Managing Teenage Acne – The New York Times

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Acne is a disease of the pilosebaceous unit — translation: the hair shaft, follicle and associated sebaceous gland and muscle. Under the influence of adolescent hormones, the glands increase their production of an oily substance called sebum that normally lubricates the skin. Sebum is a food source for bacteria called Cutibacterium acnes (also called Propionibacterium acnes) that reside in the skin. As these bacteria proliferate, they attract white blood cells that can damage the follicle walls, forming debris and dead cells that result in pimples and sometimes pustules. Or the follicles may become plugged, forming blackheads or whiteheads.

Contrary to common belief, acne does not result from surface dirt or infrequent skin cleansing. In fact, irritation of the skin from too frequent washing or, for example, by rubbing with hands or by a hat covering the forehead, can promote acne, Dr. Dellavalle said. He recommended gentle skin care with a product like Cetaphil rather than soap. Washing should be limited to twice a day, Dr. Zaenglein suggested.

The influence of diet is controversial, largely theoretical and hard to test. Global studies suggest that a high-glycemic diet — one rich in refined carbohydrates and sugars — can promote acne, as well as a host of other common Western ailments. A low-glycemic diet rich in whole grains and legumes seems to improve acne in teens and “is good medical advice for everyone,” Dr. Dellavalle said. Acne is virtually unheard-of in populations that traditionally consume such a diet.

Dairy products may aggravate acne in some people, so teens who are big milk drinkers might try cutting back to see if their acne improves. Likewise, heavy consumers of meat and poultry, rich in the amino acid leucine, may be more likely to develop acne through a complex chain reaction that stimulates the skin’s oil glands.

But the influence on acne of other dietary items like chocolate and fried foods is more myth than fact. Dr. Steven R. Feldman, dermatologist at Wake Forest University School of Medicine in Winston-Salem, told me that “within reason, diet doesn’t have a big effect on acne.” He suspects that most mistaken beliefs about diet stem from the fact that “when adolescent hormones kick in, teens get very hungry and coincidentally also get acne.”

More important than restricting diet is getting the right treatment. Most mild cases respond well to over-the-counter remedies like benzoyl peroxide, which kills acne-fostering bacteria. It is often used in combination with adapalene gel, a topical retinoid now sold over-the-counter as Differin.

But Dr. Zaenglein advised against “messing around with over-the-counter remedies if acne is extensive or severe. It’s better to treat it professionally right away to prevent scarring.”



Source : Nytimes