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It's the scourge of those teen years. The zit attack. Just about every teenager gets it in one form or another. And for them, it's a fate worse than death if a pimply breakout comes at prom time or on that first date.
Why is it that teenage acne flare ups happen during those clenching moments? It's the body's reaction to stress. But while stress can aggravate acne, it does not cause it, says Alan R. Shalita, M.D., distinguished teaching professor and chairman of the Department of Dermatology at the State University of New York's College of Medicine in Brooklyn, N.Y.
"Stress, birth control pills, eating greasy foods do not cause acne," says Shalita, citing some myths about teenage acne. However, each of those factors most definitely can aggravate an acne condition, he says.
What really causes teenage acne
Close to 100 percent of people between the ages of 12 and 17 develop the occasional whitehead, blackhead or pimple, called non-inflammatory acne, according to the American Academy of Dermatology (AAD). For many teens, a little benzoyl peroxide or other over-the-counter treatment can keep things under control. However, more than 40 percent of teens develop the more severe form, called inflammatory acne, which is serious enough to require treatment by a physician.
No one knows exactly what causes acne vulgaris, the technical term for zit attack. "In terms of severe acne, it does tend to run in families. But it's not universal," Shalita says.
However, acne does have something to do with raging hormones. Acne usually develops when the body's production of hormones called androgens kick into high gear in those teenage years. The androgens stimulate the sebaceous gland, which produces an oily substance called sebum. One of the jobs of the sebum is to carry cells shed by the glands to the skin's surface. But excess sebum can block the openings of the glands, causing cells and sebum to accumulate and form a plug called a comedo, according to the AAD.
If the plug stays below the skin's surface and is light in color, it's a whitehead. If the plug enlarges and pops out with a darkened tip, it's a blackhead. If it's red, swollen and pus-filled, it's a pimple.
Propionibacterium acnes, or P. acnes, is one of the bacteria linked to the inflammation, redness and pain associated with acne breakouts. It has developed a growing resistance to tetracycline.
Young men are more likely than young women to have more severe, longer lasting forms of acne because they produce 10 times as much androgen as girls, according to the AAD.
The myths of acne
Doesn't junk food make the skin oilier and thus make you break out? Couldn't teenagers avoid acne if they washed their faces better? According to Shalita, these are the myths about acne:
Myth #1 Acne is caused by stress. The ordinary stress of day-to-day living is not an important factor in acne. However, Shalita says some patients look worse during finals time or around that big date. The reason? "Stress is mediated through the adrenal gland," he says. The adrenal cortex gets things moving, secreting those adrogenic hormones, which then cause the sebaceous glands to produce more oil.
Myth #2 Acne is caused by diet. Extensive scientific studies have not found a connection between diet and acne. "It has been thought if you have a steady diet of shellfish or kelp, that they can be a trigger," Shalita says. But no, chocolate, French fries and pizza don't cause acne. "You're not going to make the (sebaceous) glands put out more oil by eating greasy foods," he says.
Myth #3 Birth control pills can cause acne. Sometimes, the first few months of taking birth control pills can aggravate acne by stimulating more androgen production. Nevertheless, he says, birth control pills are often recommended to improve acne conditions. Improvements or the worsening of acne can happen when the pill is just started. An acne condition can also worsen after the pill is stopped. "So, as far as acne and birth control pills are concerned, unpredictability is the rule," Shalita says.
Myth #4 Acne is caused by poor hygiene. Acne is not caused by dirt or surface skin oils. In fact, vigorous washing and scrubbing will actually irritate the skin and make acne worse. The best approach: Gently wash your face twice a day with a mild soap, pat dry and use an appropriate acne treatment for the acne.
Myth #5 You just have to let acne run its course. The truth is, acne can be cleared up. If acne products aren't working, then consider seeing a dermatologist. There is no reason why someone has to endure acne or suffer acne scars.
How do you treat acne?
The treatment for teenage acne depends on the severity of the condition, Shalita says. "Someone who has never been treated before and is relatively young would start on a topical therapy (an antibacterial preparation)," he says. "Then if that didn't work and there was a significant degree of inflammation, you would go on to oral antibiotics."
Those topical treatments include benzoyl peroxide, sulfur, resorcinol, or salicylic acid, all of which the U.S. Food and Drug Administration (FDA) has found effective for treating mild acne. Each is a "peeling agent," which cause irritation and drying that help the body loosen plugs and shed dead cells. The drugs also can prevent bacteria that can contribute to acne from forming.
Antibiotic drugs, oral contraceptives, anti-inflammatory medications (called corticosteroids) and vitamin A derivatives are prescription products used to treat more severe cases.
Vitamin A derivatives, called "retinoids," work on the skin in various ways by unclogging pores, reducing sebum output and improving the shedding of skin, depending on the preparation. One vitamin A derivative Accutane® (isotretinoin) is approved by the FDA for treating severe cystic acne for people whose skin condition does not improve sufficiently with other treatments. However, it is known to cause birth defects if taken during pregnancy and, for that reason, is generally not recommended for a woman of childbearing age, according to the FDA.
Another acne medication, Retin-A® (tretinoin) is also derived from vitamin A, but it is applied to the skin, not taken by mouth, and there have been no reports of birth defects related to its use.
Using noncomedogenic cosmetics and toiletries is also helpful because they don't clog pores.
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External Sources
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American Academy of Dermatology
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U.S. Food and Drug Administration
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This article was reviewed and updated June 2007.
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