AcneNet This Month
June 2000

Hair styles change frequently, especially among young people. When hair styles change, it is natural for teen-agers and young adults to try their best to adopt the new style.

When a hair style requires the use of a thick, oily dressing called a pomade, one of the undesired side effects of pomade use may be "pomade acne".

Here is a photo of typical pomade acne:

[Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides, and the Sulzberger Institute for Dermatologic Education]

Most if not all pomades fall into the category of comedogenic (acne-causing) cosmetics and hair dressings. The heavy oils in pomades can clog sebaceous follicles, setting the stage for formation of comedones. In addition, some of the other chemicals in pomades may be irritating to the skin, contributing to inflammation.

Pomade acne occurs on the scalp, forehead and temples where pomade comes into contact with the skin. It usually consists of comedones, with perhaps a few papules and pustules.

Pomades are generally used when a hair style requires that (1) curly hair be straightened, or (2) hair be "molded" into various shapes. Some pomades are available on the market, some are home-made.

The first step in treatment of pomade acne is to eliminate the use of the comedogenic pomade. When pomade use is discontinued, pomade acne may disappear over time. If it persists, pomade acne should be treated the same as any other acne, with gently skin cleansing (click on Acne treatments for details about daily skin care and acne treatment).

Fact of the Month

A high school football player develops acne on his forehead and chin. A soldier gets acne on his shoulders and back. A violin player begins to be bothered by acne on her neck, just below the ear, at the point where she tucks her violin against her neck when she’s playing.

What could a football player, a soldier and a violin player have in common?

They all have "acne mechanica", acne caused or aggravated by constant mechanical pressure and friction against the skin.

A typical outbreak of acne mechanica is shown in this photo:

[Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides, and the Sulzberger Institute for Dermatologic Education]

The pressure and friction caused by tightly fitting helmets, chin straps, backpacks—and violins—may cause an outbreak of acne or aggravate existing acne and cause it to become more active and inflamed. In the case of a high school football player, for example, the pressure of a helmet and chin strap could aggravate existing acne. In fact, micro-comedones or "sandpaper acne" on a teen-ager’s forehead can be aggravated into full-blown acne by the pressure and friction of a football helmet.

Young soldiers who are sent to serve in tropical regions may get a "double whammy" in regard to acne development or aggravation. In addition to pressure and friction caused by backpacks and weapon straps, the excessive humidity of the tropics can be an aggravating factor.

Acne mechanica is treated like any other acne. If possible, the cause of pressure and friction should be eliminated. This may not always be possible—for example, a professional violinist cannot stop playing the violin. If the cause of acne mechanica can’t be entirely eliminated, a dermatologist may be able to suggest effective treatment.

Each month we pose a question that is answered the following month. This month’s question:

I have friends with acne, and some of them have mostly blackheads and whiteheads and oily skin. I have acne, but my acne lesions usually get inflamed. Why is my acne so different?

We’ll have the answer, and a discussion of the answer, on AcneNet next month.

Last month’s question was:

How early in life can acne develop? Can infants get acne?

A case of neonatal acne (acne in a very young infant) is seen in this slide:

In very young infants, acne or acneiform eruptions usually occur on the cheeks or chin. There may occasionally be small pustules, but the most common acne lesions in infants are comedones and papules.

Acne that develops in a very young infant may disappear within a year, or may persist until age four or five years.

A condition called sebaceous hyperplasia, with some comedones and occasional pustules, is common in infants during the first few weeks after birth. This condition usually disappears in a few months. A temporary increase in gonadal activity can also cause acne in infants for a period of several weeks to several months. Both of these transient causes of acne can be regarded as normal events of growth and development.

The cause of persistent infant acne—acne that persists for longer than a year—should always be investigated. Consultation with an endocrinologist and pediatric dermatologist may be warranted. Causes to investigate include:

• Family history—does the infant’s parents, brothers or sisters have acne, or did they have it at some time? A close genetic connection is a high risk factor for developing acne.
• Sexual precocity—does the infant have a condition that causes very early production of sex hormones, especially the androgenic hormones associated with acne? The possibility of sexual precocity requires medical attention to prevent or moderate disabilities linked with very early sexual development.
• Growth and development abnormalities—are there any indications of problems with mental or physical development? Very early acne can be part of a developmental abnormality.
• Drug-induced acne or acneiform eruption—has the infant had any contact with a drug that can cause acne or acneiform lesions; for example, steroids or iodine-containing drugs?

Treatment of transient infant acne is usually with topical agents and gentle skin cleansing. Only rarely, in very severe cases, are antibiotics or isotretinoin prescribed.

Treatment of persistent infant acne may include treatment of an underlying condition.