Acne rosacea

You don't have to take it anymore. Here's how to fight back and win for good.

As if wrinkles and a slower metabolism aren't enough, millions of middle-aged men and women still do daily battle with acne.

"I'm in my 30s. I shouldn't have to be treating a kid's problem," says Althea, a medical administrator in New York, who asked that we not use her last name. "Who wants to be bothered?"

Unfortunately, 4 million adults in this country are bothered with acne, the most common skin disease in the United States.

Acne happens when follicles get clogged. The sebaceous glands in skin produce an oily substance called sebum that travels through the follicle up to the skin's surface. When skin cells inside the follicle stick to the sebum, things clog up and a blackhead forms. A pimple occurs when the clogged follicle ruptures, causing redness or swelling at the surface.

Follicle fiction. There are enough misconceptions about acne to confuse even the most educated patient. Many of the myths surround food and hygiene, but nothing you eat causes acne.

"There is no dietary factor related to acne that we know about," says Dr. James Leyden, dermatology professor at the University of Pennsylvania. Some people, however, believe certain foods seem to worsen their acne. If you feel this way, avoid the foods that you think irritate your skin.

Another common mistake is trying to overclean your skin. Acne isn't caused by dirt. In fact, if you scrub your skin too hard or too frequently, Dr. Leyden says you can make the inflammation worse. "Cleanse gently and superficially, not roughly and excessively," he says.

People who exercise vigorously, perspire, and don't clean their faces sufficiently are at higher risk for acne. Sweat acts as a film that combines with surface oils to trap substances in the pores. It's important to shower soon after an intense workout to remove this greasy film.

Makeup is no longer much of a concern, says Dr. Leyden. Most cosmetic companies have identified the substances that aggravate acne and offer products that don't contain them. These products are usually labeled "noncomedogenic" or "nonacnegenic," and mean the product is not likely to cause whiteheads or blackheads.

The most common mistake people make trying to get rid of acne is to squeeze or pick the inflamed areas, says Dr. Diane Berson, a New York dermatologist. "When pimples are squeezed, the irritation can cause more redness, more swelling, and more inflammation," she says. "Scarring may also develop."

Here's a tip if you constantly break out along your jaw and chin: Hold the telephone away from your face. Dermatologists at the University of Texas Southwestern Medical Center in Dallas say an individual who regularly presses the handset close to his face may irritate the area and cause acne to develop.

The weather report. High humidity and temperatures can aggravate acne, says Dr. Michael Cormier, a dermatologist who practices in southwestern Louisiana. "Any blocking of pores that is compounded by a warm, steamy climate is a problem," he says. "Humidity doesn't cause acne, but it will take it to another level." High temperatures increase sweating and oil production.

The effects of sunlight are a little more complicated. "There was a time when ultraviolet light was routinely used to treat acne because it can suppress inflammation," Dr. Cormier says. "Sunlight still has benefits and people generally do better in summer than other seasons, but now we know that it brings other risks, such as wrinkles and skin cancer, that aren't acceptable."

The stress factor. Some doctors say stress plays a role in acne, but others aren't convinced. Dr. Cormier says he sees many more outbreaks among college-age and adult women students during the stress of final examinations than at other times.

During stress periods, there is more oil production and more hormonal fluctuation. Acne is more common among women than men, Dr. Cormier says, because men don't experience the same hormonal changes. However, adrenal glands in men produce hormones that can stimulate acne. Dr. Leyden is less sure about the acne/stress connection. Stress isn't helpful for any chronic condition, and that includes acne, he says, but the connection has not been well studied.

Your options. Your dermatologist may prescribe topical creams or lotions, such as benzoyl peroxide, to unblock pores or reduce bacteria. Topical antibiotics are prescribed for less-severe cases. Oral antibiotics may be more appropriate for moderate or severe cases.

For women, birth-control pills are also a treatment option. Many doctors prescribe the pill specifically for acne because it lowers the level of hormones that are likely to cause acne. Some people should not take the pill for any reason so be sure to talk to your doctor.

Accutane, a derivative of vitamin A in pill form, is a wonder drug for some patients with severe acne. The prescription-only drug works by shrinking oil glands and killing some of the bacteria that causes cysts to form. But Accutane is expensive and can cause serious side effects. A high incidence of birth defects are associated with Accutane, so women of childbearing age are encouraged to use two forms of birth control while taking it. Talk to your doctor. Topical tretinoins, such as Retin-A and Renova, also aren't recommended for women who are pregnant or trying to become pregnant.

Dr. Cormier thinks that a relatively new topical drug, adapalene gel (sold as Differin) shows great promise. While researchers aren't exactly certain how Differin works, it helps unclog pores clogged by too many skin cells. The gel can also help prevent new pimples from forming.

Be sure to check with your insurance provider to find out if your visits to the dermatologist and prescription drug costs will be covered. Some insurance companies don't reimburse those over age 25 for Retin-A and Renova because, in addition to treating acne, these topical creams are also prescribed to treat sun-damaged skin, which most insurance companies consider cosmetic. Also, drug therapy for adult acne sometimes occurs sporadically, so check to see if there is a time or reimbursement limit on your coverage.

No matter what obstacles need to be overcome to get rid of acne, it's worth the effort. There is no reason for grown-ups to put up with pimples, Dr. Leyden says. Althea, whose acne kept reappearing for years, tells others to find a board-certified dermatologist experienced in treating acne. She did, and her acne is under control.

"I have to work in a professional environment every day and I need to be self-confident, not worrying about what other people might say or think," Althea says. "There is help out there."

COPYRIGHT 1999 Meredith Corporation