Living

The zit stops here

Acne vulgaris -- isn't that just the perfect name for it? From that first zit that showed up on your preteen face to the one that threatened to erupt just the other day -- the day of your big presentation at work -- acne seems vulgar, vulgar, vulgar. So why are we still getting pimples at this age? Maybe it's in our genes. Or maybe it's not really acne vulgaris. Wichita, Kan., dermatologist Christopher Moeller says about half of all adults who have acne really do -- they're suffering from "a hangover from their teenage acne," he says.

The other half thinks it's acne, because it looks like acne, but it's really rosacea, occasionally called acne rosacea.

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WHICH IS IT?

If you had zits as a teen and are still getting acne -- be it an occasional pimple or a chronic breakout -- it's probably because of genetics. It also may be linked to hormonal changes, such as those that occur around your period.

The older you are, the more likely the pimples you see now are from rosacea, which seems to be caused by some combination of hereditary and environmental factors. Hot foods, spicy foods, sunlight and stress are among the things that seem to aggravate rosacea.

Some people get both. Isn't that something to look forward to?

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WHAT CAN I DO?

First, acne is considered a problem when it bothers the patient. If you're chairwoman of the board, acne probably is a problem. If you're a high school football player, it might not be.

Treatment of acne and rosacea is similar. You have several options, and the first might be seeing your doctor, to make sure your breakouts aren't being caused by some other medical problem. Prescription drugs also can be responsible.

Convinced they're not? Then you might want to...

START AT HOME

Lots of acne products are available over the counter. Look for something that contains retinol (a vitamin A derivative), benzoyl peroxide and/or salicylic acid. "All three of those things have been used for decades," Moeller says, and they're found in products such as Proactiv -- but they're also in less-expensive products available at drug and discount stores.

The biggest problem with over-the-counter products: They may cause dryness and irritation.

Another at-home option is the Zeno, a device that uses heat to kill the bacteria. "Zenos actually do work," Moeller says, if they're used as the pimple starts and then every 12 hours or so. But they are for occasional zits and aren't practical for someone who gets lots of zits often. They're available through dermatologists and at some drug and discount stores; they start at about $150.

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IF THOSE DON'T WORK

See your dermatologist or physician. Here are some options he or she might recommend:

ANTIBIOTICS: Acne is caused by bacteria, so oral and topical antibiotics often are prescribed. You'll have to be on them long-term. Pills can cost $300 a month; creams might be $150. And many people need both.

LASERS: They're "nonablative," which means they don't burn, though they may cause some pain as they heat the oil glands, pores and skin to target bacteria. Each treatment is about $200, and you'll need four or five.

ACCUTANE: It's still the gold standard for bad acne. But it has serious side effects, and it causes birth defects, so women of child-bearing age must use two forms of birth control while taking it.

NICOMIDE: This is a new combination B-vitamin derivative that's approved for acne and rosacea. It's not as effective as Accutane or some antibiotics, but some people prefer it to antibiotics.

AVOIDANCE: For people with rosacea, identifying and avoiding triggers helps.

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TRUE OR FALSE?

Not washing your face causes acne: False. It isn't caused by dirt or oil on the surface of your skin.

Eating chocolate causes acne: False, sometimes. Diet has no effect on ordinary acne. But it has a huge effect on rosacea. Hot foods or beverages, spicy foods and alcohol are among triggers.

Popping zits makes them go away faster: False. In fact, you risk secondary infections and scarring if you mess with them.

Stress causes pimples: True, sometimes. Stress does affect the body, especially its immune system, so it can affect acne.

The sun clears up acne: True, but... Ultraviolet radiation will clear up acne temporarily. But it's a temporary effect, and the dermatologists who used to use it would sometimes see the same patients later -- with skin cancer.

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