ASK THE DOCTOR: Chocolate, dirt among myths about acne
By DR. JIM MITTERANDO
This is the first of a two-part series on acne.
Part II -- Zapping zits; Treating troublesome blemishesQ My daughter is 16 and has acne. I tell her she should avoid chocolate and oily foods. She tells me that she learned in her health class that these foods do not cause acne. She washes frequently and uses Oxy-10 on her pimples. What more can she do? She is interested in trying birth control pills to help her acne.
A Your daughter is correct. Neither diet nor dirty skin causes acne. Acne affects at least 85 percent of teenagers.
Rosacea - an adult form of acne characterized by pimples, flushing of the face and increased blood vessels in the skin - is a different disease that may require different treatment than teenage acne.
Acne occurs when hair follicles become plugged with oil and dead skin cells. Each follicle is connected to sebaceous glands that secrete an oily substance known as sebum to lubricate hair and skin. Sebum normally travels along the hair shafts and then out through pores onto the skin surface. When your body produces an excess amount of sebum and dead skin cells in a pore, the two can become trapped producing a whitehead. If the pore stays open, the surface of the plug may oxidize and darken, causing a blackhead. Blackheads are not caused by dirt as is commonly believed.
Pimples are raised red spots with a white center that develop when blocked pores become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce larger lumps beneath the surface of the skin called cysts, which tend to scar more than pimples. Acne is not an infection but rather inflammation and irritation. Bacteria are involved in acne but mostly because dysfunctional oil glands contribute to an increased amount of common skin bacteria. The extra bacteria produce enzymes that contribute to inflammation and swelling of oil glands.
Frequent squeezing and popping of the pimples will not help get rid of them and may, instead, cause more irritation/inflammation.
Frequent picking also can contribute to scarring. Frequent washing does not make a difference. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals can irritate and clog oil glands, which can worsen acne.
Over-the-counter products that advertise to pull the dirt or oil out of the glands do not work and may make the problem worse. Friction from hats, helmets or chin straps often exacerbate acne. Shaving can worsen acne because of friction of the razor. An electric razor can be helpful in this situation.
Acne worsens during adolescence because androgen (sex hormones) increase oil gland production as well as increase the turn over of the skin cells lining the glands making it more likely that the glands become plugged.
Contrary to what many people think, foods have little effect on acne.
Some cosmetics, sunscreens and moisturizers may worsen acne. Take care to select water-based cosmetics that are labeled ‘‘noncomedogenic’’ or ‘‘nonacnegenic’’ that are, supposedly, less likely to cause acne.
Stress as well as menstrual cycles can aggravate acne. Young women often experience premenstrual flare-ups of acne due to extra amounts of the hormone -progesterone -that occurs during the later part of the menstrual cycle. Birth control pills often improve acne by providing extra amounts of estrogen and using a progesterone that has less androgenic (male hormone) characteristics. Acne can be worsened by progesterone-only birth control such as Depo-Provera shots, Norplant inserts or the ‘‘mini-pill.’’ Birth control pills are not considered a first-line treatment for acne in women but can be added when treatment with an acne cream is inadequate.
My next column in two weeks will address treatment options for acne.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth. Send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, May 06, 2003