Facial blemishes damage more than just the skin; they demoralize the inner woman, who expected her face to clear up after adolescence.
Unfortunately, the pimples may stay or return – sometimes worse than before. They may even pop out suddenly on the skin that remained blessedly clear during the turbulent teen years.
Skin doctors call these outbreaks adult acne or chin acne. The blemishes tend to appear primarily on the chin, rather than on the forehead where teenagers typically break out. The eruptions are usually milder in adult women – a single glaring red pimple or a cluster of small bumps – but maybe no less persistent. One woman in four is afflicted.
The good news from the skin specialists is that adult acne can be controlled, if not cured. New therapies promise relief in cases that have resisted older methods. And the causes are finally beginning to be understood, which could spur new innovations in treatment.
The current view is that acne begins with the buildup of oily sebum, which is secreted into the skin pores, or follicles, by tiny glands in the skin. When these sebum plugs are attacked by bacteria, they break down into substances that irritate the skin, causing the characteristic pimply redness and swelling.
Heredity contributes to the problem. Women whose parents had acne are more likely than others to get it.
Stress often is blamed for the blemishes. Although no connection has been scientifically proven. Dr. Samuel B. Frank, a dermatologist of New York, says:
Outbreaks have a notorious habit of occurring just when a woman wants to look her best – for a party, wedding or other social occasions.
When a fulsome red pimple appears at an inopportune moment. Dr. Frank suggests having it squeezed professionals by a skin doctor. Some dermatologists say that in an emergency you can squeeze the pimple yourself, using a device called a comedo extractor that can be bought at the chemist.
Dr. Frank discourages women from picking their own pimples because it often makes the blemishes worse and can also produce or aggravate serious facial scarring. If a pimple appears while you are dressing to go out, he advises concealing it with cover-up makeup.
Cosmetics may well save the moment, but they are also believed to trigger many cases of grown-up acne – which is seen only in women. One leading acne expert, Dr. Albert Kligman, of Philadelphia, says bluntly.
A persistent low-grade acne in an adult woman is presumed due to cosmetics unless proven otherwise.
In his laboratory at the University of Pennsylvania, Dr. Kligman has tested the pimpling effect of hundreds of cosmetic ingredients – including olive oil, cocoa butter, white and red petrolatums, and lanolins.
Rouges, lipsticks, and cleansers do not cause eruptions, says Dr. Kligman. What he calls cosmetic acne is usually caused by a facial cream – a foundation, night cream, or moisturizer. Some sunscreens, particularly those that contain benzophenones, also cause problems.
It’s impossible to predict with certainty that a particular product or ingredient will cause a particular woman’s face to break out; there are just too many variables. But costly cosmetics are neither more nor less likely than cheap ones to cause adult acne, according to Dr. Kligman.
He and Dr. Frank both suggest that sufferers try using fewer cosmetics, or none at all, to determine whether cosmetics are causing skin eruptions. Dr. Frank adds that the substitution of water-based products for oil-based lotions may also help. A cosmetics salesperson, he says, should be able to guide you about which products are formulated with water and which are made with oils.
According to beauty experts, it is not the cosmetics themselves that cause trouble, but their improper removal at day’s end. Dr. Frank believes this point is well taken. He suggests that acne-prone women always use soap and water for facial cleansing instead of cold creams, which may clog the pores.
Hormones are the other principal trigger of acne in women. Pimples tend to appear just before menstruation, due to the influence of progesterone.
Skin doctors formerly prescribed strongly oestrogenic birth control pills to counter these pimples, but Dr. Frank says the low-dose pills used today contain too little estrogen to be consistently helpful. And the numerous side effects that have been associated with oral contraceptives make many doctors hesitant to prescribe them for minor skin disorders.
If a woman is already taking birth control pills and is unwilling to give them up, however, a change in brands may be beneficial. According to Dr. Frank, the progesterone in some brands is more oestrogenic than that in others, and so may cause fewer skin blemishes. Any such change should, of course, be discussed with your gynecologist.
Super-cleanliness is one of many myths about the causes and treatment of acne. “Acne is not caused by dirty skin,” explains Dr. Alan Shalita, a dermatologist at Downstate Medical Centre in Brooklyn.
While acne patients generally have an oily skin, washing removes only surface oil; it does not penetrate into the follicles where the disease originates.
This view is shared by Dr. Kligman, who explains that oil which has reached the skin surface – and so no longer contributes to the disease process – can be scrubbed off in about half a minute. On the other hand, excessive use of some soaps and too frequent water washings can cause acne. Dr. Kligman says:
The importance of washing should be toned down. We have our acne patients use whatever soap they like – and we urge moderation.
Sunshine sometimes is blamed for causing acne. While it is true that sudden exposure of winter-whitened skin to the strong tropical sun may trigger blemishes, this is a brief and uncommon occurrence. Moderate sunning is beneficial. Almost everybody’s acne is better in the summer, because of increased exposure to sunshine. A sunlamp is good but sunshine is best.
Diet was long regarded as both a cause and a cure for acne. Today many skin doctors believe that what you eat is of little importance. Dr. Kligman long ago disproved the notion that chocolate is a menace by feeding large amounts of it to acne-prone patients – without producing noticeable changes in their skin. The same is true of nuts, sweets, soft drinks, and other delectable foods.
Acne treatment today consists largely of skin preparations and medications taken by mouth. Mild acne can be controlled with the help of one of the main over-the-counter lotions and creams containing sulfur, resorcin, and/or salicylic acid. These dry and irritate the outer layer of skin, causing it to peel. Whiteheads and blackheads are exposed and carried away.
The time to abandon self-treatment and see a doctor is when a woman is unable to control her own acne. Skin specialists have new and more potent drugs and skin preparations that can be prescribed to fit a woman’s individual needs. They also have special techniques for treating very severe acne – such as injecting large, stubborn pimples with tiny amounts of steroid drugs that melt them quickly away. Because small doses are used, side effects are rare.
The potent drugs now being used are particularly helpful for adult acne, according to Dr. Frank. One is vitamin A acid. It appears to penetrate the pores, where it opens, loosens, and helps eliminate whiteheads and blackheads. Another drug, benzoyl peroxide (sometimes prescribed in combination with vitamin A acid), suppresses the growth of the acne-causing bacteria. Both drugs may produce skin peeling.
Another acne therapy involves antibiotic drugs. The antibiotic tetracycline, taken by mouth – in large doses at first, then in smaller doses as the skin improves – has been judged by a task force appointed by the American Academy of Dermatology to be a safe treatment. It is effective for many patients though, inexplicably, not for all. Side effects are rare and usually mild.
Even better, some experts say, is an antibiotic applied directly to the skin in lotion form. The topical antibiotic and other drugs used for adult acne are effective against teenage acne as well, says Dr. Frank. But different regimens may be required for adolescents.
These developments do not mean that antibiotic lotions or any of the other treatments will clear acne from the face overnight – or even in a few days. Three months is a standard trial period for acne therapies.
As we get better things to treat acne with, we can depend less on uncertain things like diet. We are getting better things. There is no panacea, but it’s easier to treat acne now than it used to be.
For the women who find they did not leave the unsightly blemishes of acne back in adolescence, this is good news indeed!