Pimples or zits, as they are so commonly known, have been considered the bane of teenage complexions since the early 20th century. Whether teens and young adults pop them, cover them with makeup, or use a steady stream of commercial products, much time and money has been spent trying to reduce the appearance of blemishes. An obsession with breakouts reflects the degree to which acne is associated with unclean or impure thoughts: in the early 20th century, popular belief held that acne was a sign of some internal spiritual struggle or sexual immorality. This only fueled the need to combat acne medically, because young women were particularly concerned with their reputations and did not want to be seen as immoral. Acne, physical beauty, and marriage were inextricably bound, and girls sought treatments for acne because they feared that without clear skin they would wind up as spinsters or old maids. Boys and men were also the target of innuendos. Male acne sufferers, for example, were called pansies, and it was assumed that they engaged in questionable activities like masturbation. Acne, when not seen as a spiritual concern, was an indicator of dirtiness, linked with the lower classes, especially at the turn of the century when scientists and Progressives began to talk about germs and the unsanitary conditions of the working class. Today it is known that acne is not caused by dirt, but rather by bacteria. However, some of the most effective treatments are available by prescription only and can be quite expensive. Thus, acne can still be seen as an affliction of the lower classes, those who cannot afford the pricey treatments to attain clear skin and are more likely to be subjected to critiques of lifestyle.
Causes and Types
Acne vulgaris is a skin disease caused by overproduction of the sebaceous glands surrounding hair follicles. There are different types of acne that vary in severity, but all acne lesions can pose problems for the afflicted. Acne is most common during adolescence, but frequently continues into adulthood. For most people acne begins to disappear once they are in their early 20s. Acne usually forms on the face and upper neck, but the chest, back, and shoulders can also be affected. The sebaceous glands are found on the face, neck, back, and chest and produce sebum, which is necessary for keeping skin healthy. If one of these follicles, or pores, gets clogged with impurities or dead skin cells it can lead to a buildup of sebum, which causes a pimple to form.
Acne pimples come in many forms and vary according to the severity of each case. Non-inflammatory acne is defined as acne lesions that are not accompanied by redness of the skin. The most common forms of non-inflammatory acne are blackheads and whiteheads. Blackheads are blocked pores, which have a dark appearance. Whiteheads appear as small white bumps on the skin. Papules are the mildest form of inflammatory acne and appear as small pink bumps on the skin, which can be painful to the touch. Pustules and nodules are the most severe forms of acne. Pustules are small, round lesions that are inflamed. Nodules are large, painful lesions deep within the skin. These will sometimes last for months and often harden into cysts. Some forms of acne are caused by hormone imbalances and can be treated with hormone therapy or the birth control pill. Periodic flare-ups of acne in women can be traced to hormonal imbalances as part of the onset of puberty, the menstal cycle, or pregnancy.
In the early 20th century, an emerging advertising industry began to target young people with acne, who were part of a new teenage consumer market. And although youth have relied on many do-it-yourself remedies, over-the-counter medications became the preferred and most widely available treatment. These treatments include the use of sulfur, salicylic acid, and benzoyl peroxide. Sulfur has been used in the treatment of acne since the 19th century and works simply by absorbing excess oil on the skin’s surface. It is a common ingredient in facial masks and many other over-the-counter treatments. Sulfur is one of the mildest acne treatments, but is not as commonly used as others due to its smell. Salicylic acid is a mild acid that encourages the shedding of dead skin cells. It works well for milder acne by keeping pores from becoming clogged and is the most commonly available over-the-counter treatment. For the more severe cases of acne, harsher and more effective medications have been sought out. In the 1920s, benzoyl peroxide began to be used by dermatologists and became available over the counter in the 1950s. Clearasil, a popular brand of acne medication, first appeared on the scene just as complexion-conscious baby boomers were coming of age in the 1950s. Benzoyl peroxide works by killing the bacteria P. acnes that causes outbreaks. It also reduces the number of blocked pores by working as an antiseptic. One of the more effective but controversial treatments is isotretinoin, sold under the brand name Accutane. It is considered to be a last-resort treatment for patients who have tried everything else with limited or no results. Accutane was introduced in 1982 and continues to be a popular treatment for patients suffering from moderate acne to severe nodular acne. While it has been considered a breakthrough miracle drug for the treatment of acne, Accutane has been known to cause serious side effects and has therefore remained controversial. In some cases, the drug causes a worsening of the symptoms before an improvement is seen and, in women, has been linked to severe birth defects. In some cases, use of the drug has been linked to an increased risk of depression.
Natural treatments such as the use of tea tree oil in place of the harsher chemical, benzoyl peroxide, may be effective in some cases. Caring for one’s overall health is also recommended. This includes drinking the recommended daily amount of water in order to flush the system and to keep skin moisturized. It is widely accepted that the most effective means of combating mild to moderate acne is to simply keep the skin clean and to refrain from touching one’s face. A lot of the greener treatments have become popular as a result of a renewed focus on natural health and the rejection of harsh chemicals in beauty rituals. These natural remedies are often more expensive than the traditional treatments, and therefore have yet to tap in to the teenage consumer market.
There are many popular theories as to what actually causes acne, but youthful indiscretions have often been blamed because it tends to peak during the teenage years. To be sure, these theories have changed over time as part of a constantly evolving medical, political, and cultural discourse. For example, sexual immorality is no longer readily linked to poor complexions. Instead, parents are more likely to urge their children to avoid eating greasy food or chocolate, thus holding teenage self-indulgence accountable. Although this has been disproven, poor eating habits remains the most popular explanation, blaming blemishes not on bacteria but on the lifestyle choices of children and families. In reality, effective treatments are expensive and time consuming and, much like unnaturally white teeth, they reveal less about the daily habits and much more about a segmented market that reflects the growing division between those who can afford costly beauty treatments and those who cannot.