Acne and Rosacea, Part 1

Oh, sometimes life can be so unfair. Just when you’ve made peace with the laugh lines and wrinkles of your aging skin — it’s turned on you. Now your face is breaking out!

Maybe it’s a crop of those whiteheads you thought you left behind in high school. Or maybe it’s hot flushing and painful red bumps. Maybe it’s adult acne, and maybe it’s rosacea. With either one, you’re not alone. Adult acne and rosacea are two of the most prevalent and chronic skin disorders facing adult American women today.

Simply put, acne is a disease of the skin and oil glands. But it’s no simple matter for the roughly 17 million Americans who have it or the nearly 80 percent of us who will develop some form of it in our lifetime. In addition, women from ages 25 to 40-plus are one of the fastest growing groups of acne patients, dermatologists say.

Acne encompasses a range of conditions from simple whiteheads and blackheads to more severe cysts and solid masses of tissue called “nodules,” with plain old pimples in between.

In his new book, “How to Wash Your Face,” (Simon & Schuster, 1999, $25), Dr. Barney Kenet says, “Acne is distressing at any age, but in adult females it can create a level of self-consciousness that interferes with personal and professional relationships.

“Indeed, adult-onset acne is a problem uniquely wrought from our westernized, late-20th century, go-go society,” adds Kenet, a dermatologic surgeon with New York Presbyterian Hospital/Cornell Medical Center in New York City. “As career pressures and family obligations mount, women find breakouts becoming more and more common. According to some experts, acne occurs in about 50 percent of upwardly mobile women.”

Acne can flare up at any time in a woman’s life — even in women who had clear skin as teens. So what causes it?

“That’s the million dollar question,” says Chicago dermatologist Dr. Kevin S. Pinski, an assistant clinical professor of dermatology at Northwestern University Medical School and member of the attending staff at Northwestern Memorial Hospital. He is also in private practice with his father.

“No one knows for sure what causes acne in adult women but hormone levels and stress are two big factors,” says Pinski. “You can also add in cosmetics and leave-on hair care products like conditioners and gels — mousse is the safest. Touching your face with your hands and contact friction from things like telephone receivers and chinstraps on bicycle helmets may also contribute to the problem.”

What about diet? Didn’t our mothers warn us about eating potato chips, chocolates and pizza? “Outdated thinking,” says Pinski. “In most cases, diet is not an issue — and neither is a lack of cleanliness. In fact, scrubbing your face — particularly with abrasives — can cause even more damage.”

It really is a myth that acne is caused by dirt, says Dr. Arnold Gurevitch, a professor and chief of the division of dermatology at the Keck’s School of Medicine of the University of Southern California. He’s also on staff at USC University Hospital in Los Angeles. “The truth is, you simply couldn’t clean you face enough to prevent acne. Excessive cleansing and scrubbing is not the answer. By their nature, acne treatments and medications are very drying to the skin. So cleansing really has to be very gentle or the skin can get chapped.”

For occasional mild outbreaks of acne, women taking birth control pills may want to talk with their gynecologist about switching to a Food and Drug Administration-approved pill with a higher level of estrogen. “They don’t work miracles but can be beneficial,” says Pinski.

For more serious cases, many dermatologists prescribe low-level doses of oral antibiotics taken over the course of several weeks or months. The idea behind prescribing antibiotics is this: Bacteria naturally live in your skin. When these bacteria get off balance — for whatever reason — acne can flare up. The antibiotics help get the bacteria back in balance and reduce the inflammation. This treatment is usually combined with a topical cream or creams, as well.

“Acne is not a curse,” says Pinski. “If you take an aggressive stand early on you can prevent years of both physical and emotional acne scars.”

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