AcneNet This Month
May 1999

When people with acne ask "What causes my acne?", there is often no simple cause-and-effect answer. The usual causes of acne have more to do with what happens inside your body than what happens from the outside.

However, there are a few types of acne that are caused by external application of comedogenic cosmetics, chemicals or drugs to the skin. These types of acne usually have many blackheads. None of these types of acne is common, but it is important to know about them.

Cosmetic acne is acne caused by comedogenic (comedo-causing) cosmetics. In the United States, most major cosmetic manufacturers label products as being non-comedogenic, and you should always look for those words on the cosmetic label. Your dermatologist also can make recommendations as to (1) whether you should use cosmetics if you have acne, or (2) what cosmetics are acceptable to use.

Pomade acne is caused by heavy hair dressings that are more likely to be sold in local neighborhood shops than in major stores. Some are so-called "hair straighteners". Pomade acne is characterized by heavy outbreaks of comedones on the forehead.

Steroid-induced acne is a type associated with the topical use of steroids. It is important to know about this type of acne only if you regularly apply steroid creams or ointments to your skin. Steroid-induced acne is rare.

Chloracne is caused when industrial chemicals called halogenated hydrocarbons come in contact with the skin. A person who gets chloracne from industrial exposure can "take it home" to other members of his or her family if the chemical is on clothing handled by other family members. If you have acne and have a job that exposes you to halogenated hydrocarbons, you should be sure to tell your physician about the exposure.

Fact of the Month

A recent AcneNet Web site visitor used the Tell us about yourself questionnaire to describe her constant and irresistible need to "pick and squeeze" her acne. She wrote that she "spends hours in front of the mirror, examining every inch of my face, picking and squeezing every blemish, no matter how tiny, that looks like a blackhead or whitehead. As a result my face is always full of little red marks where I irritated the skin by squeezing. I wish I could stop doing this, but I hate my acne so much I am just compelled to try to squeeze it out of me."

A dermatologist could tell this young woman that she is not alone. Her compelling urge to "pick and squeeze" is common enough to even have a name—excoriated acne. To excoriate means to scratch or abrade the skin—thus, acne that is scratched or abraded is excoriated acne.

Excoriated acne often appears to other people to be a mild form of acne, without pustules, nodules or cysts. To the person with the acne, however, it may be intolerable for a variety of reasons. Excoriated acne is a medically well-recognized condition that should be discussed with a dermatologist. Occasionally giving in to a temptation to squeeze a blackhead is not defined as excoriated acne. Hours in front of a mirror, squeezing every blemish, is a sign of excoriated acne that requires the attention of a dermatologist.

Question of the Month

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

Why does it take so long for the redness to go away after an inflamed acne lesion heals?

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

Answer to Last Month’s Question of the Month

Last month’s question was:

I have both blackheads (open comedones) and whiteheads (closed comedones). The whiteheads sometimes become inflamed and painful, and take weeks to go away. The blackheads are just unsightly. Why can’t I squeeze the blackheads to improve my appearance, and pop open the whiteheads before they get inflamed?

Squeezing blackheads and whiteheads might seem to be a simple, direct method of comedone control.

But, the question "to squeeze or not to squeeze" can be answered in one word—Don’t.

In the first place, squeezing out the oily contents of a comedone does nothing to keep new comedones from forming. Squeezing is a temporary method of comedone control.

Most importantly, squeezing can produce a worse problem than it solves. When you squeeze a comedone, the pressure of the "squeeze" can force the contents of the comedone downward and deeper into the skin follicle, as well as upward and out onto the skin surface. Bacteria contained in the comedone can become the focus for inflammation deeper inside the skin. As simple and direct as squeezing might seem to be, it is not a recommended method of controlling comedones (click on Acne treatments for a discussion of recommended methods for treating acne)

Likewise, you should never try to open a whitehead with a needle or other sharp instrument. Bacteria almost surely will be carried into the whitehead from the surface of the skin, and they may be bacteria that can cause truly serious infection.