Q. I am a 16-year-old college student. My problems are my pimples, blackheads and whiteheads which started to appear all over my face when I was 14. What causes these conditions? What can I do to prevent and treat these skin problems?  —Lorie S., Quezon City

A. Pimples, whiteheads and blackheads are simply the various manifestations of acne or acne vulgaris, a disease that affects the sebaceous glands of the skin, especially of the face, neck, back and chest.

The sebaceous glands are located in the deep region (dermis) of the skin where they are attached to hair follicles. They produce oil (sebum) that seeps out to the skin surface through the pores that surround the hair follicles. Sebum serves to lubricate, soften and protect the skin.

Acne usually appears during adolescence. It has genetic predisposition and affects about 90% of all teenagers severely enough in about a third of cases to warrant medical attention. It affects both sexes in equal number but the condition is usually more severe in males. The skin lesions of acne usually diminish in the early twenties, but some unlucky people will carry the condition well into their thirties, forties and beyond.

Acne is caused by several factors that potentiate each other. The major ones are: 1) sebum overproduction by the sebaceous glands, which may be largely due to the influence of the male hormones that are produced in increased amounts during puberty by the adrenal glands of both sexes; 2) hypercornification or inability of the skin to wash out fast enough dead cells causing the pores that serve as passageway for sebum to clog; and, 3) proliferation of bacteria (P. acnes) that thrive on the sebum and which causes inflammation in the sebaceous gland and surrounding tissue.

In a minority of cases, the skin lesions of acne are caused or exacerbated by intake of certain drugs such as steroids, and also by physical factors such as friction or contact with cosmetics and other irritating substances.

However, contrary to popular belief, acne is not caused nor aggravated by particular foods or emotional stress.

A well-balanced diet, adequate sleep and relaxation, regular exercise, and proper hygiene are good for general health and are, undoubtedly, also beneficial for skin health. To avoid insulting the skin too much, cosmetics and other skin preparations should be used judiciously. But other than these measures, there is very little that you can really do to prevent the appearance of pimples, whiteheads and blackheads.

However, in terms of treatment, the advances during the last few years have made it possible to obtain significant improvement in all patients with acne, including those with severe cases.

Most cases of acne will respond to topical medications. Typically, gels and creams for acne contain an ingredient such as salicylic acid, benzoyl peroxide and tretinoin that enhances shedding of skin and declogging of the pores, and/or an antibiotic such as clindamycin and erythromycin that kills the P. acne bacteria. Treatment with topical preparations should be continued for months or even years. In fact, most treatment failures are due to premature cessation of treatment.

For severe forms of acne, treatment generally involves the intake of oral medications (i.e., hormones, isotretinoin and antibiotics). However, these preparations have a lot of dangerous adverse effects and should not be used without the supervision of a physician.

In addition to topical and oral medications, it is sometimes advisable to manually extract individual pimples, whiteheads and blackheads and to inject steroids into some of the skin lesions. These procedures however, should only be performed by dermatologists (doctors who specialize in diseases of the skin).  Incidentally, dermatologists can also perform certain procedures that remove or diminish the scars caused by acne.

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