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The dilemma over acne
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 Acne is one of the most common of all skin disorders if not the commonest! It has been estimated that 70 % of the population have some clinically evident acne at some stage during adolescence.
Acne is a disorder affecting the "oil glands" technically known as the sebaceous glands. These glands are dormant during childhood and once the hormonal changes of adolescence start taking place, these glands respond to the same. Experimental work suggests that sebaceous glands are androgen driven and that other influences like stress are as important in stimulating the oil secretions.
The hormones cause the glands to secrete copious amounts of oils and at the same time affect how the skin sheds off. As a result of these changes, the ducts which drain the oils from the glands get blocked with the shedding skin. These appear to us as black heads and white heads. White heads have the intact keratin plug whereas black heads have pigmented tips from melanin pigment deposited at the follicle. These can shed off naturally or in some cases the oils continue to accumulate within the gland. This attracts bacteria and as a result there are pus filled pimples on the face. Pimples have a variable course, either they subside on their own or persist indefinitely casing cystic lesions and can heal leaving behind marks and scars.
Treatment
Understanding how acne happens helps us understand the treatment better.
There is no patient of acne who cannot be substantially helped by appropriate treatment. It must be borne in mind that before the patient presents at the physicians office he or she has almost certainly been advised by his mother, father, aunt, grandmother. Often the young sufferer is blamed in one way or another for having the disorder and doing too much of one thing or not enough of another. The following are a few common misconceptions regarding the same.
Eating oily food causes acne!
This is one of the commonest questions asked to us. No! eating oily foods plays no role in the formation of acne. But, of course you are what you eat and eating a balanced nutritious diet is only going to reflect on the skin.
Squeezing helps?
Nothing could be further away from the truth. A pimple would subside on its own naturally but if one tends to squeeze and massacre it, it only inflicts more trauma on the skin and the marks subsequently take months to clear away.
Does it help to remove black heads?
The whole gamut of problems can be solved simply if the starting point i.e the black and white heads are simply drained off at their starting point. Of course, this has to be done by a trained professional.
Why antibiotics? Does one have to have antibiotics to cure acne?
Acne is a result of bacteria thriving in the environment of oils. These bacteria cause accumulation of pus and resultant infection. Hence as with any case of infection anywhere in the body, an antibiotic is given to remove the bacteria and resultant infection. But that does not mean that one should start self medication. Let you doctor decide what's best for you.
Glycolic acids are the new mantra. Do they help or does it cause more pimples?
The glycolic acid group is derived from sugarcane, apple, grapes and milk. It causes exfoliation of the skin so it causes the black and white heads to separate out and shed off.
Of course once the superficial layers of the skin shed off, underlying acne (acne just lying beneath the skin surface, waiting to erupt) will come to the surface. So the cases should be wisely selected and done by a trained medical professional.
Why should ladies in their 30s and 40s get acne?
The term is adult acne. As mentioned earlier the androgens stimulate oil secretion and hence it is acceptable to society at large if acne occurs during adolescence. But it is often an issue of discussion when it occurs in adults. This happens mainly because of stress levels. Stress aggravates the hormonal changes which cases extra oil secretion and with changing and rather stressful lifestyles of late, stress plays a predominant role in acne in adults.
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