Brian Dube was 14 when severe acne struck.
“It was pretty bad,” said Dube of his initiation into the blotchy world that virtually all teenagers experience to some degree just before and during puberty.
A five-month course of the potent drug Accutane worked miracles.
“My face was very, very clear” for years, said Dube, who is on leave from Bristol Community College and working as a mental-health counselor in New Bedford, Mass.
Then, this year, his acne flared again. For a man of 24 who prides himself on being “pretty well-dressed,” it’s distressing, he said, to wind up again with “ugly things on your face.”
In his case, the acne came back in late winter. For many young people, acne flares up in the fall in a paroxysm of perversity–just when classes, jobs, sports and romances begin anew and the urge to put one’s best face forward is strongest.
Dermatologists don’t know why this is but they do have educated guesses–and some increasingly good ways to treat it.
Some think that exposure to the sun’s ultraviolet rays in the summer might make acne better–an effect that would clearly lessen as the days get shorter.
Several large studies have shown that UV doesn’t do much except camouflage blotches, said Dr. Robert Stern, vice chairman of the dermatology department at Beth Israel Deaconess Medical Center in Boston. A summer tan, in other words, might make red pimples and other signs of acne less noticeable.
Others suspect it’s mostly stress–the body’s hormonal response to the onslaught of intellectual, physical and emotional demands that come with new beginnings.
Whatever the trigger–and specific foods, including chocolate, have not been proved guilty, though a high-fat diet is suspect–the underlying cause of acne is an unhappy combination of hormones, clogged pores and bacteria.
A couple of years before puberty, a hormone made in the adrenal glands called DHEA (dehydroepiandrosterone) begins signaling the sebaceous glands, at the base of hair follicles in the skin, to pump out oil.
DHEA is the same hormone that some people take as a dietary supplement to ward off aging and is tightly enough linked to acne that it has been dubbed the “acne androgen,” said Dr. Donald Lookingbill, a dermatologist at the Mayo Clinic branch in Jacksonville, Fla.
Once puberty is in full swing, other androgens, or male hormones made in the ovaries and testicles, further stimulate the glands. Though males and females get acne, boys often get it worse because they have more androgens.
As the oil glands go in to overdrive, the ducts through which the oil travels to the skin surface tend to become clogged with a sticky combination of oil and cells shed from inside the duct, said Dr. Barbara Gilchrest, chairman of the dermatology department at Boston University School of Medicine.
The first sign of trouble is a tiny bump at the surface, a whitehead or “closed comedo,” in medical jargon.
If the pore enlarges, the gunk in the duct might oxidize and turn black, creating a blackhead or “open comedo.”
Bacteria in the follicle also might start gorging on the oil, or sebum, turning it into a fatty acid that causes inflammation, said Dr. Bonnie Mackool, a Massachusetts General Hospital dermatologist.
The result is an all-too-familiar blotch that most people call a zit or a pimple.
Luckily, there are many ways to banish zits, including washing your face–no more than a couple of times a day and without harsh scrubbing–with a non-irritating soap.
You also can minimize the use of “occlusive clothing”–helmets with chin straps, shoulder pads, baseball caps worn backward with the strap on your forehead and tight Spandex garments.
If you spend all day on the phone, try cleaning the receiver. If you habitually rest your chin on your hand, stop.
You should go easy on hair pomades, which can trigger acne along the hairline. That goes for makeup, too, although many brands now are “non-comedogenic”–less likely to cause acne.
“We are taught by department stores to put something on our skin constantly,” Gilchrest said, but it’s a bad idea. “If you can convince (people) to stop putting stuff on their face, acne gets better.”
Over-the-counter remedies like Oxy-5, Oxy-10 or Clearasil that contain benzoyl peroxide often help by killing bacteria. Stridex pads also help.
Steer clear of harsh scrubbers or cleansing grains. These can aggravate acne, dermatologists warn. Also resist the temptation to pop your pimples–you can make things worse.
If you try this simple stuff and nothing works, see a dermatologist, who might prescribe topical antibiotics such as erythromycin or clindamycin or oral antibiotics, usually tetracycline or erythromycin.
Retin-A, or tretinoin, is another effective prescription medication. It works by keeping follicles from clogging up. A newer form, Retin-A-Micro, works, too, and might be less irritating to the skin.
Women often get improvement with a birth-control pill called Ortho-Tricyclin that offsets the androgen hormones that can cause acne.
As a powerful last resort, some people such as Brian Dube, use Accutane, which is widely viewed as the most effective of all acne drugs because it virtually shuts down the sebaceous glands.
Accutane is highly toxic to a developing fetus, which means any woman of childbearing age who takes it must be on birth-control pills.
When acne flared this year, Dube took Accutane again, and, as before, was delighted to see his face clear up dramatically. Now, he takes an oral antibiotic and Retin-A to control small breakouts.
“You don’t have to have acne,” he said. “No matter how mild or severe it is, if it’s making you insecure, get it treated.”
