When it comes to acne, let's just say we get welcomed to the real world where we learn that life is all about taking the good with the bad. In both boys and girls, it comes with adulthood...or should I say the hormonal changes that begin to occur between the ages of 10 and 13. Isn't it ironic that, just when we realize that the other sex exists and want to look our best, we start looking our worst. And that's what I mean when I say, acne welcomes us to the real world where we learn that we have to take a little bad with every good.

First, know that acne affects both girls and boys. Unfortunately, boys are going to have more severe breakouts earlier than girls who experience acne later but in girls, acne can last longer that in boys into their 20s, 30s and even 40s. Suffice to say that it's all linked to hormonal changes in the body that occur at puberty. With the onset of puberty comes the onset of androgen hormones which, in addition to making us begin to recognize the girl or boy next door, also makes our natural sebaceous glands go into hyper-drive.

Our bodies are covered with pores and thus with sebaceous glands that are located deep within each pore. Some pores have hair follicles and others do not but either way, these glands work to produce sebum, an oil that keeps skin soft and moist. As the skin renews itself, old skin cells die and are shed off and, under the best circumstances, this happens evenly and gradually, making way for fresh new skin. It would be nice if we all shed dead skin cells in a layer but the fact of the matter is that some people shed skin unevenly and as a result, dead cells that don't sluff off mix with sebum and clump together to form a sticky plug in the pore. This plug traps oil and bacteria inside the pore and a blemish begins to form. So, contrary to popular myth, acne is not caused by eating chocolate, greasy foods or bad hygiene. It is simply caused by growing up.

In years past, acne was a thing to be ashamed of and consequently, pimples were routinely "popped" and picked at with the results of the first producing deeper and more infected tissue and the latter leading to the scars that we bear today. Thankfully, with the laid-back tenor of today's youth, kids just "deal with it". They don't let acne define them seeming to know who they are goes beyond the condition of their skin. In increasing numbers, today's teens acknowledge the problem, take whatever action they can to deal with it, and then get on with what really matters in their life...like skateboarding! In fact, Hollywood has helped out alot by incorporating this youthful problem into their series so when one of our current teen stars has a breakout in real life, it becomes part of the script and I think this really helps the non-Hollywood teenager to deal more effectively with the peer pressure of acne.

So now that you know where acne comes from and that there's really nothing you can do to eliminate it, let's talk about what I and other dermatologists that treat Hollywood actors do to treat it and lessen the severity of outbreaks. The first rule is, because dirt doesn't cause acne, don't over wash your face or body or use harsh scrubs. Two gentle washings a day is sufficient. Anything more can leave healthy skin dry and irritated, triggering the glands to produce even more oil with the result being even more "zits". Second, don't use alcohol-based products. Even though people think they understand that a blemish is an infection in the pore and alcohol can "sanitize" the area and kill the bacteria that is causing the blemish, alcohol merely strips the top layer of the skin causing dryness and irritation. Topical alcohol can't penetrate to the infection through the plugged pore. What it can do is prompt excess oil production and thus more blemishes.

Because blemishes are caused by dead skin cells that haven't sluffed off, exfoliation about twice a month is the best preventive treatment we use to lessen the chance of infection. Keeping the skin clear of "foliage" like dead skin cells keeps pores open and thus the oil flowing. As you might imagine, on the set cosmetics affect greatly the chances of clogging a pore so it's extremely important that the right chemical composition of cosmetic is used and then completely removed at the end of the production day. It serves no benefit at all to exfoliate and cleanse the skin and then load it up the next morning with animal fat-based and chemical-derivative cosmetics that, because of their chemical composition, invade the skin through the pores and then cling to the sides evading the removal process at the end of the production day. I can not overstress the importance of using good, solid, natural, balanced cosmetics on the skin to lessen the chances and severity of acne at any age. Remember, acne is most prevalent in youth but pores and sebaceous glands are forever. In fact, it is these sebaceous glands that keep our skin looking and feeling softer, more supple and younger as we age. We need to take care of them and not use anything that can clog the openings no matter what our age is.


No matter what the age is, it's always important to Beware of Sweat. Working out heats up the body and perspiration makes the skin an even more attractive environment for acne bacteria to grow. An exercise program is an active part of a balanced day for any Hollywood star defining their physical shape, physiological well-being and their emotional state. So exercise appropriately but take a shower as soon as possible after vigorous physical activity. Using the proper cleansing agent to remove the perspiration and accumulated environmental debris that accumulates during the workout, drying without rubbing the face after the shower and finishing with a toner that finishes and tightens the skin goes a long way to reducing the problems of skin blemishes at any age.


Finally, Beware the Remedies. In the U.S. alone, more than $1.4 billon is spent on acne medications and treatments each year both prescriptive and over-the-counter. In most instances, the bulk of that $1.4 billion would be better spent on chocolate ice cream because, whether it's prescriptive or non-prescriptive medications, they yield less than satisfactory results and cause bothersome or dangerous side effects. Further, most prescription medications such as antibiotics require at least three months of continuous treatment before any improvement can be expected. Often, a second, third or fourth cycle of therapy is needed.


For my patients, if there is an outbreak, I'll first go with non-prescription acne cleansers, astringents, moisturizers and pimple creams available through the companies that serve Hollywood's makeup artists. Some help unplug whiteheads and blackheads while others help encourage the skin to shed. It's important to use all products as directed. But I go with these treatments only for 6-8 weeks. If there is no improvement in acne during that time period, see a dermatologist to explore other treatment options.


The bottom line for the treatment of acne, no matter the severity, no matter the age, is prevention. With the average blemish taking 2-3 weeks to surface, the treatment you start today won't show it's effects for 6-8 weeks. So the prescription is prevention. Exfoliate with a professional exfoliation product that doesn't tear and cut at the skin but rather polishes the dead skin cells off. Cleanse with a professional agent designed for your particular type of skin. And finally use only professional cosmetics like those used in the television and motion picture environment. These products need to stay in place for a minimum of 12-16 hours a day, perform under extremely hot lights in an extremely harsh environment and then come off cleanly without leaving a residue that clings to the walls of the pores to causes infections to surface 2-3 weeks later. If the products work for Hollywood stars, they should work well for you as well in your fight against acne or other skin eruptions.