Blight of Youth

To the anguished adolescent who feels disfigured by the pimples of acne, many doctors merely give a reassuring "You'll grow out of it," and let it go at that. At the other extreme, dermatologists have tried every conceivable remedy--vitamin A, vaccines, soaps, yeast, antiseptics, astringents, diets, hormones, ultraviolet and X rays, warnings against "picking." Despite such efforts, acne continues to afflict vast numbers of adolescents (variously estimated as 50% to 90%), many with skin-scarring, soul-searing severity.

In Britain's authoritative Lancet, acne gets the full treatment from a top Harley Street skin specialist, Robert M. B. MacKenna. Balancing himself between the do-nothing and try-everything schools, Dermatologist MacKenna takes the view that "acne vulgaris is a normal accompaniment of adolescence and is an abnormality only when it ceases to be very mild and is obviously noticeable." For this second type he deplores the it-will-go-away brushoff and gets down to cases.

Pimples & Pustules. Acne, in both boys and girls, is universally associated with an upset hormone balance (male over female hormones) during puberty. (Eunuchs seldom or never have acne.) There is not a shred of evidence for the common belief that acne is a result of masturbation. For some unknown reason, the face, chest and upper back are especially susceptible. There the tiny sebaceous glands, which are designed to secrete fats to oil the skin, become clogged with an abnormally waxy form of these fats. Blackheads and pimples form over the shutdown pores; there may also be pustules, but infection is believed to be the result of the acne, not the cause of it. In severe, persistent cases, the scars left by pimples and pustules can cause lifelong disfigurement.

What to do? Dermatologist MacKenna stoutly holds that each individual case presents its own problems, but he slashes away a lot of old-fashioned injunctions. It is no use, he says, to impose such a strict diet that the victim feels forever hungry and deprived, or to prescribe special face lotions plus shampoos for the unproved relationship between dandruff and acne. Some cases can be cured, says Dr. MacKenna, by moderate restriction of sugars and starches, elimination of chocolate and cocoa in any form, from the diet, and nightly application of a paste containing 6% sulphur, 6% resorcin and 35% zinc oxide. Only those blackheads which can be squeezed out easily should be removed--every five days.

Which Came First? Dr. MacKenna will have no part of theories explaining acne in terms of emotional causes. He has seen much adolescent emotional suffering associated with acne, but it is, he believes, the result and not the cause of the trouble. To him this is sufficient reason for taking the severe case seriously.

Since the male hormone testosterone is believed to trigger eruptions of acne, some physicians have tried treatment with female hormones. But if these have any effect, they also feminize the boy patients. For this condition, as for strokes (TIME, Feb. 4) and for coronary atherosclerosis, researchers are trying to make a female hormone that does not feminize.

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