Acne
18 Remedies for Smoother Skin
As you wipe the steam off your bathroom mirror, you find yourself face-to-face with a huge pink dot on the end of your nose. This is not a good way to begin the week.
You give the mirror another wipe with your hand, then get up on your toes and lean over the sink to get a better look. It's there all right. But what's this? When you move your chin up to get a better view, you happen to glimpse a couple of whiteheads sprouting under your bottom lip.
You don't like this at all. You place one knee up on the sink and press your face close to the mirror, and there, in the gully between your nose and cheek, you find a lone blackhead staring back at you.
Stunned, you stumble back from the mirror. Sitting on the edge of the bathtub, you place your newly blemished face in your hands. Your thoughts drift back eons to a time of pimples and proms. Rocking back and forth, you wonder: What's going on here?
The answer is simple enough: You have acne. Acne may be the scourge of the adolescent years, but it can follow some people into middle age and beyond. "Women can have flare-ups at 25 or 35 years old and even older. In fact, my mother was still breaking out when she was 62," says dermatologist James E. Fulton, Jr., M.D., Ph.D., founder of the Acne Research Institute in Newport Beach, California.
Acne is really a catchall term for a variety of symptoms such as pimples, whiteheads, and blackheads, says Peter E. Pochi, M.D., professor of dermatology at Boston University School of Medicine. "It's a condition where the pores of the skin become clogged and the person gets inflamed and noninflamed lesions."
So what's the cause of all the clogging?
"Chocolate doesn't cause acne," says Dr. Fulton. "Dirty hair or skin doesn't cause it. Sex, either too much of it or a lack of it, doesn't cause it either."
So what does? Heredity—at least for the most part.
"Acne is genetic; it tends to run in families," says Dr. Fulton. "It is an inherited defect of your pores."
MEDICAL ALERT
Accutane to the Rescue
A huge pimple on the end of a nose can seem like a serious problem to the person connected to that nose. It may even seem serious to the people who find themselves staring at it when they talk to him. But acne can get much more serious than a simple blemish.
Acne is classified in four grades, the first being a mild bout with a few whiteheads and blackheads. The fourth and most serious grade consists of many whiteheads, blackheads, pustules, nodules, and cysts. Grade four acne is often accompanied by severe inflammation that becomes red or purple. And it's a sign that you should see a dermatologist.
Severe acne can result in permanent scarring if it isn't treated properly, says Peter E. Pochi, M.D. "The prescription drug Accutane will take care of severe acne very well."
If both of your parents had acne, three out of four of your brothers and sisters will get it, too. But if your sister is pimple-free while your face is a war zone, be aware that other factors can aggravate an acne outbreak. "Stress, sun exposure, seasonal changes, and climate can precipitate an acne attack," says Dr. Fulton. Certain types of makeup and taking birth control pills can also cause a breakout.
"Working women are especially vulnerable," adds Dr. Fulton. "They're prone to lots of stress, plus they tend to wear makeup a lot."
So here's some blemish-free advice, keeping in mind those who need it the most.
Change your makeup. In adult women, makeup is the major factor in acne outbreaks. "Oil-based makeup is the problem," says Dr. Fulton. "The pigments in foundation makeups, rouges, cleansing creams, or night moisturizers aren't the problem, and neither is the water in the products. It's just the oil. The oil is usually a derivative of fatty acids that are more potent than your own fatty acids. Use a non-oil-based makeup if you are prone to acne."
How Hollywood Hides Blemishes
You think that tiny, little pimple on your face is unsightly? Well, imagine how you would feel if that pimple were, say, the size of a 30 gallon garbage can.
That's the size it would appear to be if you were a star of the silver screen. Bette Davis's big, beautiful eyes would go unnoticed compared to the pimple on the tip of her nose if that pimple were allowed to remain in sight.
Ah, but we never see pimples, whiteheads, or blackheads on the faces of the stars. And why is that? Don't these folks break out? "You bet they do," says Hollywood makeup artist Maurice Stein. "The difference is, they can't let their pimples or any other blemish show."
Stein has been a makeup artist for over 25 years and he's touched up the famous faces in such movies as M*A*S*H, Funny Girl, and all five of the Planet of the Apes films.
Guerrilla warfare is the only way you can fight the pimple that always sprouts at the wrong time. So here are a few combat tips from the trenches in Hollywood. Stein says he's used these on "some of the most expensive faces in the world."
Go under cover. you can totally block out the discoloration, whether it's pink, red, or purple, according to Stein. To do that, "a person should look for a foundation makeup that has a high pigment level," he says. The more pigment per ounce, the better chance there is of putting the product on thin and still getting good coverage. "When I cover a pimple on an entertainer's face, I look for a pigment level of 50 to 70 percent. The normal range for most foundations is around 15 to 18 percent."
Do a swatch test. You can't really tell the pigment level by looking at a product, but you can tell by sampling it. "Take a drop of it and rub it on your skin," suggests Stein. "If it's so solid in color that you can't see your own skin underneath it, then you know it has a high pigment level and will do well in covering your blemish."
Read the labels. Cosmetic products that contain lanolins, isopropyl myristate, sodium lauryl sulfate, laureth-4, and D & C red dyes should also be avoided. Like oil, these ingredients are too rich for the skin.
Rinse that rouge. "Wash your makeup off thoroughly every night," says Dr. Fulton. "Use a mild soap twice a day and make sure you rinse the soap entirely off your face. Rinsing six or seven times with fresh water should do it."
Fishing for a Cause?
It may sound fishy, but if you are prone to acne, there is at least one doctor who believes that seafood and other foods containing iodine could bring on an attack.
"Iodine is a factor in some people who are prone to acne," says James E. Fulton, Jr., M.D., Ph.D. " Iodine enters the body and mixes into the bloodstream, with the excess excreted through the oil glands. As it is excreted, it irritates the pores and brings on an acne flare-up."
If you've been fishing around for a clue to the cause of your acne, here's a table of some foods and beverages and the amount, in parts per million, of iodides that they contain.
Dr. Fulton does not currently know at what level the iodides could bring on an acne attack, but he warns that "excessive long-term ingestion can induce acne attacks."
Food/Beverage Iodides (ppm)
Dairy Products
Cheddar cheese spread 27
Butter 26
Homogenized Milk 11
Sour cream 7
Cottage cheese 5
Yogurt 3
Drinking water (U.S. average) 8
Meat and Poultry
Beef liver 325
Turkey 132
Chicken 67
Hamburger 44
Miscellaneous
Tortilla chips 80
Wheat germ 46
Potato chips 40
Pretzels 15
White bread 8
Coca-Cola 3
Sugar 2
Salt
Iodized 54
Seasoned 40
Seafood
Kelp 1,020
Squid 39
Crab 33
Sole 24
Clams 20
Shrimp 17
Lobster 9
Oysters 8
Vegetables
Asparagus 169
Broccoli 90
Onions (white) 82
Corn 45
Brussels sprouts 23
Potato 9
Green beans 7
A Slick Test for Oil
Here's an easy test that you can do at home to find out just how oily your cosmetics really are.
Get a sheet of 25 percent cotton-bond typing paper and rub a thick streak of your makeup onto it. Wait 24 hours and then check for an oil ring. "Within a day the oil will spread out and you'll see a big grease ring," explains James E. Fulton, Jr., M.D., Ph.D. "The bigger the ring, the more oil there is in your makeup. Stay away from makeup that produces big oil slicks."
Go for the natural look. "Whatever makeup you use, the less you use of it, the better," says Dr. Fulton.
Blame it on the Pill. Research conducted by Dr. Fulton indicates that certain birth control pills such as Ovral, Loestrin, Norlestrin, and Norinyl can aggravate acne. If you're on the Pill and have acne problem, discuss it with your doctor. He may be able to switch you to another pill or prescribe another birth control method.
Leave well enough alone. "You shouldn't squeeze pimples or whiteheads," says Dr. Pochi. "A pimple is an inflammation, and you could add to the inflammation by squeezing it. You may cause an infection." You can't do anything to a pimple to make it go away faster, he notes. "Normally a pimple will last from one to four weeks, but it will always go away."
A whitehead is a noninflamed plugged pore, notes Dr. Pochi. "The core of a whitehead is much smaller than the core of a blackhead. When you squeeze the whitehead, the wall of the pore could break and the contents could leak out into the skin and cause a pimple. A pimple naturally forms from the rupture of a whitehead pore wall."
Know when to squeeze. Although most pimples are best left alone, there is one kind that you can squeeze to help get rid of it. "Sometimes a pimple will have a little central yellow pus head in it," explains Dr. Pochi. "Gentle squeezing usually pops these open very nicely. Once the pus is out, the pimple will heal more quickly."
Attack blackheads. You can also get rid of a blackhead by squeezing it. "A blackhead is a very blocked pore. The material inside the blocked pore is solid, and the surface of the pore is widened," explains Dr. Pochi. The black part of a blackhead is not dirt. In fact, dermatologists aren't really sure what it is, but whatever it is, it will not result in a pimple.
Use OTCs to KO acne. You can fight back an acne attack with over-the-counter products. "Use OTCs with benzoyl peroxide in them," says Dr. Fulton. "The benzoyl part pulls the peroxide into the pore and releases oxygen that kills the bacteria that aggravates acne. It's like two drugs in one. The benzoyl also suppresses the fatty acid cells that irritate the pores."
OTC acne products come in various forms, such as gels, liquids, lotions, or creams. Dr. Fulton suggests using a water-based gel. It is the least likely to irritate the skin.
He also suggests using it for an hour or so in the evening, then washing it off very thoroughly at bedtime, especially in the areas around the eyes and neck.
Don't be fooled by the numbers. Acne medications contain concentrations of benzoyl peroxide ranging from 2.5 percent to around 10 percent. The percentage, however, has little to do with the product's effectiveness. "In most tests that have been conducted, the lower-strength products were as effective as the upper-strength ones," says Thomas Gossel, Ph.D., R.Ph., a professor of pharmacology and toxicology at Ohio Northern University. "Five percent works as well as 10 percent."
Give dry skin extra care. Dry skin can be sensitive to benzoyl peroxide, so Dr. Gossel recommends you start with a lower-strength product first, then increase the concentration slowly. "You're going to get reddening of the skin when you put it on, but that is a normal reaction," he says.
Stay out of the sun. Acne medications may cause adverse reactions to the sun. "Minimize exposure to sunlight, infrared heat lamps, and sunscreens until you know how you will react," cautions Dr. Gossel, who advises a patch test for sunscreen sensitivity.
Scrub that skin. "Cleanse your skin thoroughly every time before applying any over-the-counter acne medication," says Dr. Gossel. A clean face is a happy face.
Use one treatment at a time. Don't mix treatments. If you are using an OTC acne product, you should stop using it if you are given prescription medication for your acne. "Benzoyl peroxide is a close cousin to Retin-A and other products containing vitamin A derivatives, such as Accutane," says Dr. Gossel. A person shouldn't use both of them together.
Stop the spread of acne. Apply acne medication about a half inch around the affected area, says Dr. Fulton, to help keep the acne from spreading. "The medication really doesn't fight the pimple you already have," he explains. "It acts more like a pimple preventive." Acne moves across the face from the nose out to the ear. You need to treat beyond the red inflammatory area. "When you buy an OTC product, it says to apply it to the affected area. To most people the affected area is where they see the pimples. But that's not the case at all."
PANEL OF ADVISERS
James E. Fulton, Jr., M.D., Ph.D., is a dermatologist and founder of the Acne Research Institute in Newport Beach, California. He is also coauthor of Dr. Fulton's Step-by-Step Program for Clearing Acne and codiscoverer of Retin-A (synthetic vitamin A), a prescription drug used to treat a variety of skin problems.
Thomas Gossel, Ph.D., R.Ph., is a professor of pharmacology and toxicology at Ohio Northern University in Ada and chairman of the university's Department of Pharmacology and Biomedical Sciences. He is an expert on over-the-counter products.
Peter E. Pochi, M.D., is a professor of dermatology at Boston University School of Medicine in Massachusetts.
Maurice Stein is a cosmetologist and Hollywood makeup artist. He is the owner of Cinema Secrets, a theatrical makeup house in Burbank, California.
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