Face off against adult acne

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SKIN FITNESS

You? acne? no way. you're over 30 and you've never had problem skin. Still, there are those little bumps you've been noticing. They seem to take forever to disappear, and when they do, others appear someplace else. You like having things in common with your teenage daughter, but this was not what you had in mind.

Well, my friend, wake up and smell the benzoyl peroxide ... acne can pop up at any age. But you're not alone. And you can fight back.

THE INSIDE STORY
The first step to getting your complexion cleared up is clearing up confusion about what acne is and how to prevent it. At age 40 or at age 20, acne is caused by the same thing: A hair follicle pore becomes plugged with dead skin from the follicle itself. If the plug is exposed to air, it changes color and becomes an open comedo (blackhead). If it stays closed, it's a whitehead.

To become an inflamed pimple, the process is a little more complicated. The normal skin bacteria living in the follicle proliferate and come to the attention of the immune system. Infection-fighting white blood cells decide they need to be on the scene. Already you can see that you have the makings of a rumble.

Usually, however, it's not until the night before your driver's-license photo session that the follicle walls deep in your skin decide they can't take the pressure anymore. They break and let the whole shebang travel out into the surrounding skin. And you know the rest of the story: Red. Inflamed. Painful. The deeper under your skin the follicle wall has crumbled, the more severe the pimple.

PIMPLE FALLACIES
Researchers have a couple good theories about why that great skin you had as a teenager (when your friends were breaking out) didn't come with a lifetime guarantee. But first, they want to clear up three favorite myths about the causes of these cutaneous outbursts.

French fries and chocolate cause acne. There are lots of good reasons to avoid fatty foods, and we applaud all of them. But as far as acne is concerned, studies simply haven't indicated that diet is directly involved. "Your body is pretty sophisticated. It doesn't work as simply as, 'If you eat greasy food, it'll come out on your skin,'" says Guy Webster, MD, PhD, associate professor of dermatology at Jefferson Medical College, Philadelphia.
Dirt clogs pores. Cleanliness plays almost no role in acne. The plug that you see in the follicle is not dirt from outside, and you can't scrub it away, contrary to what most teens like to believe. "It would be like scrubbing away the tip of an iceberg," says Dr. Webster. What you can do by all that scrubbing and popping and poking is rupture any comedo lurking under the skin. This can encourage inflammation and set the scene for possible scarring.
Stress can cause your face to break out. "Stress can indeed raise certain of your internal adrenal hormone levels," says Dr. Webster. "And this could be a contributing factor for some cases of acne." Or you may rub your forehead or chin when you're stressed out, which can aggravate your skin by actually rupturing follicles. But stress does not play a central role in most adult acne. The problem with the stress theory, says Dr. Webster, is that there are a zillion people who have a tendency toward acne. Yet when they're under a lot of stress, most don't get adult acne.
So what can trigger this unwanted late blooming? One theory that holds promise is that you may have inherited a sensitivity to acne that shows up later in life. "We're beginning to think that inflammatory acne could be a lot like hay fever--it's an inherited, inappropriate sensitivity to a benign thing," says Dr. Webster. In this case, you're oversensitive to the harmless bacteria in the follicle.

Another theory has to do with hormones. At different stages of your life, as various hormones change, they may either stimulate or improve acne. (Hormone-replacement therapy, however, seems to have no effect on acne.) "In some cases, acne associated with irregular menstrual cycles and excessive facial hair growth (known as hirsutism) may indicate a hormone imbalance or ovarian problems," says Tabitha Henderson, MD, senior director, dermatology research, Ortho Pharmaceutical, Raritan, NJ. "These women require a gynecologic and hormonal evaluation."

SPOT REMOVAL
When you're looking to get rid of the red, remember that squeezing might say goodbye to a pimple only to say hello to a scar. Squeezing is the surest way to rupture an oil gland and set the pimple up for infection.

So the best thing to do is dab a spot remedy on the offenders, right? That's been his personal solution, but it's not the optimum one, says Dr. Webster. "Yes, it helps," he says. But dabbing some benzoyl peroxide here and there is exactly the wrong way to use it. "You can prevent the pimples from showing up in the first place by using that compound twice a day, every day. Mainly it works to kill the offending bacteria.

"Put the product everywhere you don't want pimples--meaning your whole face or back. Eventually pimples will stop raising their ugly heads," he says. One caution: Fair-skinned people should keep the cap on the bottle and see a doctor first. Pimples may signal a problem relation of acne called rosacea, and home treatments could make rosacea worse.

Another possibility for preventing the offenders is alpha hydroxy acids. These help unplug follicles so oil can't build up there. Alpha hydroxy acids work best in higher concentrations--from a minimum of 8%. "This is why most OTC preparations don't work," says Dr. Webster.

"If the bottle doesn't say what percent alpha hydroxy acids are in the product, don't buy it. Salicylic acid (such as Fostex) is also a useful tool. It works the same way as AHAs." You may need to see a dermatologist for higher-strength AHAs.

These remedies are intended for your standard white- or blackheads. But if pimples tend to be large and inflamed, a dermatologist should be your first stop. The best medications for that job, antibiotics and retinoids (such as Retin-A and Accutane) are prescription only. Retinoids act on the cells in the follicles so they're not as prone to break away and stick together, blocking a follicle.

The worst remedy: an over-the-counter cortisone product. While there might be an initial benefit, you're also likely to have lasting problems of worse acne or supersensitive skin. Prescription cortisone is even worse.

THE CLEAREST OF THEM ALL
Even when you do everything right, problem skin does not clear up overnight. Here's what to do in the meantime (and beyond):

Don't become obsessive about your skin. "You don't have to examine your skin with a magnifying glass in search of a possible blemish," says Dr. Hen-derson. People who look too closely can end up picking and gouging their skin, which can lead to more blemishes and possible scarring.

Wash your face gently. We can't stress this enough. You don't need a special scrubber like a loofah. Since acne is not due to dirt, you don't need to wash your skin constantly. "Excessive cleansing and scrubbing with harsh abrasives may actually aggravate acne conditions," says Dr. Henderson. It may be satisfying to think that you're scrubbing that crud out of there but, in fact, you're making it worse.

Look for moisturizers and cosmetics with labels that say either noncomedogenic or nonacnegenic. The same is true of sunscreens. Many acne medications make you extra-prone to sunburn. Always combine these medications with regular sunscreen use.

Don't go on an antiacne oil-free kick. You don't have to insist on oil-free makeup for acne's sake. "Adding extra oil to the top of the skin doesn't affect acne," says Dr.Webster, although there are always a few people who react in an unpredictable way.

DIAGRAM: WHITEHEAD (CLOSED COMEDO)

PHOTO (COLOR): Mother and daughter

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by Pamela Boyer

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