Someday, waking up to find a pimple on your face won’t merit more than a momentary shrug. You’ll just take a pill or rub in a dab of cream, and—poof—the pimple will be gone. Unfortunately, that day hasn’t arrived yet. The treatments available today will usually

make pimples go away, but it will probably take days—even weeks or more, contrary to what television commercials suggest.

If you’re like most teenagers, before you decide to seek professional help from your family doctor or a dermatologist, you’ll probably want to try one of the over-the-counter medications you’ve heard about. You won’t have any trouble finding one at your drugstore or supermarket—at least three hundred acne remedies are on the market! Americans currently spend more than $175 million each year on over-the-counter acne remedies.

To most people, fighting acne means grabbing the tube of medication you keep in the medicine cabinet whenever one of those ugly pimples pops up. You rub it in desperately, hoping the pimple will vanish. More than likely, you will be very disappointed.

If your acne is only a mild case, you might shrug and try to live with your pimples, figuring there’s nothing you can really do, anyway. But you’d be wrong there, too. The acne remedies you can buy over the counter can be effective for most people, if they are used correctly.

Doctors say the reason many people find acne medications ineffective is that they don’t use them properly. Acne medications should not be rubbed only on the pimples, but on the entire area where acne occurs. For every pimple you can see, others are just starting and are not yet visible. (Remember, pimples can take weeks to develop.) Some doctors think that if you stick to a daily cleaning routine, followed by the application of one of the acne medications, not only will it clear up your skin, it will actually minimize future breakouts! Now that’s a good reason to begin a plan of attack on acne as soon as possible.

Cleaning is the Way to Start

Cleaning your skin properly before you apply an acne medication can help it to work more effectively. Thorough cleaning with soap and water helps remove excess oil, dirt, and dead skin cells. Many medicated soaps contain sulfur, salicylic acid, or benzoyl peroxide, ingredients that kill bacteria and soften and peel dead skin. Should you use one of them? Some doctors suggest that although these products can be helpful for many people, soaps do not usually stay on the skin long enough for the ”medication” in them to sink into the pores. If you are using an acne medication such as benzoyl peroxide, the extra medication in the soap may be unnecessary.

Abrasive cleansers contain gritty particles that work to gently irritate the skin. They rough away dead skin cells by scratching away some of the outer layers. They can be quite helpful for people with stubborn acne problems. Often they may help get rid of pimples faster. Some people, though, find that abrasive cleansers, pads, and brushes irritate the skin too much. Sometimes the irritation can rupture follicles, causing inflammation and even making the acne worse.

Another useful cleaning product is a facial mask. It is applied in the form of a cream or lotion, which is left on for fifteen minutes or more while the face is soaked with moist cloths or steamed to open the pores. The facial mask can help to clean away dead skin cells deeper than normal cleaning. However, if you use one of these facial masks, you should remember it will make your skin more sensitive to acne medications, because the medication will penetrate deeper—there isn’t as much “shield” to protect the body. Some cleansing masks combine acne medication with a facial mask.

Some doctors suggest to their patients that a mild, fragrance-free soap is really all they need when washing is combined with using an acne medication. Choosing the right cleaning product is something you will have to decide, in light of your own personal preferences as well as the sensitivity of your skin.

How often should you wash your face? Too much washing can actually be bad. Dermatologists generally suggest that twice a day in the winter and three times a day in summer is sufficient. You should use warm water—never hot, which causes the blood vessels in the skin to expand and can add to inflammation. After you gently lather in the soap with your fingertips, you should rinse it off completely. Some doctors suggest rinsing with warm water ten times or more to make sure all soap residue is gone. Then pat dry with an absorbent towel, and your face (or other affected area) is ready for the acne medication.

DECISIONS, DECISIONS . . .

Going to the store to buy an acne remedy can be a little overwhelming. There are so many different products of so many different types! You can choose from countless numbers of medicated soaps, astringents (which are usually alcohol- based for cleaning off excess oil and dirt), abrasive cleansers and abrasive pads and brushes (which work to scrub off the outer layers of your skin very much like the scouring pads you use on pots and pans), acne creams and lotions, and acne cover-up products. How are you supposed to know what you really need?

You can ask other people what worked or didn’t work for them. Unfortunately, what works for some people doesn’t always work for others. And if someone else didn’t use the product properly, his or her opinion may not be valid. The best thing to do is to understand how these different types of products work and what the differences are, take into account your own personal factors—such as how sensitive your skin is—and choose a course of action. Try it out and see how it works. If it works, stick with it. If it doesn’t, try something else.

As you now know, acne is caused by sebum and dead cells clumping together and sticking to the follicle walls as well as by the irritating effects of an overpopulation of bacteria. Acne medications try to counteract the acne process by combating one or both of these factors.

Benzoyl Peroxide: The Over-the-Counter Champ

Many of the acne products of the past contained drugssuch as alcohol, resorcinol, salicylic acid, and sulfur as their main ingredients. These drugs were not very effective, and they tended to irritate sensitive skin. Then in the mid-1970’s, a drug that had been discovered in the 1920’s was tested on acne patients. The results were so dramatic that now the drug—benzoyl peroxide—is the most widely used over-the-counter acne medication and the one most often recommended by dermatologists.

Benzoyl peroxide works in two ways to fight acne. It kills bacteria, and it causes a mild drying and peeling of the skin.

A ”peroxide” is a chemical that contains extra oxygen—more than the usual amount. Peroxides tend to be rather reactive compounds, giving up their extra oxygen at the slightest provocation. When you apply a benzoyl peroxide product to your skin, it seeps down into the follicle. It encounters a variety of natural body chemicals on the way, and chemical reactions occur, releasing oxygen. But the bacteria that produce the oily substance that irritates the skin prefer to live in anaerobic conditions where there is little or no oxygen. The oxygen released from the benzoyl peroxide kills many of the bacteria.

As benzoyl peroxide soaks into the skin and seeps into the follicles, it also produces another important effect. It loosens the dead skin cells that have clumped to the follicle walls, allowing them to be washed away in the flow of sebum. Of course, you can’t see that happening, but your skin will look drier and will gently peel for at least the first month. The technical name for something that causes the skin to peel is an exfoliant. Why would you want your skin to peel? Actually, it isn’t the peeling effect you can see that is helping to clear up your acne but rather the peeling that is happening on a microscopic scale, down inside the follicles.

Not everyone can use benzoyl peroxide. Some find it too irritating, especially those with very fair complexions. Others develop an allergy to benzoyl peroxide and begin to have reactions after using it successfully for a while. Black people and Asians should be especially careful because the peeling effects sometimes cause unwanted dark spots in people whose skin can produce large amounts of melanin. Many acne sufferers must resort to a product that may be less effective—one that contains sulfur or salicylic acid, for example.

Benzoyl peroxide medications come in various forms: lotions, creams, and gels. Gels seem to be most effective, but they are usually available only by prescription. Benzoyl peroxide products also come in different strengths—5-percent and 10-percent solutions. The more sensitive your skin, the lower the percentage you should use. You should always work up slowly to determine how much you should use and how often you need to apply it.

You may find benzoyl peroxide irritating at first, but in time your body may be able to get used to it. One doctor’s suggestion, and perhaps the safest approach, is to start out using the medication once a day, before you go to sleep each night. Rub it gently over the whole area where acne pimples occur, not just on the pimples themselves. Wash the medication off after fifteen minutes the first night. Then, over a week, gradually increase the time you leave it on each night. By the end of the week you should be able to leave the medication on for the entire night. Then, in the morning, it should be washed off.Eventually you might want to work up to twice-a-day applications.

When using benzoyl peroxide, you should experience some amount of dryness and peeling. But if nothing happens, you may need to use a stronger solution or apply it more often or for longer periods of time. If too much dryness and peeling occur, decrease the strength or number of applications.

What to Consider?

Remember when using acne medications not to get them in or around your eyes or lips, or in your nose or mouth. Some people find medications are particularly irritating to the neck, so apply them there with caution if you have acne in that area.

There are some important things to remember when using benzoyl peroxide. Like hydrogen peroxide, it can bleach hair and clothes. So be sure not to get any on your good clothing. Many people find it’s best to wear a white T-shirt to bed, particularly if you are putting the medication on your neck or back. Also be careful when you are in the sun. The sun itself causes a mild peeling, and if sunlight is combined with the medication, peeling can occur at a much higher rate. The results can be quite uncomfortable!

Remember, too, that for the first month almost everyone experiences some amount of mild ”hotness” in the area being treated. However, if the medication causes severe burning feelings and your skin becomes red and inflamed, you should stop using benzoyl per oxide immediately. About one in twenty people are allergic to this drug.

Benzoyl peroxide is sensitive to heat, which causes the drug to lose its strength as some of the reactive peroxide breaks down. Therefore, you should keep it in the refrigerator.

After your skin gets used to benzoyl peroxide, you might want to work up to a higher strength—to 10 percent, for example—or apply it more often. However, be sure to work up slowly to any new strength.

Staying Acne-Free

After one to three months of using benzoyl peroxide in a regular daily treatment, most people find their acne greatly improved, and many find that new breakouts occur much less often. For best results you should try not to miss a day in treatment. You don’t want to give the acne process any chance to begin forming new block-ups in the follicles.

Even after the acne seems to be gone, you can’t just relax and forget about it. Experts suggest you continue using the acne medication at a lower ” maintenance” level. There are no cures for acne. Your pimples may be gone for the moment, but you still have all your follicles, and your body is still producing oil. In time, your population of C. acnes will start multiplying all over again. So if you stop applying the acne medications, acne will more than likely flare up again. Until your body conditions change, you have the best chance of staying acne-free if you stick to a regular program of cleaning and medication.

To Pick or Not To Pick?

Picking at pimples and popping “zits” is a sensitive issue. Almost everyone is guilty of popping a pimple at one time or another. Some kinds of lesions may actually heal faster when they are drained. Blackheads, for example, which are open to the surface, can be carefully drained. Soaking your skin with a wet washcloth first can help to soften the material in the pores and make them easier to drain. The trick is never to squeeze too hard and to stop if the pore does not empty easily. You have to be very careful not to force any material down into the skin. This could cause the follicle to rupture, producing inflammation. Drugstores sell comedo extractors designed for “popping” these pimples. However, many dermatologists suggest that their patients should leave all lesions alone. Picking and scratching and pop ping can lead to inflammation and infection, which could cause scars where ordinary pimples would have healed without a trace. If pimples really bother you, you should let a dermatologist drain the lesions. He or she will know the safest way to minimize problems.

Some people really cannot help themselves when it comes to picking at their pimples. It becomes an obsession. Acne excoria occurs in those individuals who actually dig out every tiny bump that flares up under the skin. This causes scabs and inflammation, which prompt more picking. The result, unfortunately, is often permanent scarring.