Skin Strategies for Clear Skin

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Pimples, zits, blemishes-call them what you will, the bumps and blotches associated with acne are distressing with a capital D!

Why do some of us break out while others don't? Experts aren't sure. What they do know is that acne results from a complex interac*tion of factors, including genetic predisposition, hormones that cause the sebaceous (oil) glands to enlarge and excessive oil production.

Acne can be aggravated by factors outside the body too. The oils in some skin creams or cosmetics can block pores, triggering pimples (but less so than you may think). Stress can also be a factor, especially in women whose acne first flares up after their teens.

While experts don't understand exactly why adult skin sometimes reverts to adolescent behavior, they know how blemishes form. Your skin is constantly renewing itself, and under normal conditions, dead horny cells surface and shed. But when, instead, these cells stick together, they plug the hair follicle, forming what's called a comedone. "Open" comedones are commonly known as blackheads; the "closed" variety, whiteheads. When a closed comedone ruptures, you get a pimple.

Pimples also vary in size and appearance. Papules are tender pimples that look like reddish bumps. Pustules are pimples that have "come to a head." Deep cysts are inflamed "bubbles" that contain blood and pus and can cause scarring. If you have severe blem*ishes and enlarged blood vessels around the nose, chin or cheeks and you flush or blush easily, see a dermatologist: You may have rosacea (pronounced ro-ZAY-shuh), a skin condition that looks like acne but isn't.

Your antiblemish strategy will depend on what kind of blemish (or blemishes) you have. But no matter which type of pimples you're facing, a dermatologist can help clear up the
problem with a variety of very effective treatments.

The Breakout Blues: Not Just for Teens
As mentioned, the end of adolescence doesn't automatically mean the end of blemishes. In fact, some women who remained acne-free during their teens may find themselves facing flare-ups for the first time as adults. Post adolescent acne, which predominantly affects career women in their twenties, thirties and forties (often just before their periods), is stress-induced - fueled by the pressures of juggling career, family and relationships. Postmenopausal acne, hitting in the fifties or be*yond, may be influenced by a hormonal imbalance caused by re*duced estrogen production.

Both types of "late-blooming acne" usually involve whiteheads and a few scattered blemishes and are more likely to affect women with darker or oily skin (or, in postmenopausal women, with for*merly oily skin and large pores) who did not have acne in their teens.

Benzoyl Peroxide: An On-Your-Own Blemish Blacker
For mild acne, dermatologists often recommend an over-the-counter solution, gel or soap formulated with benzoyl peroxide (available in 2.5, 5 or 10 percent formulas), which kills P. acnes, the bacteria that cause acne. Apply to clean, dry skin and only on the blemish itself. If you have severe blem*ishes and enlarged blood vessels around the nose, chin or cheeks and you flush or blush easily, see a dermatologist: You may have rosacea (pronounced ro-ZAY-shuh), a skin condition that looks like acne but isn't.

Your anti-blemish strategy will depend on what kind of blemish (or blemishes) you have. But no matter which type of pimples you're facing, a dermatologist can help clear up the problem with a variety of effective treatments.

Benzoyl Peroxide: An On-Your-Own Blemish Blacker
For mild acne, dermatologists often recommend an over-the-counter solution, gel or soap formulated with benzoyl peroxide (available in 2.5, 5 or 10 percent formulas), which kills P. acnes, the bacteria that cause acne. Apply to clean, dry skin and only on the blemish itself. The antibacterial action of a full-strength product will produce a
mild peeling. But kinder, gentler formulas, with a lower concentra*tion of benzoyl peroxide and timed-release action, can work just as effectively without over drying or irritating your skin.

Be aware, however, that some people are extremely sensitive to benzoyl peroxide in any amount. Their skin reddens and swells after use. If that hap*pens to you, discontinue using this product immediately.
Rk Relief.

If your blemishes are more severe, your dermatologist may have you use Retin-A at night and benzoyl peroxide in the morning. Used in tandem, they can be more effective than either one alone. Never apply them at the same time; benzoyl peroxide can oxidize and inac*tivate the Retin-A.

Take them out with topical antibiotics. While applying an antibi*otic like clindamycin or erythromycin directly to the skin doesn't work quite as well as taking oral antibiotics, they have one important advantage: They have fewer side effects than oral antibiotics.

Hit pimples with alpha hydroxy acids (AHAs). These acids, de*rived from fruit, vegetables and sugar cane, act as exfoliants (which slough off dead skin cells) and are being used to rejuvenate skin. But they can also work on acne. When used under a doctor's supervi*sion, AHAs can be extraordinarily effective in the prevention and treatment of acne. Stronger solutions can be left on for varying periods of time, then washed off.

A minishot of steroids. Dermatologists can also shrink cysts with a shot of an anti-inflammatory corticosteroid. If you have a large area of inflammation, the best treatment is to inject a small amount of a corticosteroid. It stops the inflammation very quickly.

Take aim with Accutane. The oral counterpart of Retin-A, Accutane (isotretinoin) is reserved for severe acne that does not respond to topical or other oral medications. Accutane shrinks the seba*ceous glands and suppresses oil production, cutting off the stuff that fuels pimples and cysts. What's more, it may continue to help even after you stop taking it months later, when oil production has returned to normal.

But this drug can cause a number of significant side effects, in*cluding peeling skin; red, irritated eyelids; and parched, inflamed lips. Most alarmingly, Accutane is associated with birth defects. So women (including teens) should not take this drug unless they're 100 percent certain that there's no chance they are pregnant or will con*ceive within 30 days of stopping treatment with Accutane.

As for what not to do, a few dermatologists still prescribe certain types of birth control pills for severe acne, but it's rare. Too often, the Pill works at first, then becomes ineffective.

Whether you're faced with a tiny pimple on your chin or a full-fledged flare-up, these strategies can help you attain clearer, smoother skin