A more common and important variant, which occurs in women, is acne cosmetica. This appears to be precipitated by the prolonged use of cosmetics, especially those containing lanolin or petrolatum. In particular, various cleansing creams and moisturizers may contain chemicals which can aggravate acne. They do not so much obstruct the ducts physically, but rather appear to induce comedones chemically. The treatment is simple, entailing avoidance of cosmetics until the inflammation settles down.

There is a fairly characteristic acne-like dermatitis of the lower face which occurs mainly in young women. The pimples are small and not usually pustular. Frequently the condition is treated as a dermatitis, with steroid creams, which initially may improve the appearance but actually prolong the course of the problem. Women with this complaint are frequently found to be taking the contraceptive pill, which is thought (by some) to be the causative factor. The trouble may occur several years after commencing to take the Pill, and can occur with any brand although statistically the mini-type Pills are more frequently implicated. As with other types of acne, treatment with tetracyclines along with cessation of the use of steroid creams cures the problem. (The taking of the Pill can usually be continued after treatment,)

Acne can be a devastating disease coming as it often does at a time when young people wish to be looking their best, and identifying with the beautiful idols of their peer group. Many parents are heard to tell their children that they will ‘grow out of it’, that ‘it will clear when you turn 22′ or ‘when you marry’; finally, if it has not improved, as predicted it would, by the time that ‘ you have children*, the sufferers will often angrily seek active treatment.

Fortunately most cases clear up with little or no help. However the severity of the disorder will depend on a person’s hormone balance and the receptivity of the oil glands. About adolescence, many hormonal and emotional changes are under way. We all possess endocrine glands (such as the adrenals, ovaries, testicles and thyroid) which secrete hormones into the blood stream. These are chemicals that regulate the function of other endocrine glands as well as the blood vessels, oil glands, hair follicles and so forth. There is a dose link between the endocrine and nervous systems which is controlled by a gland attached to the base of the brain called the pituitary. As a result of this link, emotional situations will affect a person’s hormones and vice versa. Consequently as a result of, for example, premenstrual or examination stress, the skin tends to become oilier and ‘break out’. Similarly, male hormones cause the oil glands to enlarge and produce more oil, while in susceptible males, they will cause baldness.

This interaction between a person’s emotions and hormones is essential to the understanding and subsequent treatment of patients with acne. Many individuals have their social, emotional and even professional lives ruined because they do not have ‘a clear skin’. Consequently it is most important that such people should be able to seek sympathetic counselling and appropriate care. The condition may not seem too bad to an observer but if it upsets an individual’s self-esteem or body image, treatment is essential.

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