really know what they are putting on their faces," Lily said.

Women with acne are advised to use a thin layer of mild cosmetics, such as a water-based foundation, and thinly pat loose facial powder to avoid clogging of pores.

As part of a daily routine, Lily stressed the importance of maintaining personal hygiene by washing and cleansing the face to remove dirt, cosmetics and sebum on the face twice a day.

"Choose pH balanced facial soap and gently clean the face from impurities and cosmetics," she said, adding that using an astringent after cleansing will help control sebum production.

People with a mild acne problem may use over-the-counter acne medicines containing sulfur and resorcin tinctures. But Lily said that if the condition worsens then people must immediately consult a dermatologist, who may prescribe antibiotics such as tetracycline, doxycycline and clindamycin in capsule or ointment form for patients with infections.

For people with very oily skin, a dermatologist will usually give an antiandrogen medication to control oil glands and specially formulated treatment, containing sulfur, resorcin and vitamin A acid, to clean out clogged pores and treat the infection.

Cleansing

For proper daily facial care at home, senior manager of Swiss- based La Prairie beauty clinique Jeanne Thong said thorough but gentle skin cleansing in trouble areas, like the face, neck and chest, is important, especially for people living in a heavily polluted area like Jakarta.

She also said that acne breaking out along the jawline might indicate possible digestive problems and stress, while eruptions along the hairline can be caused by dirty hair.

"Choose the right skin products available, in this case the ones for problematic skin. And for those with combination skin, they may need different products for their facial area," she said.

Jeanne advised people to evenly apply facial foam or jelly and use wet white cotton pads to remove dirt for three minutes and rinse with clean water. If the cotton looks dirty at the first cleansing, repeat the step a second time.

"Rinsing with room temperature water is better than warm water and using facial cotton is more effective to absorb dirt than the hands, but don't overdo it, leave out the acne spots."

When doing facial cleansing, many people concentrate on the cheeks, but this will lead to uneven skin tone, with a darker hairline and lighter cheeks.

After the cleansing, use facial toner for oily skin to ensure that the skin is clean and to balance the skin's acidity level. For those with acne all over their face, use cotton to apply toner by gently patting the face to avoid scraping the acne and potential scarring.

A specially formulated acne cream prescribed by a dermatologist may then be used, but only on the troubled areas. A moisturizer for oily skin should then be gently applied.

"If they routinely perform this facial care at home, they will see the difference in just seven days. They need to see a beautician who will properly remove the acne every week," she said.

As for makeup, Jeanne said using a thin layer of oil free foundation is imperative, not only to give a fine look, but also to protect facial skin against the sun's rays and pollution. The next phase is to lightly dab loose or compact powder.

She warned women to avoid using a cheap makeup base that contains mercury, as it will clog the pores and cause a tightening sensation on the facial skin.

"It is also important to make sure that your hands are clean when doing facial cleansing and keep sponges and brushes for facial cosmetics clean to prevent spreading the bacteria to other areas," she added.