Chapter List

• Introduction to Total Health for Women
• Acne
• Alcoholism
• Allergies
• Anemia
• Angina
• Appendicitis
• Arthritis
• Asthma
• Back Pain
• Bladder Infections
• Breast Cancer
• Breast Implant Complications
• Breast Lumpiness
• Bronchitis
• Cervical Cancer
• Cesarean Section
• Chronic Fatigue
• Colds and Flu
• Cold Sores
• Colorectal Cancer
• Constipation
• Depression
• Dermatitis
• Diabetes
• Diarrhea
• Eating Disorders
• Eczema
• Endometrial Cancer
• Endometriosis
• Fatigue
• Fibroids
• Fibromyalgia
• Food Allergies
• Foot Pain
• Gallstones
• Gender Discrimination
• Gum Disease
• Hair Loss
• Headache
• Hearing Loss
• Heartburn
• Heart Disease
• Heart Palpitations
• Hemorrhoids
• Hepatitis
• High Blood Pressure
• High Cholesterol
• Hiv and Aids
• Hysterectomy
• Incontinence
• Infertility
• Inflammatory Bowel Disease
• Inhibited Sexual Desire
• Insomnia
• Irritable Bowel Syndrome
• Lactose Intolerance
• Laryngitis
• Lung Cancer
• Lupus
• Menopausal Changes
• Menstrual Problems
• Motion Sickness
• Muscle Cramps
• Neck and Shoulder Pain
• Oral Cancer
• Osteoporosis
• Ovarian Cancer
• Overweight
• Painful Intercourse
• Panic Attacks
• Pelvic Inflammatory Disease
• Phlebitis
• Physical and Emotional Abuse
• Pneumonia
• Post-Pregnancy Problems
• Post-Traumatic Stress Disorder
• Premenstrual Syndrome
• Psoriasis
• Raynauds Disease
• Repetitive Strain Injury
• Rosacea
• Sexually Transmitted Diseases
• Sinusitis
• Skin Cancer
• Smoking
• Stress
• Stroke
• Temporomandibular Disorder
• Tendinitis and Bursitis
• Thyroid Disease
• Ulcers
• Unwanted Hair
• Vaginal Infections
• Varicose Veins
• Vision Problems
• Water Retention
• Yeast Infections

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Acne

Acne

Outmaneuvering Outbreaks

Outbreaks of acne can undermine self-esteem in even the most self-assured of women, from those who thought they'd broken up with breakouts in adolescence to those who reveled in peaches-and-cream complexions.

Acne is more of a problem for women than men, experts agree. An estimated 20 percent of women in their twenties through forties experience acne.

The problem begins under the skin's surface in the sebaceous glands. Sebum, a waxy, oily material that keeps the skin supple and moist, is excreted through the hair follicles. But there are certain times in a woman's life when sebum production increases--most notably during puberty, pregnancy, part of the menstrual cycle and during menopause.

As sebum production lays the groundwork for eruptions, the affected follicles eventually become plugged up. A combination of sebum, bacteria, pigment and dead keratin cells (the top layer of the skin) creates clogged pores--the genesis of breakouts.

Different kinds of blemishes come under the category of acne. Whiteheads are small, closed white bumps that emerge when a follicle clogs and swells. Blackheads are the tiny, dark, raised bumps that appear when the pore of a clogged follicle remains open. Papules are red, swollen pimples that pop up when a clogged follicle releases its contents into the surrounding tissue and produces inflammation. Pustules are pus-filled inflammations caused by an attack of white cells on the follicle's contents.

Getting Rid of the Scars Some acne can leave scars--and there are a number of treatments and procedures to smooth them out. Here are some of the options. Dermabrasion. A refrigerant is sprayed on the area, numbing the skin and creating a firm surface. The area is then sanded with a spinning stainless steel wheel studded with minuscule industrial-grade diamonds. The sharp edges of the scar are planed down, and the base of the scar is also abraded, which may stimulate some growth in the center and overall smoothing of the surface. "Dermabrasion can change the scar from a deep box shape to a smooth dell in the skin," according to Allison Vidimos, M.D., a dermatologic surgeon at the Cleveland Clinic in Ohio. If scarring is severe and deep, the process can be repeated in six months to a year. One caveat: Beware of the sun. After a dermabrasion, sun exposure can cause problems with darkening of the skin. Collagen injections. Collagen is a protein that gives skin its form. For injections, physicians use highly purified bovine (cow) collagen, mixed with lidocaine, a numbing agent to anesthetize the treated area. To find out whether a collagen injection might help clear up scars, place a finger on either side of the scar and stretch the skin. "If the scar disappears," explains Dr. Vidimos, "you're probably a good candidate for this treatment." The procedure is simple: Your doctor will inject collagen into the scars at the level of the dermis, the second layer of skin, where collagen is normally produced. Since the body "melts away" collagen over time, you'll probably need another round of treatments in three to nine months, depending on where it's injected, says Dr. Vidimos. Since a small percentage of people have experienced allergic reactions to collagen, your doctor should test a small area for an allergic reaction before you begin full treatments. Also, the safety of collagen injections has not been established for pregnant or nursing women. Fat injections. Deep scars caused by loss of fat may be corrected with fat injections, sometimes known as lipo injections. For this procedure, fat is surgically removed from another part of the body, rinsed and then injected into the scar, where some of it may grow. This procedure provides correction that usually lasts from 6 to 12 months. Chemical peels. Mild or superficial peels--which gently remove a top layer of skin cells--are done with trichloroacetic acid or alpha hydroxy acid. For severe acne conditions, doctors use phenol peels, which are usually administered under general anesthesia by cosmetic surgeons. For average scarring, you might get a trichloroacetic acid peel, administered by a doctor. "These peels work beautifully on shallow crater scars," says Letantia Bussell, M.D., director of Beverly Hills Dermatology Consultants in California. Punch excision. This procedure can be effective for women who have narrow, deep "icepick" scars. A round, cookie-cutter-type punch is used to physically "lift" the scar out, and the sides of the scar are then stitched together. Laser dermabrasion. For this treatment, a carbon dioxide laser is used to abrade the skin. "Unlike dermabrasion, laser is a relatively bloodless way of sanding the skin," says Dr. Vidimos. But as with dermabrasion, the laser treatment also has its drawbacks--if performed inappropriately, it can cause new scarring or uneven pigmentation.

Family Ties--And Other Factors

Experts say that heredity plays an important role in determining whether you're acne-prone. "If both parents endured severe acne, their children have a good chance of getting it," says Allison Vidimos, M.D., a dermatologic surgeon at the Cleveland Clinic in Ohio.

Then there are hormones. One group of culprits is comprised of the male hormones, androgens, that even float around in a woman's system. When the balance between female and male hormones in your system is upset and more male hormones start churning through the body, more sebum is produced. As a result, acne develops.

But there's another key player in the system. The female hormone estrogen helps to decrease acne by keeping oil production at a reasonable level. That's why adult acne often occurs during menopause--when estrogen production decreases--and frequently quiets down in postmenopausal women.

Another acne factor is what you spread on top of your skin. "Makeup can clog pores, especially if it's not completely washed off before sleep," says Letantia Bussell, M.D., director of Beverly Hills Dermatology Consultants in California. "Although many cosmetics contain antibacterial agents," Dr. Bussell says, "those agents have a limited life span and wear out." For this reason, she advises women not to use old makeup that's been around more than six months.

And then there's stress. Experts speculate that stress also triggers a temporary increase in sebum production, and they are investigating the link. "We don't know how the connection to sebum works," comments Dr. Vidimos, "but women do break out before weddings, exams or a date. You want to look good, and boom! There's a prominent zit on your forehead."

If your acne has really begun to bother you, or if you just can't put up with unwanted outbreaks, a doctor or dermatologist can prescribe a wide range of treatments. Among the oral antibiotics available are tetracycline (Monodox), erythromycin (Ilosone) and minocycline (Dynacin). To influence hormonal factors, a doctor might recommend oral contraceptives with high doses of estrogen or a drug that regulates androgen (called an androgen antagonist).

Another alternative is isotretinoin (Accutane), a powerful prescription vitamin A derivative. Doctors sometimes recommend it for cystic acne--the most severe kind that can lead to scarring. Accutane must be used with extreme caution, however, since it can cause birth defects.

Consider Retin-A To rein in your acne and control flare-ups, talk with your dermatologist about using Retin-A. "It's the most effective topical medication," says Sheryl Clark, M.D., a dermatologist at the New York Hospital-Cornell Medical Center in New York City. "It really works at all levels of acne." Unlike most topical medications that treat surface blemishes, Retin-A contains an active ingredient called tretinoin that penetrates affected hair follicles beneath the skin. By speeding up the elimination of sebum from follicles, the medication loosens existing plugs and pushes them out onto the skin's surface, where they can be shed. Equally important, Retin-A inhibits future outbreaks by preventing the formation of new plugs. If you already have dry skin, you'll probably benefit from Retin-A in the cream form, which contains nonclogging moisturizers. But it's also available in a more drying gel form for oilier skin. The medication is applied at night after washing your face and allowing 15 to 20 minutes to ensure that your skin is dry. Optimal results take at least 12 weeks. You can expect to experience some flaking at first from the top layers, according to Dr. Clark. "That means the treatment is doing its job." Although the flaking can be a nuisance, it lasts only four to six weeks--and it shouldn't prompt you to stop treatment prematurely. If you tough it out, the skin usually builds up a tolerance and the shedding ends. With Retin-A your skin becomes more sensitive to sun exposure, and it's extremely important to take precautions. If you vacation where the hazard of sun exposure is great, Dr. Clark advises you stop treatment for the duration of the vacation and use a sunscreen with a sun protection factor (SPF) of 15.

Complexion Lexicon

For occasional acne, you probably won't need prescription medication. In fact, you may be able to clear up the problem with a few strategic moves. Some items from the pharmacy and a change in your skin-care routine may do the trick. Here's what doctors suggest.

Go topical. If you'd like to try a do-it-yourself method for clearing up a case of mild acne, try an over-the-counter medication. A benzoyl peroxide wash, Clearasil product or other drying medication might do the trick.

Discover peel appeal. Some products have a peeling effect that removes excess skin cells, which helps prevent clogged pores.

"Products containing salicylic acid--a relative of aspirin--act as mild peels and can loosen clogged pores," says Dr. Vidimos. Other products contain sulfur and resorcinol, and these offer a "double whammy," she says. These agents are antibacterial and also act as peeling agents.

Other products that have a superficial peeling effect contain lactic acid, glycolic acid or other alpha hydroxy acids. Many of these preparations can be purchased over the counter, according to Dr. Vidimos. "They can be very effective."

Don't scrub. Frequent scrubbing of your face won't help, even though you might think it will unclog the pores. "Don't wash more than twice a day--it stimulates the follicles," warns Ida M. Tiongco, M.D., clinical assistant professor of dermatology at the New York Hospital-Cornell Medical Center in New York City.

Many women believe grainy cleansers will help to further purge their pores, but it's not so, according to Sheryl Clark, M.D., a dermatologist at the New York Hospital-Cornell Medical Center. "Scrubbing with abrasives can actually make acne worse," she says. "Use a mild cleanser without fragrance, additives or potentially harsh preservatives." Washing gently twice a day with a mild soap like Dove should do the trick.

Camouflage correctly. To avoid provoking flare-ups, lay off oil-based makeups. These foundations stick to the walls of follicles, clogging them with oils, says Dr. Vidimos. Many makeups that do a swell job of covering blemishes are hellish on pores. If you must use regular makeup, try a water-based foundation to cover. Before buying, look for the word "noncomedogenic" on the label.

Don't give your skin a nightcap. Give a wide berth to thick night creams and products containing petroleum jelly, lanolin, tars, coconut oil or cocoa butter. Covering your skin at night, they clog pores and help promote acne.

Jettison those germs. Without knowing it, you may be infecting your own makeup. "If you're using a powder puff or sponge on blemished areas, germs from the surface of the skin stick to the applicator," explains Dr. Bussell. "When you return the puff to your compact, the germs begin to grow in the makeup."

Instead, use a tissue or disposable cotton pad to apply pressed powder or bleach, Dr. Bussell suggests. For liquid foundation, she recommends application with fresh cotton swabs. Also, avoid washing brushes and reusing them, because the bristles could pick up fungi and bacteria from the water.

Squelch the squeeze. To avoid additional scarring, do not pick or squeeze! "When you try to force the contents of an acne lesion up and out, inadvertently you may force the contents down and in, causing further inflammation and potentially a scar," says Dr. Vidimos.

Monitor your meals. There's no evidence that the traditional "bad" foods--like chocolate, cola, peanuts and potato chips--actually cause acne. But researchers say foods and mineral supplements high in iodine will aggravate the condition. "Foods to watch out for are shellfish, iodized salt, kelp and seaweed," says Dr. Vidimos.

Shun too much sun. Although most of us are aware that too much sun can be damaging to the skin, many people with acne believe heavy doses of sun will heal lesions. According to Dr. Clark, "While small doses of sun can promote exfoliation of the top layers of skin, too much sun or heat could produce more sebum, which could worsen the acne."

Be extra wary of sun if you're using topical or oral medications, which can make the skin more sensitive to the sun's rays. And after workouts and brisk walks, give yourself a gentle facial wash to remove sweat from the surface of the skin. Be sure to use a sunscreen if you're going to laze on the beach.

Give treatments time. If you do get a dermatologist's prescription for acne treatment, be sure to follow the doctor's directions, says Dr. Vidimos. And don't expect instant results. It may take a month or more before you'll know if treatments will work at all. Have patience.

Also, If one treatment fails to give you favorable results, the doctor may recommend other options. Dosages can be increased or decreased, and preparations can be recombined. "I've never, ever seen a patient whose acne couldn't be cleared," says Dr. Clark.