Facing me was an attractive young woman. It was her misfortune that she was one of the many people troubled with Acne vulgaris, a condition which is very difficult to control. She was particularly upset because her wedding day was not far off and the stressful situation, extra work and sleepless nights were making her condition worse. It seemed like a vicious circle, because the more she worried, the worse her acne became, which in turn made her worry still more. During my many years in practice I have often come across similar situations and I cannot help but sympathise: I know that compared to other serious health conditions acne can be viewed as a trivial complaint, but this doesn’t alter the fact that the sufferer is often emotionally insecure. More so, as this affliction often rears its head during the sensitive years of teenagers, which are so important in their mental development. Whether it concerns teenagers or adults, acne vulgaris can be a tenacious problem. If it is treated in a sensible and intelligent manner, much distress can be avoided.
What is acne vulgaris? Merck’s Manual, the physician’s handbook, says that it is a common chronic inflammatory disease of the sebaceous glands and the pilosebaceous follicles of the skin, characterised by papules, pustules, cysts, inflammatory plaque or nodules, and usually associated with seborrhoea. It is said that the exact cause of acne vulgaris is unknown, but that there are predisposing causes, such as an increased activity of the pilosebaceous complexities and very often a hormonal imbalance, which is why teenagers in particular have so many problems. Hereditary influences can play a role and certain foods have been known to aggravate this problem. A good rule to remember is that a healthy diet is important. There might also be some infection, like staphylococcus and possibly allergies play a role. In other cases there are deficiencies of vitamins, minerals and trace elements, and problems of sudden flare-ups caused by the digestive system.
In women, the ovaries play a large part, and this is often the reason why before, during or after menstruation, acne sufferers experience sudden flare-ups. If there is a real problem, and it is allowed to run on unchecked, the condition may well continue until the age of thirty or so. In most cases, however, if the patient co-operates, I have been able to control the condition to a large extent. Hygiene is essential and thorough cleansing is necessary. It is most important that the patient co-operates and does not pick or squeeze, which can cause lesions and permanent scarring, and it is certainly no use covering the spots with a layer of make-up. If this is considered necessary, it helps to be discriminating in the make and amounts used. Hydrotherapy treatment can often be of help, especially if an ioniser is used, and ultraviolet treatment may also be beneficial. Natural sunshine is best, but in our northern climate it may be necessary to supplement this with ultraviolet rays.
I reassured the bride-to-be that her skin would improve greatly if she followed my advice and I emphasised that she was not alone in her plight. Some 70-75 per cent of all teenagers get acne. The hormonal change in teenagers is substantial. The hormones act on the thousands of small glands in the skin, and if the skin produces too much sebum, the chances are high that acne will develop. When blocked, the glandular ducts and pores form blackheads. Infection, combined with swelling, is the cause of the problem, and when the skin is not thoroughly cleansed, it becomes very rough and sometimes very dry or greasy. Washing certainly does not help to overcome acne, it just keeps the surface clear of excessive grease. It is much better to care for the skin with a cleansing milk or a very mild soap. It is also important to be aware of excessive perspiration, as this too can aggravate an acne condition. I must stress that squeezing, pushing or rubbing the spot is to be discouraged, as the fragile skin is easily damaged and scarred.
Many sufferers enquire hopefully if their acne will ever disappear completely. It certainly does disappear but the timing varies: in some cases it may take a long time, whereas with other people it will disappear quickly. Although predominantly a teenage problem, acne can cause a number of conditions from early childhood to adulthood, affecting both male and female. A young man from Belgium recently visited my clinic in the Netherlands. After hearing his story I realised that he had become very introverted as a result of his skin problems. He was very keen to find a girlfriend, but his acne had given him an inferiority complex. I told him that his acne problem could be cleared, but suggested that in the meantime he might consider growing a beard. He admitted that he had never thought of that and was certainly going to give it a try.
*16\147\2*
