Clive Anderson
LAST MONTH, we consulted with two young ladies who were chosen from the many who had responded to The Gleaner's advertisement to take part in the acne treatment series.
On first encounter, these were two very personable young ladies who were sufficiently frustrated by their skin condition to accept the scrutiny of The Gleaner readership in their quest for help.
SOME INITIAL OBSERVATIONS
No good men?
There were apparently no men among the numerous applicants. Why was this? It's not that men have acne less frequently than women. The incidence in men and women is roughly the same. It may be that men are less likely to consent to having their acne treatment publicised. It is noticeable that generally fewer men than women present themselves for treatment. This is true whether we are speaking of visits to the dermatologist or to the family practitioner. Men tend to ignore health problems until late in the day. They do fewer check-ups and are less likely to have regular screening tests. When was the last time you heard a man say he was off to do his annual digital rectal test for prostate cancer?
Never too early
One of the ladies noted that the acne onset coincided with the start of her menses. Like most persons, she started having her acne during adolescent years when the sebaceous glands became active. After ignoring it during the early years, she became conscious of it with her growing self-awareness and started using the myriad treatments available for getting rid of acne.
Most parents tend to underestimate the significance of the bumps and spots to the children. They feel that they will grow out of it, that everybody gets it, that washing the face more often or better is all that is needed. The acne only takes on significance when they notice a change in the child's behaviour shyness, holding the hand in front of the face, not speaking up. Now it's time for the magic potions that abound on the shelves or are hawked over the TV. The reason there are so many of these is that they do not work. Acne is a serious disease that should be treated aggressively early, so as to prevent scaring to the skin and to the psyche.
A female thing
The other lady described her acne as having started in adulthood. " I had perfect skin during teenage years ...' This is not uncommon. Adult onset acne is becoming more frequent. The cause is still unknown. There are theories about hormonal levels in the diet. Some ladies have a particular disorder called polycystic ovarian disease where persisting ovarian cysts produce extra hormones. In many, the hormonal levels are normal, but the skin overreacts to this normal level. These ladies often notice a flare with the menses. Treatment options then must include a means of blocking the effect of the hormone on the skin.
Good treatment is hard work
Acne treatment requires discipline and dedication. A lot of time is spent during the consultation ensuring that the patient understands the cause of the acne and how they are formed. It is important for them to understand how the cells lining the ducts from the glands slough off and stick together to form a plug, thus forcing sebum to accumulate below the skin in the whitehead. They must appreciate the role of bacteria in breaking down the trapped sebum and forming inflammatory products that irritate the skin, forming tender bumps and pustules. They will then understand why one product is seldom successful in treating the acne. It will be clear that a successful regimen requires a treatment to reduce the skin bacterial count and another product to normalise the process of replacement of the cells in the gland wall, hence preventing blockage.
PREVENTING BUMPS
The treatment is aimed at stopping the formation of bumps and so must be used both on the bumps already present and skin where bumps appear. The response is slow requiring at least one month for noticeable improvement. Often the patient demands treatment also for the spots that the bumps leave. The acne treatments can be irritating to the skin and may make the skin more sensitive to the sun. It is important to use a mild soap to cleanse, and the use of a facial moisturiser with a sunblock may become necessary.
In future articles, we will describe the ladies treatment and their progress.
Dr. Clive Anderson is a dermatologist and
venereologist; email: yourhealth@gleanerjm.com.
