Acne is a problem of the unit of the hair follicles and the sebaceous glands. Almost everybody gets at least one or two small bumps on the face in teenage life. People often tend to attribute this to "heat". But the fact is that this is the handiwork of the hormonal changes associated with puberty. The same hormones that produce the onset of menstrual periods in girls and the growth of facial and body hair in boys are responsible for producing acne. But why some people tend to get more severe acne as compared to others is because hormone levels vary from person to person. More importantly how one’s skin reacts to circulating levels of the hormones decides the intensity of acne. People having an oily complexion tend to get more severe pimples.

Certain bacteria are normal residents of the hair follicles. Under the influence of the hormones, these bacteria tend to multiply, and produce inflammation. In order to control these bacteria, prolonged courses of antibiotics are often necessary. The good news is that most of the antibiotics for treating acne are safe for long-term administration.

A lot of old-timers would argue that for a condition which eventually goes away on its own, is there really a need to treat it? Why one prefers to treat acne nowadays is that there is no fixed age at which acne will disappear completely. Until that happens, the teenager is subjected to ridicule and suffers from low self-esteem. Also, when larger lesions subside on their own, they leave behind marks and scars, some of which may be permanent. The aim of treatment is to keep the face clear and control acne till the time it goes on its own.

I am often asked,"What is the best treatment for pimples or acne?" I have to patiently explain the questioner that there is no magic bullet for treating acne. There are many effective medicines for treating acne, but the deciding factor for what treatment is right for a particular case is what kind of skin lesions are more predominant. Acne can present with whiteheads, blackheads, red raised areas (pimples), pus-filled areas, large boils and balloon-like cavities filled with fluid (cysts). A person with a profusion of blackheads will do well with a comedolytic cream, whereas someone with cysts will benefit from certain internal medications. I thus emphasize that treatment has to be individualized for each patient, depending upon the type of acne present.

In girls, acne has a significant relation to the menstrual periods. Women having irregular or scanty periods are more prone to developing acne. Most women experience a premenstrual flare of acne. Hormonal preparations like oral contraceptive pills can exacerbate acne. So do certain other internal medications. The application of oily substances like cold creams, moisturizers, sunscreens, foundation creams and lotions can worsen acne. People with acne should preferably avoid facials. Emotional stress, particularly examinations, interviews and major functions are often associated with aggravation of acne. Friction like pressing, squeezing and manipulating worsens acne, as does waxing the upper arm and back.

There are quite a few myths surrounding acne. Various foods like oily or spicy foods and chocolates are presumed culprits, and considered taboo. There is not enough scientific proof confirming the role of foods in worsening acne. But it is always a good idea to go easy on very sugary foods and avoid a profusion of dairy products.. Other factors thought to play a major role in acne are upset tummy or constipation and some propagate the myth that acne is a blood impurity. This is sought to be rectified by some "blood purifiers". There is very little substance in these notions. Another myth is that acne occurs only in teenage life. In some women, acne can occur even in middle age and is called late-onset acne.

My main contention is that in this day and age, with the kind of treatment we have, and armed with the correct information, no young person should be tormented with the ignominy of acne playing a spoilsport in the "prime of life"