Acne | Hirsutism | Hyperpigmentation | Ingrown Hair

Acne

Acne is the result of hormones stimulating the pilosebaceous unit, which is defined as the hair follicle and the sebaceous (oil) glands that are attached to and empty into it. As the hormones stimulate the whole thing, the result can be either excess facial hair for women (see hirsutism) or acne, or both.

The oil joins with dead skin cells in the mouth of the follicle (pore) to form a plug. When the oil can't get out, it fills up and stretches the follicle. This causes an environment friendly to acne-causing bacteria, and an infection results.

The contents of the follicle are now inflamed, and it is not until the pus from the inflammation works its way to the surface that the pimple can break and drain.

If you squeeze when the inflammation is still down underneath, the infected contents have nowhere to go but to break out of the follicle into neighboring tissue. This up-to-now sterile tissue sees all this as a foreign invasion and sends in its antibodies which put up a fight, and then you have a deep, sore, cyst. All this infectious activity can lead to scarring.

The tendency to acne is hereditary, but it can be aggravated (though not caused) by a greasy diet, a dirty workplace, and touching with the fingers.

To take care of acne, you need to cleanse gently with a good cleanser. If you have an effective cleanser, you will not be tempted to scrub. After all, the tissue is sore and inflamed and needs gentle treatment. If you have active acne, use a clean washcloth every time.

Then you need to treat the acne bacteria with benzoyl peroxide (BP). The acne bacteria are anaerobic; the BP gets down into the follicle and releases oxygen on them. Some claim that a dab of tea tree oil (from any health food store) does just as well.

BP needs to be used preventively, over all the affected area. Put it on for a short time at first, then work up to once a day or even twice a day, leaving it on. Your skin may get dry and irritated at first, so go slowly; the skin will adjust. It's best to start with lower-strength formulas, such as 2.5% for mild acne, 5% for moderate, and 10% only if things are really bad.

You also need to exfoliate the old dead skin cells so that they won't clog the pores and cause the situation in the first place. For this we have a glycolic or other hydroxy acid.

A regimen of washing, exfoliating, and medicating should keep the acne under control. Your local esthetician will probably offer acne facials, and that is an excellent way to see improvement fast. S/he may use high-frequency current to dry and sterilize the affected area.

A good way to start home care would be a glycolic acid cleanser and a tube of benzoyl peroxide gel: 5% for moderate acne, 10% for a bad case. The next step would be to add a daily glycolic acid or salicylic acid product for better exfoliation. Another way would be to use a benzoyl peroxide cleanser and then later add a topical glycolic or salicylic to exfoliate.

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Hirsutism

Hirsutism is excess male-pattern hair on a woman, caused by so-called "male" hormones. Acne also follows this pattern, as it is linked to the same stimulation of the hair follicle. Often it's not so much that you have too many free testosterones in your system as that your follicles are exceptionally sensitive to your normal level of the hormone.

If you are a woman and have heavy hair growth in male-pattern areas such as upper lip, beard, sideburns, chest (not breast - that's pretty normal) and especially if your periods aren't regular, the best thing is to consult an endocrinologist. The answer may (or may not) be giving estrogen or using an androgen blocker such as spironolactone. Both have side effects. At the same time, it would be good to have electrolysis done, as it took a long time to stimulate those follicles to grow the hair; it will take just as long to overcome that stimulation.

For more information, see hair removal, and perhaps read Dr. Geoffrey Redmond's book (for understanding the hormones, not for options in hair removal) The Good News About Women's Hormones.

Another, perhaps more accessible, opinion on hormones is available from John R. Lee, MD in his book on the properties of natural progesterone.

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Hyperpigmentation

Hyperpigmentation is the occurrence of brown spots on the skin caused by sun damage and aging, as well as hormonal coloration. Acne can also leave hyperpigmentation. There is no instant treatment, since the majority of sun damage is said to have been done by age 18, so our brown spots have had a long time to develop and surface. Getting rid of them depends largely on how deep they are. If they are in the dermis (are deep in the skin) , then nothing will touch them except maybe laser resurfacing. If they are in the epidermis, then treatment is much more promising. Most pigmentation is a combination, so using these products should at least lighten the spots. If the pigmentation is recent, it is more likely to fade well.

Exfoliants like glycolic acid help by taking off skin layers and encouraging the rapid turnover of cells. Hydroquinones are bleaching agents which do the job but they produce an allergic response in some people. Kojic acid is now being widely used, apparently without significant complications. Some fading products combine these to good effect.

Topical vitamin A appears to regulate the melanocytes, which produce the pigment. This is why dermatologists prescribe retinoids (Retin-A) for hyperpigmentation. Topical vitamin A is an important part of a fading program, not to mention its other benefits.

Use of topical vitamin C also usually results in a more even pigmentation, along with its stimulation of collagen production and anti-oxidant properties.

These are pharmaceutical products. Fading can be done "naturally" with botanicals, but this is slower and more expensive, and it won't have such complete success.

Mainly, wear an effective sunscreen all the time you are using these fading agents, as they make your skin even more susceptible to sun damage. Hyperpigmentation is not something that can be cured - just controlled.

Jan Marini's "Lightening Gel" (formerly "Eventone")is the most elegant and pleasing (Kojic and Glycolic - and a touch of hydroquinone); MD Formulations' Skin Bleaching Gel goes with the more conventional 2% hydroquinone. Both can be used for putting just on the spots, but to get an even complexion, they should be used on the whole face. All require the use of sun protection forever.

For discussion of topical vitamins A & C, see skincare.

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Ingrown Hair

Ingrown hairs may appear after shaving, waxing, or any other hair removal method. The first line of defense (on the body, not the face) is using a loofah or buff cloth to exfoliate. On both body and face, the solution is about the same as for acne: exfoliate to clean out the pores and medicate to stop the bacteria. Benzoyl peroxide will fight the infection itself and do some exfoliation, and a glycolic acid lotion (for body or face) will help to keep the pores from closing and trapping the hairs.

See Md Formulations or Jan Marini for glycolics and other hydroxy exfoliators and BPO. But if you have serious ingrown hairs, there is TendSkin, which is salicylic-acid based. It is made especially for ingrown hairs and is really the only thing out there with good success in this area.

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