Lawrence Charles Parish MD
Q: My teenage daughter and her girlfriend just returned from a health food store laden down with potions for acne and relieved of their babysitting money. Will any of these products work?
A: Let's start at the beginning: Acne is an affliction of the sebaceous glands, the grease producing glands, predominantly on the face and scalp. When these are triggered by the sex hormones, they produce too much sebum. If the sebum or grease can ooze out onto the face and scalp, the areas become oily.
But when the sebum becomes trapped in the sebaceous gland opening, acne develops. First, there is a comedo (white head) which often oxidizes and becomes black (black head). If irritated, a papule or red bump results, followed by a pustule, and finally an abscess.
Diet: There is no evidence that chocolate or any other food affects the development of acne. Many years ago, a study was conducted in which volunteers ate a pound of chocolate a day for thirty days, and no zits appeared or disappeared due to the diet. Soft drinks were prohibited. But, again, there is no evidence that drinking soda makes any difference. In fact, a survey of the literature about colas showed that Coca Cola might even be beneficial. However, there is no basis to telling a teenager not to drink soda.
Touching the Skin: While it may not be pleasant to see a teen's hands on his face all the time, just touching his skin doesn't affect the development of pimples. However, picking, squeezing, scratching or whatever term you choose, can result in scarring.
Acne lesions will eventually disappear without treatment, but proper treatment will eliminate them much more quickly. Trying to physically remove a zit leads to dig marks on the face and the diagnosis of "acne excoriČe de jeune filles."
Scrubbing the Face: Using a scrub cloth, loufa, or abrasive cleansers will just aggravate the skin. While it used to be thought that vigorously removing the debris from the face would help to lessen the acne lesions, we now know that this worsens the condition. It's best for teens to wash their faces with their hands. The temperature of the water has no affect on acne or pustule formation.
Water, Vitamins, and Herbs: Drinking lots of water, taking numerous vitamins, and succumbing to the latest natural fad will doing nothing but increase bathroom time, waste money, and possibly make the acne patient sick.
Moisturizers: The skin is not dry! Using moisturizers is contraindicated in acne becasuse the skin is actually oily. The scale on the face is debris and not dryness. Applying lotions and moisturizes will just aggravate the condition and create more zits. No teenager should be applying such preparations to the face.
Over-the-Counter Agents: Some are very, very good and some are very, very bad. Benzyl peroxides creams and gels are useful but may be irritting at first. Keratolytics such as sulfur based preparations can be helpful. The key to their use is to know what to expect and not to expect. No topical will cure acne in three days and some may be initially irritating, making it seem as if the teen's skin is actually getting worse.
Read the Ingredients: Some are so diluted that they cannot be efficacious. Others may play upon outmoded concepts such as scrubbing or peeling. Guard against products that claim to cure everything.
Conclusions: Acne can be treated. It is not something "You just will grow out of it." If an ad in the store or on television is too good to be true, it probably needs questioning.
Lawrence Charles Parish, M.D., is a clinical professor of Dermatology and Cutaneous Biology and director of the Jefferson Center for International Dermatology, Jefferson Medical College, Philadelphia, PA. Please send your questions and comments to him care of Pediatrics for Parents, P.O. Box 63716, Philadelphia, PA 19147.
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