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Complexion Perfection

Causes of Acne

Healthy, glowing skin is easily one of the best beauty assets a woman can have. Ideally, you want your skin to look great all year round, not just during the summer, winter, or on special occasions. Thatís why itís essential to nip in the bud skin care problems that might crop up.
To best understand why acne happens, picture this: most of our skin is covered with tiny follicles that contain oil-producing sebaceous glands. Along with these sebaceous glands, we also have tiny hairs growing up inside small canals within each follicle. The place on the skinís surface where each follicular canal opens is called a pore.
Clear skin (without eruptions) occurs when the cells lining the canal shed regularly and are carried out by the oil produced by the sebaceous glands through the pore to the skinís surface. A problem begins when cells clump together, causing a plug. At the same time, the normal bacteria in the follicle start to increase, feeding on the oil and blocking the pore. When the blockage, or plug, reaches the surface of the skin, it appears as a blackhead, caused when the dead skin cells and oil fill the pore and are visible. Plugs that remain just below the skinís surface are whiteheads.
Many people have inflammatory acne, which occurs when the skin bacteria produce irritating substances that may break into the skin surrounding the follicle. Than, ďpus pimplesĒ (small pus-filled lumps), papules (small red lumps that protrude above the skinís surface), nodules (large red lumps that protrude above the skinís surface), and cysts may form. This type of acne, called cystic acne, is the most severe and requires treatment by a dermatologist.
Fluctuating hormones can also contribute to acne breakouts, which is why teenagers tend to break out, why women break out around their periods, and why women may break out during pregnancy and postpartum. Hormones cause oil glands to enlarge and to produce more oil during puberty and throughout the teen years. Also, during those years, the follicle wall thickens and cells clump together, blocking the follicular canal. The areas with the largest, most active oil glands Ė the forehead, nose, and chin (T-zone) Ė are most likely to develop acne. But acne can also develop on the neck, back, shoulders, and chest.
In addition, anything that puts pressure on certain parts of the skin may bring on whatís called ďfriction acne.Ē This term applies to blemishes that occur where pressure is applied to skin, such as around the mouth of a flute player or on the side of the face and around the chin of people who spend considerable time on the phone, cradling it with their face and chin.

Teen Acne

This type of acne normally shows up in teenagers between the ages of 10 and 20. It is characterized by blackheads, whiteheads, papules, pustules, cysts, and nodules that erupt on the face in the T-zone and on the inner cheeks (nearest the nose). This type of acne occurs because of the hormonal changes that take place during puberty.

Adult Acne

There are two sub-types of adult acne. The first looks like teen acne, but it occurs in women and men over the age of 20. The second type, hormonal acne, is caused by fluctuating hormones and consists of cysts and nodules that frequently donít come to a head. Hormonal acne is distributed more along the jawline, chin, and upper and outer neck area.

Acne-Troubled Skin

If you suffer from acne, donít despair. There are many, many ways to treat the condition. Some of the most common methods include using topical preparations or oral, or systemic, agents. For topical treatments, you can find a number of effective agents available over the counter and many with a prescription. One of the most popular topical treatments, which has been around for decades, is benzoyl peroxide. Itís a terrific ingredient for several reasons: you can get it without a prescription; most pharmacies carry it; and it is the active agent in many pricey acne products that are sold in department stores and over the Internet. Other topical acne treatments include salicylic acid, vitamin A, and of course, alpha hydroxyl acids. If I had to pick one for the first choice, it would be benzoyl peroxide, because itís the only one that is antibacterial and also exfoliates the skin, unblocks pores, and dries up excess oil.

Are You Allergic?

There are only two drawbacks to using benzoyl peroxide products. One, they can be slightly drying and irritating, so itís a good idea to choose a strength thatís not too irritating for the skin; if youíre not sure, stick with a 5 percent concentration. The other drawback is a big, though rare, one. Approximately 5 percent of the population is allergic to benzoyl peroxide and will react to the product by breaking out in an itchy, scaly rash, resembling the one you get from poison ivy.

Other Choices

If you find you are allergic to benzoyl peroxide, you may choose to use one of a few other over-the-counter anti-acne agents, including glycolic acid and the rest of the alpha hydroxyl acid family. These agents work by exfoliating the skin, opening up the pores, and allowing the sebum from the sebaceous glands to come up freely to the skinís surface, where it can get cleansed off, rather than allowing it to hang around and block the pores. Another very effective acid, which comes in a wide variety of cleansers, creams, and masks, and works well at exfoliating skin and unblocking clogged pores, is a beta hydroxyl acid called salicylic acid.
Many women swear by another over-the-counter agent, retinol, to help their acne. Like tretinoin in Retin-A, retinol is from the vitamin A family and can help increase exfoliation and normalize the cells that line the pores so they donít get blocked down below the surface. When you have acne, the cells lining the pores clump together and form a plug that blocks the pores below the surface of the skin. Vitamin A gets down there and normalizes this abnormality so that the cells do what mother nature intended, which is to come up through the pores and out onto the skinís surface along with the sebum.

Program for Acne-Troubled Skin

To treat your condition:
  • Wash your skin with a cleanser containing salicylic acid (such as SalAc Wash, Neutrogena Oil-Free Acne Wash, or Oil of Olay Age Defying Series Daily Renewal Cleanser).
  • Apply an oil-free moisturizer with an SPF of 15 or higher. Choose products that contain glycolic acid or another alpha hydroxyl acid. This gives a double benefit: the alpha hydroxyl acid opens pores as it sloughs off dead skin cells, while it simultaneously moisturizes the skin. Oil-free moisturizers that have SPF 15 and also contain alpha hydroxyl acids include NeoStrata, Neutrogena, and Purpose.
  • In the evening, cleanse with a cleanser containing alpha hydroxyl and apply a cream containing benzoyl peroxide (such as Oxy5, Clearasil, or Neutrogena On-the-Spot Acne Treatment).
Guerrilla Tactics to Fight Acne
  • Clean your face at least twice a day, especially if you perspire heavily. Use a mild cleanser for in between cleansing, such as after working out.
  • Use only makeup and moisturizers that are noncomedogenic and use only oil-free sunscreens.
  • Clean your cosmetic brushes and makeup pads with soapy water at least two or three times a week.
  • Avoid touching your face during the day. Keep in mind that hands are full of microscopic bacteria that can transfer to your face and aggravate your condition. Also, wash your hands after handling money, which has been shown to contain a great amount of bacteria and germs.
  • Remove all your makeup before going to bed.
  • Change your pillowcases at least every few days and wash your sheets often.
  • Avoid resting your face on the telephone, a good breeder for bacteria.
  • Cleanse your telephone with an alcohol pad.

How Do I Know I Have Adult Acne?

Adult acne is becoming a huge problem with women (and some men) over the age of 20. A surprisingly large number of patients suffering from adult acne, the majority of them women, come into my office complaining of acne breakouts for the first time. Others with the problem see it as a continuation of their ďteenage acne phase.Ē Regardless of whether the breakouts are recurrent or new, they can make you feel horrible about the way you look and wreak havoc on your self-esteem and social life.
When patients say they have adult acne, I first check to make certain that what they think they have is the correct diagnosis. Many conditions can imitate or mimic adult acne, such as rosacea, yeast infections of the hair follicles, and breakouts resulting from pores that have been blocked by oil-based makeup products or leave-in hair products, such as hairspray, mousse, and gel.
In women, the facial lesions may be present all the time or may flare up only in the week directly preceding the start of the menstrual cycle. Why is the week before the menstrual cycle crucial? That is the time during which the progesterone spike occurs. Progesterone is the female hormone that induces ovulation, and it closely resembles the male hormone testosterone. Because the hormone is similar in its chemical makeup to testosterone, it works the same way in stimulating the oil glands, resulting in acne flare-ups prior to ovulation.
DID YOU KNOW THATÖ Contrary to popular belief, sunbathing makes zits worse, not better. The initial, temporary drying effect Ė and the blemish-concealing tan Ė may fool you, but UV rays actually stimulate oil production. At the same time, they thicken the outer layer of your skin, which blocks your pores and leads to breakouts.
QUICK TIP: To test if you are allergic to benzoyl peroxide, take a tiny amount and apply it to the skin of your inner forearm, just below the elbow crease. The skin there is just as sensitive as the skin on your face. Do this every evening for two or three nights in a row. If your skin becomes red and itchy, itís a sure sign you are allergic, so donít put the benzoyl peroxide on your face.
QUICK TIP: Rule of thumb to follow: If you have acne, ease up on the salt. High iodine intake can result in acne on the face, chest, and back.
QUICK TIP: If you have acne, make sure to wash your facecloth often. Otherwise, you are simply wiping oil, dirt, grime, and makeup on freshly washed skin, creating a breeding ground for pimples and acne.

Is It Your Hairspray?

Sometimes hormonal acne looks like something else that I call ďhairspray acne.Ē This type of breakout occurs when leave-in hair-styling products, such as sprays, mousses, and gels, flake off onto the sides of the face and neck during the day. This ďmigrationĒ can end up blocking the pores in these areas and lead to acne and ugly cysts. I always say when a woman comes to me who has mostly cysts and nodules along her jawline and side of her neck, itís H or H acne Ė hairspray or hormones.
Basically, if your acne flares up or gets worse with your menstrual cycle, there is a hormonal component to it. If you donít think itís hormonally based (meaning it doesnít flare up around your cycle), but it looks the way I described hormonal acne as looking, then you may want to avoid using leave-in hair products, including two-in-one shampoo/conditioner products, which are responsible for breakouts in many people.

A Reason to Help

According to a study funded by Neutrogena, 46 percent of teenagers with mild to moderate facial acne reported that acne had a damaging effect on their physical self-image. Twenty-seven percent said it had negatively impacted their social life.

Acne-Prone Shopping Cart Checklist

Avoid these ingredients and products, which can make you break out:
  • Any oils, especially mineral oil, safflower oil, peanut oil
  • Petrolatum
  • Lanolin
  • Artificial fragrance and colors
  • S.D. alcohol

  • To help a pimple heal faster, soothe the skin with a cool compress.
  • To hide a pimple, dab on a sheer water-based concealer or oil-free foundation. Follow with another tiny dab of concealer and then dust the area with loose, translucent powder for a no-shine finish.

A Reason to Glow

Based on new research, cited in the book The Survival of the Prettiest by Dr. Nancy Etcoff, a psychologist at Massachusetts General Hospital and a teacher at Harvard Medical School, men have historically viewed women whose skin wasnít smooth and glowing (read, had acne, wrinkles, or sun-damaged skin) with caution. Thatís because, in prehistoric times women who had breakouts and whose skin wasnít smooth and glowing were often carriers of parasites Ė obviously, not a manís first choice for the mother of his future children. Scientists say this prehistoric instinct is carried in our genes, which explains why beauty is not just the product of what society (and magazines) tell us it is. Measures of beauty are, in fact, also intrinsic to human nature.

How to Zap a Zit

Hereís my professional opinion on the best way to zap a zit: Find a way to prevent it from forming in the first place! What many people donít realize is that it can take as long as eight weeks from the time a pore gets blocked to the time it erupts on the skin in the form of a pimple. In effect, by the time you are painstakingly applying topical products to a pimple that has broken out on your skin, itís about eight weeks too late. Thatís why, if you are at all prone to breakouts, itís a good idea to put together a daily routine designed to prevent breakouts in the first place. But if you canít wait, have a major date of presentation, and need quick relief, pick up some 10 percent benzoyl peroxide (as long as youíre not one of the 5 percent of the population who is allergic to it). No other product can beat the potent drying, exfoliating, and antibacterial effects of 10 percent benzoyl peroxide (found in Clearasil and Oxy-10). Save your money and avoid buying any product, especially an expensive ďdesignerĒ or ďbrand nameĒ product, that has less than 10 percent of this active ingredient. All you need to zap a zit very quickly is a tiny dot of 10 percent benzoyl peroxide, two or three times a day.
If your zit is more like a cyst (a slightly deeper lesion), then you may also want to try applying warm compresses. Simply wet a washcloth, handkerchief, or any clean, soft cloth with warm water and gently hold it to the cyst or pimple for several minutes at a time, several times a day. If worse comes to worst, and your pimple or cyst is especially large, or if you have a hot date, important party, big presentation or even wedding pictures and canít spare the time to wait a day or two for the pimple to heal and disappear, then I recommend you make a quick trip to the dermatologist for a little cortisone injection. This will usually zap the zit or cyst within 24 hours.

The Right Way to Squeeze

While dermatologists always caution against the evils of squeezing zits (youíll make them worse; youíll scar; it doesnít help), the truth is, people do squeeze their pimples. They canít help themselves. I think part of it is the social anxiety caused by having an unsightly eruption marring your facial beauty and part of it is that people have an urge to self-treat, hoping the zit will just pop and go away.
Iím here to tell you itís possible, but only Ė and I repeat only Ė if you pop your pimple in the most hygienic way possible. Hereís what you need to do: go to your local pharmacy and for a few bucks ($5 to $15), pick up something called a comedone extractor (translation, pimple popper or zit zapper). These are usually small, metal devices with a small cup on one end and a hole in the bottom. To use the conedome extractor, first disinfect both the pimple and the zapper over the pus pimple and press down firmly. This will usually open up the pimple and discharge the pus without scarring or driving the infection deeper into the skin. This way is far better than squeezing your pimple between two fingers, which can actually cause infection by driving the pus from the pimple into deeper tissues.

The Truth about Tea Tree Oil

Many people rush out to buy products containing tea tree oil to treat their breakouts. Hereís what I think: though tea tree oil works as an anti-inflammatory and is also antibacterial, it has a serious flaw when it comes to treating breakouts Ė the oil itself may block pores. Still, if youíve used tea tree oil successfully in the past to zap your zits and find it hasnít blocked your pores, then by all means continue to do what works for you. I donít recommend it as an acne therapy to my patients, because I feel many other superior products are already available for them to choose from.

The Color in Your Skin

If your skin has changed color recently, it is a warning sign that you need to pay attention to whatís going on.
If your skin is red: it means your skin is inflamed and irritated. For example, sunburn will cause your skin to flush red. Redness in the center of the face (cheeks, nose, and chin) accompanied by pimples may indicate rosacea, a skin disease involving blood vessels. Spicy foods, caffeine, alcohol, stress, heat, and certain birth-control pills can aggravate rosacea. Antibiotics or blood pressure medications (like Clonidine or Corgard) may be taken for a few months to stabilize the condition, after which it might disappear for up to two years. Chronic redness without pimples and across the nose and cheeks in a butterfly shape may signal lupus erythematosus, an autoimmune disease that requires medical attention. In that case, see your doctor.
If your skin is sallow: it could mean you havenít been sleeping enough, in which case the cure is apparent Ė get some shut-eye. Sun damage could also be the cause, as could smoking, which reduces blood supply, causing the skin to look sallow. Brighten your complexion with a cream or lotion containing retinol or alpha hydroxyl acid (AHA) or with a vitamin C serum.
If your skin pales: this happens when the skinís pigment cells are destroyed or damaged in some way, causing the body to produce less pigment. For example, skin often looks lighter after a rash, sunburn, heat burn, or sore. This is called postinflammatory hypopigmentation, a loss of pigmentation due to inflammation. Itís most common in darker complexions. Exfoliating may make it worse. The best way to approach this problem is to use sun protection on the damaged areas and on the surrounding skin. (The unaffected skin will likely darken faster in response to sunlight than will the affected lighter areas, making the difference between them even more noticeable.) You can also use alpha hydroxyl or vitamin A compounds to help normalize the differences in pigmentation. If the affected area continues to increase you may have vitiligo, an autoimmune disease, and should see a doctor.

The 10 Commandments of Skin Care

Follow these rules, and youíll keep time on your side.
  1. Wear a sunscreen that protects against both UVA and UVB rays every day. The main cause of skin aging and wrinkles is incidental exposure to the sun (when youíre driving, walking, etc.).
  2. Donít smoke. Smoking causes the skin to age prematurely and saps the skin of oxygen. It also causes the skin to look sallow and unattractive (due to lack of oxygen).
  3. Avoid drinking alcohol. Like smoking, drinking too much alcohol dehydrates the skin and can cause the skin to age prematurely.
  4. Keep stress down to a minimum. Excess stress can contribute to premature aging by preventing nutrients and oxygen from reaching your skin.
  5. Drink lots of water, about eight 8-ounce glasses a day.
  6. Get enough sleep. Our body repairs and rejuvenates itself while we sleep.
  7. Eat a healthy, well-balanced diet.
  8. Move your body. Regular exercise increases the flow of nutrients and oxygen to the skin, giving it a healthy glow.
  9. Wear sunglasses. This will protect the eyes and the delicate skin around them. Check the label to make sure the lenses provide UVA and UVB protection.
  10. Take short showers and baths in warm rather than hot water, to avoid further dehydrating and irritating the skin.
QUICK TIP: If you think you have a sensitivity to any of your cosmetics products (your skin breaks out, gets irritated and rashy), you may have contaminated the product by touching it with your fingers. A better bet is to find applicators and bottles that allow you to squeeze or pour the products onto the tip of the finger rather than reaching into the bottle.

The Question Corner

The Most Common Skin Care and Beauty Questions

  • Is it true that daily facial exercises will prevent wrinkling?
    Facial wrinkles occur due to two factors: gravity pulling on muscles and the natural breakdown of skin elasticity due to aging. (Lack of moisture and sun exposure accelerate the effects of gravity and aging.) Facial exercises pull skin too much, and once skin begins to lose elasticity, wrinkles can develop. Constantly furrowing the brow, squinting, or puckering your lips Ė even smiling Ė will create wrinkles or worsen those you have. Can wrinkles be erased? Yes, with Retin-A, alpha hydroxy acids, chemical peels, Botox, laser resurfacing, plastic surgery, dermabrasion, and filler injections, such as collagen, fat, Dermologen, and Gortex. Repetitive facial exercises can actually aggravate, rather than prevent, wrinkles.
  • How do I fix my sun-damaged skin?
    Over time, the sun erodes the skinís ability to produce collagen, slowing it down until the skin loses its elasticity. Sun damage is basically cumulative, which means that 70 percent of it comes from casual exposure, such as from walking down the street, driving a car, and riding a bike. Every tiny little bit of exposure adds up in your sun bank, until voila, you reach the point that the bank is full, and your skin suffers sun damage.
    First of all, to nip the ongoing problem in the bud and to reduce future damage, look for sunscreens that give you both UVA and UVB protection. Glycolic acid peels are mild, but can create a subtle improvement in the skin by sloughing off damaged skin cells.
    Also, get a prescription for a vitamin A derivative topical, such as Retin-A, which helps get rid of wrinkles and reverse sun damage in the outer skin-cell layer. Nonprescription vitamin C products are also helpful.
    Another treatment consists of a peel that contains two topical solutions used together Ė the Jessner solution, an alpha hydroxyl peeling solution, and Efudex, and anti-sun damage medicine. The peels are performed as a series of eight weekly treatments. First, the Jessner solution goes on, then the Efudex, which is left on the skin. The beauty of the treatment is that it results in little redness or peeling.
    Collagen injections by a dermatologist or a plastic surgeon can help plump up sagging skin that has lost its support.
  • How can I fight under-eye bags?
    The skin under eyes and on lids can get puffy from a multitude of evils: alcohol, crying, and/or salt consumption. Prevent this by sleeping with your head propped up (fluid tends to pool under your eyes when your head is level with your body). When it comes to under-eye treatments, make sure they contain key antioxidents, such as vitamins A, C, and E.
  • Can you shrink large pores?
    No. Your pores donít change size. Once a pore is stretched, it can never fully close, but it can appear smaller by cleansing it of sebum and dirt. Moisturizers hydrate skin, making pores appear smaller against moisture-filled skin. Masks and astringents mildly irritate the face, causing skin to puff up around pores, making them look smaller. An astringent that contains ingredients like witch hazel, aluminum salts, lactic acid, and citric acid can help shrink pores temporarily. Also try pore-cleansing strips, which adhere to the skin and are then pulled away, at the same time pulling away pore-clogging oil and dirt. Pore treatments to try include Biore Self-Heating Moisture Mask, Almayís StayClean Medicated Pore Strips, and Elizabeth Ardenís Pore-Fix C.
  • I have back acne. What can I do?
    Wash your back daily with a gentle-bristled scrub brush. For blackheads and little red bumps, wash with a mild, salicyclic acid cleanser, such as SalAc Wash. Also dab on a 2.5 to 10 percent benzoyl peroxide treatment (if the skin is oily and not irritated, you can go to 10 percent). But donít try scrubbing and applying benzoyl peroxide on serious acne Ė any large, red, or painful cysts need to be looked at by your dermatologist. Also, take care using benzoyl peroxide, because it can bleach clothing it comes into contact with.
  • Iíve been breaking out on my decolletage. What should I do?
    The skin on your upper chest, or decolletage, is very delicate, and that area contains fewer sebaceous glands than the face. Consequently, oil and sweat can build up, especially after workouts, resulting in chest pimples. If you get breakouts, wash with a mild, antibacterial soap. Then, treat pimples with an over-the-counter 2.5 percent (if skin is very oily, 10 percent) benzoyl peroxide product thatís tinted to cover as it heals (try Neutrogena On-the-Spot Acne Treatment Cream). Follow with an oil-free facial moisturizer, or use an AHA cream to keep skin clean, clear, and protected (such as Purpose, Neutrogena, Eucerin, or LíOreal Plenitude Excell-A3 Cream with SPF 8).
  • How can I tame my rough elbows and knees?
    Got rough spots there? Youíre not alone. The skinís top layer of dead cells (the stratum corneum) is thicker on knees and elbows, because these parts get bumped and chafed constantly. Apply a good moisturizer with urea, salicylic acid, or an alpha hydroxyl acid. If skin becomes cracked and painful, get a super-sloughing, 12 percent AHA product (now available over-the-counter as Am-Lactin, or the prescription Lac-Hydrin). If that doesnít help, se your dermatologist.
  • What can I do about pimples on my buttocks?
    Little bumps popping out on your butt? This can result from tight-fitting clothes, which can slow the skinís natural exfoliating process and lead to bump buildup. Normally, bacteria sit on the skin, but tight-fitting clothing can rub the bacteria back down into the pores, causing breakouts. Plus, your normal sweat provides a moist breeding ground on which bacteria can proliferate. To fix: wear looser-fitting clothing and wash with an antibacterial soap, such as Dial, Lever 2000, or Oilatum AD. Another remedy is to avoid using any fabric softeners in the dryer, because the fibers left on your underwear can further irritate your skin. Use an AHA lotion to speed exfoliation.
  • Do the best exfoliators have tiny, dry particles in them?
    Although they may feel like theyíre working, exfoliators of this type can actually scratch and abrade the skin. Avoid products containing sharp, hard particles, especially natural ingredients, such as ground walnut shells, apricot seeds, and oatmeal, because all can cause microscopic tears in the skin. Some companies are forsaking natural grains for smooth, synthetic spherical beads. For maximum benefit: gently massage scrub into wet skin for three minutes and rinse with tepid water.
  • Should you apply alcohol to oily skin to reduce oil?
    Never. Alcohol dehydrates skinís upper layers and alters its pH balance, leaving it susceptible to breakouts. In fact, it may cause glands to work harder to replace the lost oil.
  • How do I take care of my lips, so they donít chap?
    To soothe dry, possibly chapped lips, slick on a lip protector. Follow with just a dab of a lip-toned lipstick for the most natural look possible. Be careful about the lipstick you use. Matte lipsticks, which lack certain moisturizing ingredients, tend to leave lips parched Ė especially in cold weather. The same holds for lip balms that contain phenol, which also can be too drying. A better choice: lip gloss or a cream-based lipstick fortified with aloe, mineral oil, or vitamin E (try Cabotís). To keep lips smooth, always wear lip balm on its own or under your lipstick. Look for a balm loaded with emollients, such as petrolatum, lanolin, and cocoa butter. Balms work in two ways: they create a barrier against the harsh elements, and they seal in moisturizer.
  • What are all these blotches and splotches on my face, and how can I get rid of them?
    Brown spots and freckles are caused by the sun. Either you havenít always worn sunscreen, or your sun sensitivity is heightened due to an increase in estrogen from birth-control pills or pregnancy. Future spots are preventable with sunscreen, but to tackle the ones youíve got, try incorporating into your routine AHAs or a cream from the vitamin A family. Hydroquinone is also an effective bleaching agent (found over-the-counter in Bioelements Pigment Discourager as well as in the by-prescription products Lustra AF, Eldoquin, and Melenex). A word of warning: in darker skins, hydroquinone may create the opposite effect of making skin even darker. New skin lighteners containing botanical extracts combined with vitamin C and AHAs eliminate that problem. Red areas are usually blood vessels showing through the skin, a form of rosacea. The causes are almost anything that makes skin flush: alcohol, spicy food, exercise, sun exposure. Over time, the vessels become permanently dilated. Trying to avoid some of these sources is one way to calm your color. A doctor can also prescribe topical or oral antibiotics that can diminish redness.
DID YOU KNOW THAT... There are 400 to 900 sebaceous glands per every square centimeter on your face, and 100 per square centimeter on your trunk, arms, and legs.


From "Beautiful Skin" by David E. Bank, M.D., with Estelle Sobel