Acne is a skin disorder that occurs most commonly among teen-agers. It consists of various kinds of blemishes, mainly on the face, upper chest, and back. A few blemishes are normal, but severe acne may result in permanent scarring. Some teen-agers find severe acne so distressing that they develop emotional problems.

In most cases, acne appears during early adolescence--at about the age of 13, when a child starts to develop physically into an adult. This development is controlled by chemical substances called hormones. One kind of hormone stimulates the oil glands in the skin. These glands, which are called sebaceous glands, grow larger and produce more oil. Each sebaceous gland empties into a hair follicle, a cylinderlike structure that surrounds a hair. Normally, the oil empties out of the follicle through a pore that opens onto the skin surface.

Sometimes the pores become plugged and oil accumulates under the plugs. A plugged pore forms a blemish called a blackhead or whitehead. The black color of a blackhead comes from a normal skin pigment that darkens when exposed to air. A whitehead develops if a pore is so clogged that no air can enter.

Small, pus-filled bumps called pimples, or tender red lumps called cysts, may also develop. In pimples and cysts, a type of bacteria called Propionibacterium acnes breeds in the follicles, sebaceous glands, and backed-up oil, producing inflammation that causes the redness and pus. Cysts may leave permanent scars, but pimples usually do not scar unless squeezed or picked.

A poor diet, worry, and various bad habits are often blamed for acne, but they have little to do with the disorder. A balanced diet, enough sleep and exercise, and regular washing are good for the complexion and general health but cannot prevent or cure acne. Mild acne can be treated with nonprescription lotions that contain benzoyl peroxide or other medications. Heavy makeup makes acne worse and should not be used.

Severe acne should be treated by a physician. An antibiotic called tetracycline may be prescribed. This drug blocks the growth and reproduction of Propionibacterium acnes bacteria. Medications containing vitamin A acid may be applied to the skin to help prevent new blemishes.

Other treatment used by doctors includes removing blackheads, freezing the skin with dry ice or liquid nitrogen to make it peel, and using a sun lamp. A drug called isotretinoin may be used to treat severe acne. But this drug, which has the trade name Accutane, can cause birth defects. It should not be used by women who are pregnant or who may become pregnant while undergoing treatment.

Puberty, period in the human life span during which the organs of sexual reproduction mature. This maturation is evidenced in females by the onset of menstruation, in males by the production of semen, and in both by the enlargement of the external genitalia. Rapid growth marks a range of physiological changes. Various secondary sexual characteristics also appear for the first time during puberty; in males, production of body hair increases markedly, particularly in the pubic, axillary, and facial regions, and the voice usually changes and becomes deeper in tone; in females, hair also appears in the pubic and axillary regions, and the breasts become enlarged. Accelerated development of the sweat glands in both sexes may trigger acne.

Puberty usually occurs in males between the ages of 13 and 16, and in females between the ages of 11 and 14. Among the pathological conditions related to puberty are amenorrhea and pubertas praecox. The former is characterized by an absence or cessation of menstrual flow not caused by pregnancy. The latter is the premature appearance in the male or female of the typical physiological characteristics of puberty and is caused by disturbances of secretion in the anterior pituitary, in the adrenals, or in the gonads.

One side effect of the war against cancer has been the discovery of a much needed cure for acne. A small percentage of acne patients with severe and extensive cases show little response to currently available drugs and X rays. However, a chemical being tested as a cancer-preventing agent by the National Cancer Institute completely cleared the acne in 13 out of 14 cases of scarring, antibiotic-resistant, cystic acne.

Investigators were especially impressed that, 20 months after treatment, the skins of the patients remained clear. The experimental drug is 13-cis-retinoic acid, a derivative of vitamin A, and the treatment seemed to work by inhibiting secretions of the skin's sebaceous glands. Because vitamin A can cause fetal abnormalities in animals, the treatment will not be used for women who may become pregnant. Long-term studies to determine its safety for others were expected to take about three years.

Erythromycin, antibiotic drug used to treat a wide variety of bacterial infections. These infections include respiratory tract infections such as pneumonia, urinary tract infections, ear and skin infections, gonorrhea, syphilis, rheumatic fever, whooping cough, and diphtheria. The drug is also used in a form applied directly to the skin to treat acne. It works by interfering with the formation of essential proteins in the invading bacteria, preventing their multiplication and growth.

Erythromycin is available by prescription in capsules, tablets, ointment, gel, and various liquids. Depending on the site of the infection, the drug is taken orally or applied directly to the infected area. Dosages range from 250 to 1000 mg taken every six hours. Children may take most forms of this drug, with dosages determined by body weight. Some forms of this drug should be taken on an empty stomach (one hour before or two hours after a meal). Erythromycin’s effectiveness is usually apparent after three to five days. However, the entire prescribed course of treatment should be completed to avoid recurrence of infection.

Patients with liver disease should not take this drug. It should be used with caution by patients with a history of allergies, impaired kidney function, or abnormal heart rhythm. It is generally safe for use during pregnancy (except in the form known as erythromycin estolate); however, breast-feeding mothers should be aware that this drug appears in breast milk.

Possible side effects include abdominal pain, nausea, vomiting, loss of appetite, or diarrhea. Also seen are skin rash, hives, eye irritation, yellowing of the eyes or skin, dizziness, rapid heartbeat, or temporary hearing loss.

Erythromycin can react adversely with a variety of drugs. These include other antibiotics (including penicillin), blood-thinners, carbamazepine, digoxin, lovastatin, phenytoin, and theophylline. Erythromycin should never be combined with astemizole.

Tetracycline, antibiotic drug used to treat various bacterial infections, including urinary tract infections, Rocky Mountain spotted fever, trachoma (a chronic eye infection), and gonorrhea. Tetracycline is also sometimes used to treat early stages of Lyme disease, acne, gum disease, and certain gastrointestinal ulcers. It works by interfering with the invading bacteria’s ability to form essential proteins, thereby halting their growth.

Tetracycline is available by prescription in capsule form, taken orally, and in a reconstituted powder solution, applied topically. Typical capsule dosages range from 1 to 2 g per day, taken in one to four doses, with a recommended maximum of 4 g per day. Unless this drug causes stomach upset, it should be taken on an empty stomach (one hour before or two hours after a meal) with a full glass of water. It should not be combined with milk or other dairy products. Tetracycline usually relieves symptoms after 48 hours of treatment, but it should be taken for the prescribed length of time to avoid recurrence of infection.

Patients with severe liver disease or pregnant or breast-feeding women should not take this drug. Patients with impaired liver or kidney function or with systemic lupus erythematosus should use tetracycline with caution.
Possible side effects include diarrhea, nausea, vomiting, skin rash, itching, light sensitivity, facial swelling, headache, blurred vision, chest pain, sore throat, difficulty swallowing, or in infants, a bulging soft spot on the head. Children may develop discolored teeth with long-term use.

Tetracycline may interact adversely with antacids and other common gastrointestinal medications, oral contraceptives, blood thinners, lithium, penicillin, isotretinoin, cholestyramine, and sucralfate.

Pimple is a red, raised skin blemish that usually contains pus. The most common cause of pimples is acne, a skin disorder that frequently occurs among teen-agers.

Acne consists of various kinds of blemishes that appear on the face, upper chest, and back. It is caused by hormone changes during the teen years. One kind of hormone stimulates the oil glands, which then grow larger and produce much oil. The pores (openings) of the oil glands at the skin surface are easily plugged, and oil accumulates under the plugs. A plugged pore forms a blemish called a blackhead or whitehead. Pimples are caused by the acne bacillus, a germ that thrives in the backed-up oil. The germ makes irritating substances from the oil, causing redness and pus. Mild acne can be treated by washing affected areas regularly and using such nonprescription medicines as benzoyl peroxide. Severe acne should be treated by a doctor. Pimples should not be squeezed. Squeezing may cause scarring.

Other causes of pimples include infections by staphylococcal and streptococcal bacteria. Unlike acne, in which there are many blemishes, these infections usually start with one pimple. This pimple may develop into a boil. Doctors treat these infections with antibiotics.

Many black men with curly facial hair develop pimples where they shave. These painful "shaving bumps" occur because the coarse, curved whiskers tend to grow into the skin after shaving. Growing a beard relieves this condition.
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