09/09/96 THE SKINNY ON ADULT PIMPLES

THE SKINNY ON ADULT PIMPLES

Wisdom does not always come with age, and neither does clear skin. Acne can remain a nuisance long after the nervous passions of puberty have cooled. ``So many people think they're home free once they get past adolescence, and that's just not true,'' says John Wolf Jr., chairman of Baylor College of Medicine's dermatology department.
Indeed, 1 in 9 adults between ages 25 and 44 consulted a doctor about acne last year, while millions more probably tried to deal with the problem on their own, says the Journal of the American Academy of Dermatology. However, the battle against the bumps has gotten easier thanks to a greater understanding of what causes acne, along with new topical remedies that are kinder to the skin than any previously prescribed.
CLOGGED CANALS. The severity of acne varies, but the culprit is always the same: clogged pores. Pores serve as pipelines between oil glands and the skin's surface. When these canals get stopped up, bacteria feed on the oil within and multiply until an army of white blood cells marches onto the scene to launch a defensive attack against the invaders. Overcrowded, the follicle becomes swollen, creating what is politely known as a blemish.
So how does a pore get plugged? Genetics plays a critical role. ``There are people who can smear Vaseline all over their face and not get acne because it's not in their genes,'' says Debra Jaliman, who teaches clinical dermatology at Mt. Sinai School of Medicine in New York. A number of factors contribute to acne among those who are genetically susceptible. Hormonal fluctuations, such as those prior to menstruation, inspire glands to pump more oil than pores can take. Sweating causes skin to swell and closes off pores, just as pressure against the skin keeps oil from escaping. Goopy cosmetics such as lotions with lanolin or jojoba can clog the works.
And as anyone who has awakened the day of a job interview only to discover an ugly protrusion on the chin can attest, stress also aggravates acne. Ongoing research at the University of Pennsylvania School of Medicine shows that anxiety provokes an inflammatory response near the skin's surface that ``can turn a tiny plug into a big, bad pimple,'' says George Murphy, professor of dermatology. And nervous picking at the face can make things worse.
Other than taking a hands-off approach, Gary White, clinical dermatologist at Kaiser Permanente in San Diego, recommends washing as many times a day as necessary with a mild cleanser ``so that the face isn't shiny'' from excess oil or sweat. And be aware that just because a soap or other cosmetic says ``noncomedogenic,'' that does not mean it won't cause acne. ``There are no federal regulations in place before someone can make such a claim,'' says John Bailey Jr., director of the Food & Drug Administration's Office of Cosmetics & Colors.
Experts also advise using a topical antibacterial ointment such as benzoyl peroxide (2% to 15% strength) to combat acne. Formulas are available over the counter and by prescription and have a range of efficacy depending on the individual, so a certain amount of experimentation may be necessary. Prescription-only topical retinoid preparations, such as Retin-A by Ortho, are also widely recommended because of their draining effect on pores, even though irritation and peeling often occur. New products called Differin (by Galderma Laboratories) and Zorac (1997 release by Allergan) are similar to retinoids but cause less irritation.
SHRIMP AND FRIES. If problems are more severe than the occasional breakout, dermatologists suggest oral antibiotics. Therapies that control hormonal fluctuations are another option. But the biggest gun in the acne arsenal is Accutane, a vitamin A derivative that shuts off oil production in the glands. ``Doctors prescribe Accutane as a last resort,'' says Baylor's Wolf, because it's toxic if not taken as directed and causes birth defects in children conceived while their mother is on the drug.
Finally, dermatologists do not agree on whether certain foods exacerbate acne. ``There's not enough research,'' says Donald Lookingbill, chief of dermatology at Pennsylvania State University-College of Medicine. Yet he counsels patients to steer clear of foods they think may be problematic, such as chocolate, shrimp, iodized salt, french fries, and kelp. Regardless of the cause of acne, a little skin savvy can often lead to a nearly flawless face.
EDITED BY AMY DUNKIN By Kate Murphy