Braving the 'bumps' of life--acne

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Acne is a disease--a disease that demands sympathetic management. It scars not just the skin but also the psyche. Acne is a very common condition and touches the lives of most of us, yet it remains a disease that people in general know little about--and about which there is enormous misunderstanding.

What is acne?

Acne is a chronic inflammatory condition in the skin and is most often caused by an abnormal response in the skin to normal levels of the male hormone testosterone. Although it's related to hormones, most people's acne is not caused by any actual abnormality in the hormones. The key symptoms that occur in the skin and lead to acne spots are:

Increased oil production

Partial blockage of the hair canal which leads to the development of the non-inflammatory blackheads and whiteheads.

Eventually, the complete blockage of the hair canal which allows oil to accumulate, with growth of bacteria that are normally present in the skin, resulting in inflammation and giving rise to the inflammatory lesions of acne--the red papale, the pustule and the cyst.

The development of 'bumps'

When you develop acne, it is rather like a biological switch being tamed on. We do not fully understand why, but the switch is activated in most people by fluxes in hormone levels around the time of puberty. It may be switched on later in life by stress--and in fact this stress is the most common cause of first-time acne in women in their mid- or late 20s.

This stress-related "maturity onset acne" was first recognized in the United States in businesswomen who were climbing the corporate ladder. Because of their acne, many of these women gave up their jobs. Across the spectrum of acne sufferers, many find that their acne flares up when they are under stress--during exam times or when a relationship breaks up.

Treatment options

There are a wide variety of treatments available for acne. One of the first things you should do to take charge of your acne is make an appointment with your doctor so you can talk about your acne with a specialist and find a treatment that will work for you.

Take a positive, active role in your treatment. Try not to let embarrassment hinder your description of the symptoms, and indeed, how you feel about yourself and your acne. Your emotional state is just as important as your skin condition so you should be prepared to answer questions about the way you feel.

Types of treatment

There is a wide range of prescriptions, over-the-counter and alternative therapies available for acne. Your doctor or pharmacist can help you choose one which suits your needs best.

Salicylic acid: It comes in the form of a gel, a cream or a wash. The acid is applied at night and washed off the following morning, and it works by dissolving the dead skin cells that block up the hair canal. With the skin cells removed, oil is free to flow out of the pore, and infection is less likely to occur. Allergies are not common, but some users have found the acid dries out the skin and leaves it itchy.

Vitamin A derivatives: The build-up of dead skin cells that contribute to acne is caused by abnormal growth in the skin cells lining the hair canal. Vitamin A not only normalizes cell growth, thus preventing blockages from forming, but also unseats existing blockages. Vitamin A has a further beneficial effect--it increases the production of collagen in the structure-forming part of the skin and effectively "pads out" the growing part of the skin, producing an overall smoother surface. In real terms this can mean fewer wrinkles plus less obvious acne scarring.

Although useful in the fight against acne, vitamin A derivatives, such as Retin A, can irritate the skin, so it's best to start with a low strength product. Always ensure that your vitamin A treatment is thoroughly washed off after use as it can cause a sunburn reaction in sunny conditions.

Complementary therapies

The condition of our skin can be a good indicator of our overall well-being. Alternative and complementary therapies have fewer side effects and tend to pay attention to a wider range of symptoms than "spot specific" drug treatments. As such they're often successful in the long-term, helping sufferers toward better health all over.

Non-drug therapies can be used in conjunction with your pharmaceutical treatment or on their own as an alternative form of medicine altogether. With the support of your healthcare provider, you can find a therapy or combination of therapies that will work best for you.

Sunlight: Many acne patients say they get better when they go on a sunny holiday and often come back completely clear. The longer wavelength light rays excite chemicals called porphyrins, which kill the bacteria in acne spots--so sunlight acts like a natural antibiotic. Hot, dry sunshine is best, as the skin is exposed to the beneficial effects of the sun without the problems associated with high humidity conditions. If humidity is too high, moisture will be taken up into the hair canal, encouraging blockages and thus risking a flare-up.

Holistic medicine

Rather than prescribing a treatment designed merely to get rid of spots on the skin, a holistic practitioner will search for the long-term cause of the spots by looking at your "whole" health (not just the skin), and, more importantly, at some "invisible" elements such as your energy and your emotional state.

Because we're all different, holistic prescriptions vary depending on the unique constitution and personality of each person. Holistic therapies recognize that the deeper causes of acne vary between individuals--so there will never be a single, standard cure.

Traditional Chinese Medicine (TCM)

Skin conditions have been consistently shown to be receptive to treatment with Chinese medicine. TCM practitioners believe that any form of illness indicates imbalance in the body. Their treatment is designed to heal the whole person by re-establishing balance in body and spirit.

A TCM doctor will assess the health of your body and spirit by making careful observations and will prescribe a herb tea blended especially for you from about eight to 12 Chinese herbs. The variety of different blends available to the practitioner is enormous. Altogether there are around 160 different Chinese herbs to choose from.

Acupuncture

Acupuncturists theorize that health problems such as acne occur when our body's energy channels--or meridians-become blocked. Unable to flow freely, the disrupted energy will always be associated with some sort of physical and emotional health problems.

The acupuncturist stimulates and frees up energy points along the main meridians. Once cleared, the flow and balance of energies in the body will be better harmonized and health problems such as acne can be greatly helped.

Homeopathy

Rather than applying a treatment to fix or "fight" a condition, the homeopath uses minute amounts of a natural substance, the effect of which actually mimics that of the condition being treated. Like a vaccine, the homeopathic remedy stimulates the body's healing mechanisms. The amount of active ingredient in a homeopathic remedy is so small as to be virtually undetectable--causing some to query how and why homeopathic remedies can be effective. Homeopaths, however, have consistently shown that the more diluted a remedy, the more powerful will be its effect. The popularity of homeopathic treatment continues to grow.

There are over 2,000 different homeopathic remedies available to the practitioner and, as with TCM treatment, the prescription will be tailored precisely to suit each patient's unique temperament and particular acne.

Making acne worse

A holistic view will help the treatment of any disease. Issues like lifestyle and stress levels are always relevant, and while a healthy lifestyle will increase your chance of getting a good response to acne therapy, we can also identify a number of factors associated with making acne worse:

Stress: At work or at home, stress is a key contributor to problem acne. Studies have shown that therapy to help a patient handle stress will concurrently improve their response to medical treatment for their acne.
Hormones: Hormones themselves are not a cause of acne, but some people's overreaction to hormones leads to acne. Hormone-related acne is often triggered by the changes just before a menstrual period, and some sufferers will find that progesterone-only contraceptive pills make acne worse.
Sweating and high humidity: Humid conditions that make the skin sweat and tight fitting clothes, which retain sweat close to the skin, will cause swelling and blockage in the hair canal. If the blockage becomes acute, inflammatory spots will result. Acne sufferers should avoid high humidity climates and other sweat inducing places such as steam baths and saunas.
Temperature: Although sunshine is good for the skin, hot weather will produce more oil. Therefore, try to stay cool in the summertime and you will improve the condition of your skin.
Generally poor diet: While it's a myth that fatty foods make acne worse, it's definitely true that a diet lacking in the right nutrition will impact on physical health and could well lead to skin problems such as acne. Make sure you eat a balanced diet including fresh fruit and vegetables.
Picking at spots and squeezing the skin: Always avoid picking at spots. It will increase inflammation, spread bacteria and is likely to lead to scarring.
Some prescription drugs: Sometimes acne is a side effect of drugs taken for other conditions. Talk to your doctor if you think this may be the case.
Cosmetics: Some cosmetics will exacerbate acne. Cosmetics that conceal spots, however, can be very important for acne management as a much-needed psychological prop for sufferers. So there's no need to totally avoid cosmetics, but do make sure you choose the correct ones--preferably a product that is labeled as non-comedogenic. Always use low-oil or oil-free moisturizers.
Acne scarring

Scarring can be hell to live with. There are no easy ways to get rid of scars once they have formed. Tinted moisturizer or bronzing lotion are helpful ways of playing down acne scars, but actual scar reduction treatments, such as derm-abrasion, chemical peeling and laser resurfacing, are costly and invasive.

The good thing to know is that acne scarring is preventable. It's far better to learn how to avoid scarring in the first place. The two simple keys to avoiding acne scarring are:

Treat all acne at an early stage before scarring has a chance to form.
Never pick at your spots. Picking at spots makes spots last longer and can spread infection too. It causes minute damage to the skin and hair canals. In the long-term, it's very likely to leave scars behind. Don't do it!
Don't let your acne rule you. Have patience, but take charge! Take an active role and seek out treatment that suits your type and your needs.

Tony Chu, M.D., is a leading dermatologist at the Imperial College of Science, Technology, and Medicine, Hammersmith Hospital, London. An acne sufferer himself, in 1990 he founded the Acne Support Group. He is the author of The Good Skin Doctor (published by Thorsons, paperback, 0-7225-3675-5, available through National Book Network, 800-462-6420 and bookstores).

Just the facts

There are many myths about the causes of acne. Here are nine pointers to clarify just what acne is: 1. Acne is a chronic inflammatory disease of the skin, which is not caused by anything you have done either to yourself or to your skin.

2. Acne does tend to run in families. If you have one parent who had severe acne, your chances of developing bad acne are higher. Also, if you have a parent who has had persistent acne, your chances of developing persistent acne are higher.
3. Acne does have a tendency to be a long-term condition. Although it will resolve spontaneously in 70 percent of people after four or five years, there is no way of predicting whose will resolve after four or five years and whose will continue to cause problems for 30 or 40 years.
4. Acne should not be ignored. It's best to seek treatment as early as possible to prevent scarring of the skin and to limit the embarrassment and psychological side effects that the disease causes.
5. Acne is not caused by the food you eat and, in particular, is not caused by eating fatty foods or chocolate.
6. Acne is not related to sex, either too much or too little, or to masturbation.
7. Acne does not necessarily get better during pregnancy. In some women it can get worse during pregnancy.
8. Acne is not caused by poor hygiene of the skin. The skin should be washed regularly twice a day. Excess washing of the skin can cause problems with drying of the skin.
9. Acne spots should not be squeezed. If you have blackheads, use a conedome spoon or tape remover.
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By Tony Chu

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