Are You Self-Consciousness About Your Acne?

Everyone is self-conscious about something. But sensi­tiveness about one’s appearance is likely to be particu­larly strong in young people. The girl who is a little overweight wishes she were thinner. The boy who is short does everything he can to make himself appear taller. As the saying goes, “The grass is always greener on the other side of the fence.”

It has already been said that starting shortly after the age of twelve there occurred an increasing interest in the way you looked. Before this period, it made more differ­ence to your parents than to you whether your face was clean and your hair combed. But from this time on, you became increasingly self-critical of your appearance.

Because of this change in attitude, everyone with acne is seriously concerned by the way his appearance is being affected. Many an hour is spent squeezing out black­heads. How many times a day do you examine your face in a mirror hoping that it will look better than it did an hour before? Restless nights are passed worrying that a new lesion will appear just before that all-important date. It may even be that not a day goes by without your dreading the thought of going to school or the office. Suppose someone should make a remark about your face or, even worse, talk about your appearance with friends!

Because of what they consider an unsightly appear­ance, young men and women with acne develop feelings of self-consciousness which are greater than they might have ordinarily. These feelings are so common that you can be sure that everyone with acne has experienced them. Just knowing that self-consciousness occurs in others with and even without acne may be of some con­solation to you.

But let us see if we can clarify the problem more by explaining why young people are so sensitive about their appearance. First of all, while it is true that no one likes to have an eruption on the face, not everyone suffers the same amount of self-consciousness from it. It may be com­pared to the difference in discomfort from an itching skin rash. The itching will drive some people frantic, while others are only slightly disturbed. Generally speak­ing, the way one reacts to itching, or the amount of self-consciousness that one has with acne, depends on one’s frame of mind. You know that when you are worried and unhappy about something, you are irritable and easily upset by trivial things. These same things would not bother you at all under happier circumstances.

What about this business of being so sensitive? How does one get to be this way? The way you react through­out your life to any given situation, good or bad, depends on the early experiences of your childhood. If you were fortunate enough to have an ideally happy childhood, it is likely that you will not be unduly sensitive. Your reac­tions to life’s ups and downs will be taken in stride and it will take an awful lot to hurt your feelings. On the other hand, if childhood was a nightmare of fears and unhappiness, the opposite will be true.

Among other things, you will have a tendency to be easily upset and impatient at not immediately having what you want when you want it. Underlying feelings of inferiority and lack of self-confidence will be shown by your self-consciousness, unsureness and over sensitiveness.

Now it is not quite as simple as this. First of all, most of you have had neither completely happy nor com­pletely unhappy childhoods. Perhaps you cannot remem­ber the unpleasant experiences which occurred in your childhood. We try to push unpleasant experiences out of our memory. But in everyone’s childhood, inevitably, there have been many experiences which, at the time they occurred, caused unhappiness.

These even hap­pened in the happiest of homes. Because of these experi­ences, long forgotten perhaps, everyone has some feelings of self-consciousness. In some they are stronger than in others. None of us is completely free of these feelings, whether we have acne or not.

When you have acne, in a place where everyone can see it, your sensitiveness about the way people react to you is understandably increased. But most of you mag­nify your own sensitiveness and fail to realize that these same feelings are present in others. You are not aware that people can act in a way that covers up their selfconsciousness. Some of your friends, for example, may always appear to be self-confident and happy. Secretly you envy the way they always seem so sure of themselves. They appear so relaxed and at ease with people, while you are trembling inside. Actually, if you really knew their private thoughts, you would find that they have their troubles, too!

The self-consciousness that almost all young people with acne have about their appearance shows that what others think about them is extremely important. This is true partly because you have been brought up to be overly aware of the reaction others have to what you do. We call it making a good impression. It is one thing to be thoughtful and considerate, but this is entirely differ­ent from living your entire life in order to make a good impression.

In the long run, contentment, personal satisfaction and happiness come from within. You must be your own judge and jury. If you are convinced that you have done things to the best of your ability, you will not be so easily hurt by the opinions of others. From such an atti­tude you can derive a sense of self-confidence that no person or change of fortune can ever take away.

With proper attention your complexion can be cleared. Acne is not something which will always be with you. In fact, with treatment, no evidence may remain to indicate that you ever had acne. But while you are re­ceiving treatment, you need not be miserable. Allowing yourself to be so upset certainly will not help your acne and might possibly aggravate it.

Remember that the only way to go through life is with the conviction that what others think of your appear­ance doesn’t alter the kind of person you are. Sure, it is pleasant to have everyone admire you. But whether they do or not must not mean the difference between happi­ness and unhappiness. You cannot rely on the admiration of others to make you feel that life is worth living. If you do, as long as you get this attention you may be on top of the world, but what will happen if it stops? Your confidence in yourself is something which can be with you always.

Try not to be overly critical of your appearance. After all, your acne is only a small part of the whole you. Re­member that the self-consciousness you do have is an oversensitiveness or mental exaggeration of how you think you appear to others.

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What is acne?

Acne Vulgaris: A: Cystic acne on the face, B: ...

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In order to discuss acne properly, it will be necessary from time to time to use medical terms, which will be explained as they are used. But first there is a nonmedical word, “pimple,” which is so commonly used, as well as misused, that something should be said about it if only to explain it away.

It is neither a good descriptive word, since it means different things to different people, nor an accepted scientific term. Therefore, in its place, the correct medical term “lesion” will be used. An acne le­sion is any one of the changes which occurs in the ap­pearance of the skin. The most common lesion of acne, the one that starts all the trouble as you will soon see, is the “blackhead.”

One of the main characteristics of acne is the oiliness of the skin. Sometimes one can see an oily film over the parts of the face where the oil glands occur in greatest numbers, particularly about the sides and front of the nose, chin and forehead. If one wipes his finger over these areas, a film of oil will easily come off on it.

Some of you have probably noticed that if pressure is placed on the side of the nose, you can squeeze out a whitish creamy substance. This is the way sebum looks while it is still in the oil glands and ducts. It only becomes oily as it is secreted onto the skin.

A close inspection of the skin will sometimes show that there are numerous blackheads present. Probably you have been very conscious of your blackheads. Try­ing to remove them is a common pastime with young people. Sometimes they spend hours in front of a mirror trying to squeeze them out. When you do not know how to remove blackheads properly, it can be a rather painful process. Incorrectly removing these acne lesions bruises the skin and causes more damage and a more unsightly appearance than the blackhead itself.

I have seen acne patients come into the treatment room to have their blackheads removed quite certain they are going to be hurt. It is always a pleasant surprise for them to learn that, properly done, it is a painless procedure. Insignificant in size though they may be, these black­heads are at the root of many acne lesions. Therefore, you should know what blackheads are and how they are formed.

You will remember that the oil-gland secretion gets to the surface of the skin through the channels of the hair follicles, which act as ducts. The openings at the end of these ducts on the surface of the skin are called the oil-gland or follicle openings. It is in these openings that blackheads occur.

The formation of blackheads is partly due to the presence of dried and hardened oil from the glands below which makes a plug at the opening of the duct. Contrary to popular belief, the dark color of blackheads is not from dirt. That is why blackheads can­not be removed simply by washing. The black discolora­tion comes from chemical changes in the composition of the dried, fatty plug due to exposure to air over a period of time.

Another reason why blackheads form is that the fol­licle openings may become obstructed by the overgrowth of the horny-layer cells. When the layers of the skin were described, it was mentioned that in acne the horny-layer cells in and about the follicle openings reproduce at a greater rate than they die and shed. Now we see that one of the results of this is the clogging of the follicle open­ings. This horny-layer growth, occurring as it does in millions of these openings, gives the skin a coarse, gritty feeling and a dusky or dirty appearance. It is going to take considerably more than mere scrubbing of the skin to help your acne.

The tender inflamed lesions containing pus which are so typical of acne arise in slowly progressive stages start­ing with these simple blackheads. When the plugged oil-gland openings containing the blackheads and the skin immediately about them become swollen, inflamed and tender, they are called papules. As these papules get worse and enlarge into more intensely inflamed lesions containing pus, they are called pustules. By the time the inflammation of an acne lesion has gotten to the point where papules and pustules are formed, the blackhead may no longer be visible. In fact, many papules and pustules occur without a blackhead ever being seen.

Invisible plugging deep down in the oil-gland duct is the cause of many inflammatory acne lesions. If your acne eruption has been present for many months or years, most likely there will be other lesions present besides blackheads, papules and pustules. You know already that due to the formation of blackheads the oil-gland ducts become plugged.

The plugging pre­vents the sebum from getting to the surface of the skin, yet the gland keeps right on manufacturing and pump­ing out more oily material. Often there is only one thing that the gland can do with all this backed-up secretion, and that is to balloon out. Due to this injury to the gland it is very easy for a bacterial infection to get started. Eventually the infection produces an inflamed, tender, pus-containing, saclike structure under the .surface of the skin. This is called a cyst. Sometimes infection does not occur; then the cyst appears as a firm, cream-colored papule which contains fatty material but not pus.

Most cysts are about the size of a large green pea. But sometimes they can get as large as a walnut or even larger. The bigger they are, the more local damage they cause to the skin. The number of cysts that are present in an acne eruption varies. There may be only an occa­sional cyst in an area like the back of the ears, for ex­ample, or there may be many cysts scattered throughout the entire acne eruption. The destruction that these le­sions cause to the deeper layers of the skin very often re­sults in scarring.

Scarring is due to an overgrowth of the connective-tissue fibers of the dermis at the site of formerly active acne lesions. At first the connective tissue attempts to wall oflf the inflammation and infection to prevent them from spreading. Later it replaces the parts of the skin which have been destroyed. Scarring does not always occur in acne. Most papules and pustules and even some cysts eventually heal without leaving a scar. But certain pustules and some cysts which have been present for a long time cause a lot of damage to the deep layers of the skin and usually leave broad, flat scars.

Another type of scarring which occurs is best de­scribed as a pitting of the skin. The pitted appearance is due to the scarring and enlargement of the oil-gland openings from many months of plugging and inflamma­tion. The inflammation destroys the elastic fibers of the dermis. When the skin loses its elasticity, the oil-gland openings cannot close. These changes in the skin are usually seen about the nose and cheeks.

In some instances, as though enough harm had not al­ready been done, the scars themselves have a tendency to overgrow and thicken, becoming cordlike, and when they do, they are called keloids. Keloids usually occur in acne of the chest and back when there has been severe inflammation and infection for many months.

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