Moms come into my office on a regular basis with their sons or daughters requesting treatment for face pimples. This is usually followed by a comment that their child is so vain! Is the concern for the pimples and blemishes on the face just vanity or a matter of self- esteem? Social media sites such as the Facebook, MySpace and Twitter have become an integral part of modern-day society, so much so that adolescents’ lives revolve around them. Once we have considered this, it is almost unfair of us to assume that our teenagers should not be concerned with how they look on these sites and otherwise. As a result of the constant scrutiny on these sites, teenagers are now faced with expectation of magazine perfect face and skin. This expectation may be made even more difficult in countries like Jamaica where teenagers using make-up to cover skin imperfections is not the social norm and is not allowed in school.

The medical term for pimples is Acne Vulgaris (AV). Almost every teenager has experienced this skin condition in one form or another. The exact cause of AV is complex and only partially understood, but one could oversimplify and say that AV is caused by sticky skin cells in the opening of the hair follicles. The oily material produced by sebaceous glands is part of the reason that the cells are sticky. This process is mainly influenced by growth hormone in the teenage years. For girls, this process is worsened by menstrual cycle (monthly menses). The cells form “plugs” in the opening of the hair follicle, and these are called comedones (“white-heads” or “black-heads”).

The occlusion of the pores causes the bacteria that live in the sebaceous glands to multiply quickly and causes the comedones to enlarge. Some of the comedones “explode” and turn into big red “papules” and “pustules”. The explosion results in the irritation of the melanocytes (pigment factories) nearby, causing them to produce excess pigment. This explains why there are dark spots (hyperpigmentation) even though the pimple has not been “squeezed”.

The souvenir dark spots left by the burnt out pimples have a multiplier effect. In short order, the face is covered with unsightly blemishes (dark spots)! In the more severe cases, the pustules merge together to form large deep acne cysts which after exploding may heal and form raised keloid scars. Keloids are notoriously difficult to treat and can be recurrent even after treatments. Some acne cysts heal with pitted scars instead. There is no effective treatment for pitted acne scars and they are permanent. The psychological impact is lifelong!

Management:

(1) Dissolve the oily plug in the pores by washing the face with ariSulfur bar, neutrogena acne bar, glycolic or salicylic acid wash as directed by skin therapist.

(2) Kill the bacteria using sulfur (ariSulfur bar) or over-the-counter benzoyl peroxide treatment.

(3) Fade the dark spots by exfoliating the pigmented dead skin cells using glycolic, salicylic acid or sulfur products(ariSulfur bar).

If the condition does not improve or is causing social withdrawal, do see a dermatologist who will formulate an individualied treatment plan to help you to manage your teenage acne.

The aim of treating teenage acne is to prevent physical and mental scarring, thereby improving self-esteem.

Next week, I will discuss keloids and razor bumps resulting from shaving.