Dear Dr. Peg,
I have serious acne, but not on my face - on my back. This has a nasty side effect of making little bloodstains on the back of my nightshirt, because I unconsciously squeeze while asleep. How can I reduce the number of zits on my back?
Dear Sufferer,
Zits suck, as if I need to tell you. Acne, pimples, zits, blemishes, pizza face - this ugly rogue has many aliases. From social embarrassment to severe scarring, acne causes trouble for 45 million Americans every year. Would you believe we spend $100 million a year just on over-the-counter acne remedies? That doesn't count the cost of all the prescription medicine people use. And you can't put a price on misery.
It could be worse. You could be Rodney Dangerfield, the great American comedian, who once said, "I had plenty of pimples as a kid. One day I fell asleep in the library. When I woke up, a blind man was reading my face."
Carol Burnett described adolescence as "just one big walking pimple." As if that weren't bad enough, pimples often pop up well into adulthood. Acne is not just about being young. It is not about being unsanitary or eating too many french fries. Anyone can get pimples. But do not despair. There are things you can do about it.
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Four basic factors contribute to the development of zits: too many skin cells, too much oil, bacterial invasion and inflammation. The end result is blocked, infected and inflamed pores, aka pimples.
Your skin is covered with hair. Every hair grows out of its own hair follicle. Every hair follicle has its own little gland that produces an oily lubricant called sebum. This thick, oily stuff is secreted out the pores or gland openings. It helps the hair grow and keeps the skin soft. What happens in acne is that the pores get dammed up by overgrowth of certain cells, causing buildup of sebum behind the dam. This is a whitehead. If the backup is big enough with enough pressure, the surface ruptures and the sebum gets oxidized by the air. Oxidization turns it black, hence a blackhead. Bacteria go after the oil-rich environment and cause infection and inflammation. The result is the aptly named acne vulgaris.
As you have testified, this process can happen just about anywhere on your skin. The face is the most common acne site, followed by the back and chest.
Anything that helps clear pores will help acne. Wash once or twice a day with mild soap to remove excess oil and bacteria. Don't scrub hard, because that can increase inflammation and make it worse. For back acne, I recommend washing with a soft sponge on a stick.
Anything that blocks pores will worsen acne. Pressure on the skin can prevent the oil from releasing properly. Leaning on your hand or your phone too much is an example of this. Topical oils, cosmetics and lotions can block the glands, as can certain hair products. Keep your hair off your face, especially when you sleep, and make sure products you use on your skin are labeled "noncomedogenic." That means nonacne-causing. Wash off makeup before bed.
Don't pick your zits. It might feel good and get rid of the whitehead, but popping pimples increases inflammation and makes infection and scarring more likely. In other words, you'll make it worse. Hands off.
Sweat and high humidity can make acne worse. Shower after exercising. Try washing your back before bed, wear lightweight or no pajamas, and keep your bedroom cool so you don't sweat at night.
Hormones definitely play a role in acne, which is why most adolescents have acne at some point. Women may have a premenstrual increase in acne or acne related to a birth control pill. Stress hormones can also increase acne, so do what you can to reduce your stress.
If basic measures aren't enough, you can hit your local grocery store or drugstore and pick up a topical remedy. You have no doubt seen the dizzying array. There are creams, gels, washes, scrubs, pads, pumps, sticks, cover-up makeup and so on. Most of the acne products contain salicylic acid or benzoyl peroxide. These two chemicals help remove excess oil and kill bacteria. Some products contain alpha hydroxyl acids, which soften the skin and remove dead cells. I can't recommend one product or type over another. Experiment and go with what works best for you without drying your skin out too badly. Word to the wise: Acne often gets worse before it gets better once you start treatment, so hang in there. After a couple weeks you should start to see improvement. Acne is usually a long-term problem, so be patient. You may have to treat it for months or even years.
If over-the-counter remedies don't do the trick, come see us. Depending on your situation, we'll prescribe topical or oral medications. Student Health and Counseling even has a dermatology clinic for tough cases. Start with an appointment with one of our providers. 277-3136.
Peggy Spencer, M.D., is a board-certified family physician. She has been a UNM Student Health physician for 17 years and a Daily Lobo contributing columnist for three years. She is co-author of the book 50 Ways to Leave Your 40s, released in March. Drop your questions in her box in the lobby of Student Health and Counseling, or e-mail her directly at Pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health provider.
