Put Your Best Face Forward, Part 1

When Diane York-Goldman speaks online about skin care, she said most of the questions are about acne. But speaking face-to-face before a group in school? It may be on everyone’s mind, but no one asks about it. “There’s so much embarrassment,” she said.

York-Goldman, an actress and model, is co-author with her dermatologist husband, Dr. Mitchel P. Goldman, of “You Glow, Girl: The Ultimate Health and Skin Care Guide for Teens,” (Quality Medical Publishing, 2011, $22.50).

The psychological impact of acne can be so strong that “kids get very depressed. They refuse to go to school, or won’t go to the prom,” said Dr. Debra Jaliman, a New York City dermatologist and clinical instructor at Mount Sinai School of Medicine. “They won’t make eye contact, they’ll have their hair in their face. Acne affects self-esteem tremendously.”

When it comes to getting want you want, it’s not the blemish but the lack of good feeling about yourself that can block the way. York-Goldman, who judges beauty pageants, said, for example in the most recent one she judged, “the winner wasn’t the prettiest girl, but the one who had the most self-esteem — the glow that comes from the inside out.”

If acne is holding your teen back, help him or her take charge of the situation. “There is no need to have acne now with the medications we have,” said Dr. Zoe Draelos, a dermatologist in private practice in High Point, N.C., and a scientist who does independent research for many companies that make prescription and over-the-counter skin care products. “Start with the safest, easiest, most basic treatments and then go to more exotic treatments. There are various options for various grades of acne.”

First Things First
Acne affects both boys and girls, with boys actually having more acne and worse cases of it, York-Goldman said. “And they can’t cover it up as well because they don’t wear makeup.”

The place to begin attacking your teen’s acne issues is by understanding acne better. First of all, it’s not their fault.

There is a genetic propensity to have acne, or not. Though few escape without any blemishes at some point in their lives, some people actually never do break out. But the majority will have some form of acne, whether it’s whiteheads, blackheads, pimples, pustules, cysts or scarring acne.

“Once you have a genetic predisposition, the oil glands are more sensitive to the circulating hormones. Acne is caused by too much bacteria, too much oil deep in the oil glands and by dead skin cells clogging the pores,” said Jaliman, who is a spokeswoman for the American Academy of


You can make acne worse, for example by picking at your skin. But scarring comes mainly comes from being unlucky enough to have scarring type acne, Jaliman said, not from anything you did.

Nor does acne come from being too dirty. In fact, said York-Goldman, we tend to wash too much in this country, irritating the skin and removing essential oils. You only need to wash your face well at the beginning and the end of the day, and after activities such as sports.

It helps to understand how acne emerges, said Goldman, who is in private practice in La Jolla, Calif., and is associate clinical professor in dermatology at the University of California at San Diego. He explains the stages of acne as follows:

In young adults, hormones really get working and stimulate the oil glands to make more oil. Oil glands then empty oils into hair follicles called pores. If you have a genetic predisposition for it, the cells that line those pores become really sticky. Then the excess oil that is produced under hormonal stimulation can’t get out.

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