Acne A Problem That`s Ageless

Skin Problems Plague Adults

February 01, 1987|By Teresa Barker, Special to The Tribune.

Some time after you get your driver`s license, your high school diploma and your first legal drink, you figure your acne days are numbered.

``Don`t worry,`` everyone tells the tortured, pimpled teenager, ``you`ll outgrow it.`` The good news is, most do. The bad news is, there are more zits to come. A formidable array of acnes can get adults on the job, or at home, or at war. The most common version isn`t even a true acne but goes by the name and wreaks similar vengeance on a middle-aged face. Acne rosacea, as it`s called, at first produces a flushed, ruddy complexion, but it can progress with time to create the drunken, bulbous red-nosed look that only a W.C. Fields fan could love.

``People in their 30s or 40s will come in and they won`t want to say they have acne--they`ll call it a complexion problem--but a lot of adults have these problems, and maybe because there`s more disposable income, a lot more people these days are willing to seek professional help to deal with them,``

says Dr. Susan Primmer, a former acne researcher at University of Chicago, now a dermatologist in private practice in New Jersey.

``We`re seeing more older patients, in part because they`re starting to pay more attention to their skin--President Reagan`s skin cancer made everyone start thinking--then once they`re here, they start asking about the other 50 little bumps on their face.``

Acne is a simple, though in many ways still unexplained, condition in which a hair follicle, or pore, becomes clogged by a mixture of the skin`s natural oil and surface bacteria. As more oil is produced within the skin and unable to escape to the surface, it creates an inflammation in the form of red bumps, whiteheads and blackheads. Fluctuating hormones appear to be a key factor in adolescent acne, but scientists aren`t certain exactly how they create the skin problem.

Hormonal imbalances can continue to trigger acne in adults, but more frequently the flare-ups appear to have other origins.

Some acne bumps are a simple reflection of a person`s work or wardrobe. Friction acne produces a usually painful pimple or bump where a foreign object persistently rubs the skin. Anyone who sits with chin against telephone receiver all day is a prime candidate for a friction zit. So are those who wear hats with chin straps. Underwear that rubs the wrong way can do it, too. A flair for fashionable coiffures can produce a facial flare-up called pomade acne, so named for the heavy styling goos we use. The condition is characterized by tiny bumps at the hairline.

Acne also can be a side-effect of drugs or other chemical agents, from steroids to anticonvulsants to iodides in some medications and vitamins. Or it can be tell-tale evidence of poisons within. Victims of dioxin poisoning

--sometimes from chemical spills or military use, as with Agent Orange defoliant--frequently develop a rash of tiny blackheads around the outer eye region.

The most common version of adult acne, however, is rosacea--technically not acne at all because the hair follicle is not the source of the problem. In rosacea, the tiny blood vessels of the face become enlarged and the tissue surrounding them becomes inflamed. In the early stages this may appear as red streaks, or a simple blush that doesn`t fade away.

As rosacea progresses, so does the red, ruddy look, sometimes accompanied by a mild form of conjunctivitis, or inflammation of the eye. Those symptoms are often assumed by others to be signs of an alcoholic. In fact, alcohol can make rosacea worse, but the symptoms may be just as severe in a non-drinker.

Spicy foods, stress or excessive cold or sun also exacerbate existing rosacea, but none actually cause the condition. Scientists don`t know what does.

``For years it was thought to be a continuation of the adolescent disease, but it isn`t,`` says Dr. Peter Pochi, professor of dermatology at Boston University School of Medicine and a leading authority on acne.

``The reason for the inflammation is unknown,`` Pochi says. ``If you do a biopsy of the reddened skin that was long thought to be full of blood vessels that had opened up, what you find instead is inflammation of the tissue.

``Perhaps hormones play a role, but it`s never been satisfactorily explained. It isn`t that no one cares--there have been millions and millions of dollars spent on research. When you`ve got something that`s on the face, that`s chronic and a lot of people have it, it`s important. We just don`t have the answers.``

The flushed-face look is more a cosmetic concern than a medical one. The mild inflammation alone is not considered health-threatening, nor does it portend worse things--such as skin cancer--as some sufferers fear. But who really wants to be pushing 40, still squeezing a Clearsil tube?

Although there is no cure for rosacea, several drug treatments have proven highly effective in reducing the rough and reddish look. Successful non-drug alternatives range from traditional cosmetic surgery techniques to new laser procedures.