Beauty, the old saying goes, is only skin deep. Unfortunately, so are pimples.

The difference is that while very few of us can claim to be beautiful (certainly not I, as a glance at my column photo will attest), almost all of us have had pimples.

Our skin contains two kinds of glands: sweat glands and sebaceous glands. The latter exude an oily substance called sebum through our pores, lubricating our skin and hair. In some places on our bodies (parts of the face, back, shoulders and chest), there are as many as 100 sebaceous glands per square inch of skin.

Occasionally, these sebaceous glands get plugged.. This disorder is called acne–and just about everybody (nine out of 10 of us) has suffered from it, especially during adolescence.

The plug is made up of oil, dead cells from the lining of the tube leading from the gland to the pore, and bacteria. If the skin pore remains open, exposure to the air causes the plug to discolor and darken, resulting in a “comedone,” better known as a blackhead. (The black is not dirt, so no amount of washing will make it go away.) If the skin pore is closed, a whitehead forms instead, the white color coming from a build-up of white blood cells, which are attracted to the site to attack the bacteria in the plug.

Strictly speaking, neither a blackhead or a whitehead is a pimple, which is bigger, redder and more painful. A pimple forms when bacterial growth gets out of hand: the sebaceous gland eventually bursts, causing inflammation, swelling and pain. More white blood cells rush to the site to fight the inflammation; they, in turn, can mix with the oil, bacteria and dead cells to form the worst kind of pimple of all, a white-tipped pustule–which, for some reason, we want to pick at and squeeze, although we shouldn’t, because that just spreads the infection around and can cause scarring.

The underlying cause of acne is unknown, but there does seem to be a strong hereditary factor: children of parents who both suffered a lot from acne are more likely to suffer from it themselves, and identical twins tend to share skin problems just like they share looks. Adolescence is the worst time for acne because the hormones called androgens that flood both male and female bodies with the onset of puberty stimulate the sebaceous glands. People who suffer from acne aren’t producing any more of these hormones than anyone else–it’s just that their skins are unusually sensitive to it.

Adults, too, suffer from acne, but it’s rarer than it is in teenagers. Some dermatologists feel that stress is a contributing or even the primary factor in adult acne. One consolation for growing old is that acne is very rare in elderly people.

There are a lot of myths about acne. First, eating chocolate or fried, fatty foods will not give you acne. There’s no connection between the oil in those foods and the kind of oil that’s plugging your pores (unless you’re taking chocolate baths are getting a daily rub-down with french fries–and if you are, I don’t want to know about it). That said, some individuals do have a sensitivity to a particular food, so if you’re absolutely convinced that, for example, doughnuts give you pimples, you could be right.

Second, acne isn’t a sign of dirty skin. The problem arises inside the skin itself, not on its surface. In fact, too much scrubbing with too-strong soap can even make matters worse.

Third, the sun does not dry up acne–at least, not enough to offset the fact that exposure to the sun thickens the skin, which can itself block pores.

Of course, once you have pimples, you’re not as concerned about what causes them as you are about how to get rid of them. For the occasional pimple, one beauty columnist recommends a little drop of any toothpaste. The sodium in the toothpaste helps dry it up. The menthol in the paste, however, may leave a red mark on sensitive skin, in which case calamine lotion is a better alternative.

Another suggestion is to apply a hot compress for ten minutes every couple of hours, which brings white blood cells to the area to speed healing. Then, if the pimple is still red just before you’re going out on the biggest date of your life, apply ice. This constricts blood vessels, reducing inflammation.

Careful application of makeup can help hide pimples, but makeup can also aggravate them, especially oil-based makeups, which are intended for older women who are more concerned with wrinkles than pimples. Younger women, especially teenagers, should look for oil-free and/or oil-absorbent makeups.

Doctors treat acne in a variety of ways, depending on the severity of the condition. The basic treatments are applied directly to the skin. Benzoyl peroxide is one of the most common, and is the active ingredient in many over-the-counter acne preparations. It works, oddly enough, by irritating the skin, causing it to shed its surface layer along with excess sebum. Sometimes antibiotic lotions are applied to reduce the inflammation and swelling. For blackheads, vitamin A acid, better known as Retin-A, works well; it reduces surface sebum.

Severe cases may be treated with oral antibiotics, but that can result in antibiotic-resistant strains of other infections. Severe pimples can be injected with cortisone-like drugs to reduce inflammation, and blackheads can be extracted before they become inflamed. Cosmetic surgery can help reduce scarring from severe acne.

A rather drastic treatment for severe acne is accutane, derived from Vitamin A, which shuts down oil production in the body–but it has some unpleasant side effects, ranging from dry lips and peeling skin to possible birth defects.

One of the newest treatments is alpha hydroxy acids, or AHAs, which come from fruit. AHAs help slough off dead cells and unplug pores. Mild AHA solutions are available over the counter; dermatologists use stronger solutions on their patients.

The point is, you don’t have to be a hostage to your skin: help is available. And the good thing about pimples is that sooner or later you outgrow the worst of them.

The bad thing is that you never outgrow them completely. I should know. Chocolate may not cause pimples, but, judging by this bump on my forehead, writing about them does.

Permanent link to this article: https://edwardwillett.com/1994/05/pimples/

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