Acne vulgaris, or pimples, are nothing more than plugged-up skin pores (see diagram). Whether they are white heads, black heads, big or small, they are all just different stages of the same problem: blocked skin pores. The best way to understand acne is to understand the changes your skin undergoes with the release of sex hormones at puberty. - Oil production in the sebaceous glands (sebum) fills up the pores inside and seals them on the surface. - More solid skin debris (keratin) is produced and plugs the pore opening. Because these changes occur more on the face, shoulders, back, and chest, that's where acne is worst.

Blocked hair follicle pore builds up skin oil and becomes infected.

Once the outlet for your skin oil gland is closed, the oily/waxy sebum builds up beneath the surface and causes a "white head." If the sebum is exposed to air but still stuck in the pore, it darkens into a "black head." Infection from bacteria or irritation causes swelling, redness, and pus. These infected cysts are the worst form of acne and can spread infection and cause permanent scarring.

Anything affecting the amount of skin oil, dead skin cells, dirt and other debris, or infectious bacteria will affect your acne in that area. Of course, the best way to prevent big, red, painful pimples is to stop squeezing and picking! This often just bursts the acne pore deep inside, enlarging and spreading the pimple.

Squeezing an infected pimple or cyst causes infection to burst out both above and below the skin, spreading the infection and causing scars.

Try to think of acne prevention as one goal: keeping your pores open. You'll have to follow several steps every day for the best results:

• Wash your face twice a day, and especially after sports or other sweaty or dirty activity. Don't use a harsh detergent or very drying, abrasive soap.

• Gentle cleansing with a soft washcloth and mild facial soap is best. The purpose is to gently remove oil, dirt, and bacteria from the pores; scrubbing off a few layers of skin won't help and causes more damage.

• Use water-based cosmetics only. Read make-up labels. Oil-based products (containing lanolin, mineral oil, or cocoa butter) plug up pores and worsen acne. After you finish removing make-up, be sure to wash your face as described above.

• Avoid head bands, chin straps, and other athletic gear. They may cause or worsen your acne just by skin contact. Environments with lots of dirt or oil in the air (machine shops, commercial kitchens) will also coat exposed skin and plug your pores. Although some individuals may get "breakouts" with certain foods, it's a myth that chocolate, caffeine, or greasy foods should generally be avoided.

An important note about tanning: it may temporarily improve your complexion, but it probably does so by damaging your skin and follicles. Premature aging and wrinkles can be visible in your 20's. So don't tan for the temporary improvement of acne.

By turning the suggestions above into consistent everyday habits, you may improve acne. If you don't get good results, OTC topical medication is the next step.

OTC treatment is aimed at breaking down solid debris blocking the pores and removing it. Following the suggestions below will help you achieve that goal.

• A twice-daily regimen of gentle cleansing with a soft wash cloth and unscented, gentle soap will remove oil from your skin surface and pores, as well as some microscopic solid material and bacteria.

• After your skin has dried, apply a keratolytic medicine. It will help break down dead skin cells that remain behind and keep them out of the pores, and readies them for removal the next time you wash your face.

• You may apply water-based cosmetics after this routine in the morning. At night, remove cosmetics with a gentle water-soluble make-up remover before washing your face, then apply the medication again.

Remember, consistency is very important in treating acne. So be sure to make the above routine a habit! Self-treating your acne with OTC medicines can improve your complexion, but not cure it. If you are not satisfied with the results, the next step is to see a doctor.

We must note that the active ingredient benzoyl peroxide is no longer a Category I agent. It remains highly effective and available in both prescription and OTC forms. However, the FDA has not seen evidence to conclusively prove its long-term safety. Since there is no firm evidence that it is unsafe, it remains available and widely used by physicians and the public.

• Acnezine is a proven formula that can help clear acne as well as prevent future breakouts from occurring. It is an all-natural treatment with powerful skin clearing botanicals that can show results in just a few days.

• Neutrogena Unscented soap. This soap has a less drying effect than most commercial bath soaps, and because it’s fragrance-free, has a very low frequency of skin irritation.

• Oxy-10 Maximum Strength (benzoyl peroxide 10%). See Treatment for discussion of benzoyl peroxide. Though not Category I, it remains one of the most effective keratolytic agents to break down dead skin cells and debris, thus keeping your pores open.

Despite your best efforts as outlined above, sometimes acne gets out of control. If there are more than ten white heads and/or black heads on one side of the face, you should consult a physician. If there are more than three or four red, inflamed, pustular lesions on either side of the face, back, or chest, a doctor visit is also recommended. Combinations of certain prescription medications can be more effective than OTC products if your acne reaches this level of severity.

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