WHAT kind of a man are you to worry about a few zits on your face? Only women and wimps worry about them. Natural part of growing up. You'll grow out of it.
For many boys and even men in their 20s, 30s and 40s (as many as 5 per cent of men in their 40s have acne), the reality is very different. It's horrible having acne. The painstaking, dreary wretchedness of it. The war weariness of it, advertising disease on your face 24 hours a day. There can seem no private space where you can escape the public gaze and soothe your wounded pride.
Many boys and men with acne get depressed. They often do less well in exams than their peers. Men with acne are discriminated against at interviews and are more likely to be unemployed than their porcelain skinned competitors.
Acne is brutal. It usually strikes when we're at our most vulnerable, just as we're grappling with the messy business of growing up - although it can also start for the first time in older men.
Men have committed suicide because of acne and others have become agrophobic, withdrawing into themselves and terrified even to go out.
How unfair, then, that sufferers must put up with platitudes like "You'll grow out of it" and "Ah, sure it's only a fewspots". If acne can cause physical, psychological, educational, socioeconomic and sexual disadvantage, isn't that enough without the twitters of the well meaning to boot?
Men sometimes suffer from more severe acne than women. This is because acne vulgaris is caused by male hormones which are naturally found in greater abundance in men. Androgenic hormones overstimulate the production of sebum, the oil produced by the sebaceous glands in the skin. This excess of oil blocks the gland, giving rise to a blackhead or whitehead.
Bacteria called Propioni bacterium acnes living deep in the sebaceous glands now get to work. They break down the oil into fatty acids which seep into the surrounding skin. The surrounding skin goes red and a pimple or pustule appears.
It's an old wives' tale that diet causes acne. It doesn't. Consultant dermatologist Dr Gillian Murphy stresses that "diet has nothing to do with acne". And she believes that facial washes are a bit of a nonsense because acne has nothing do with unclean skin. "You don't get it from not washing," she says.
In fact, acne sufferers are likely to clean their skin more often than others. Consultant dermatologist Dr Nicholas Walsh agrees that facials do not have a major role to play in the treatment of acne. But he advises those working in the fast food industry that deep fatfryers can cause or aggravate the condition. He says that older men have less acne than women, possibly because they use cosmetics, which can be a factor, less than women.
Dr Walsh urges men with acne to go to their GP and, if necessary, arrange to see a dermatologist. Treatment, he explains, isn't so much recommended because of spots currently on your face but rather to prevent life long scarring. Scars can continue long after active acne has ceased.
Limerick based consultant dermatologist Dr Bart Ramsay says acne can impede men's formation of relationships, thwart their careers and reduce career options. He stresses the longevity of acne. "Patients can have it for four or five years and wonder will it ever end."
Dr Ramsay knows of men who have given up sport because of the embarrassment of showing their backs covered with lesions. He also points out that acne can have an effect on body fat. In men it reduces body fat while women with acne have a tendency to gain weight. He says drinking lots of water to counteract it is as much a myth as diet and facials.
So what's a guy to do? First, see a GP who can either treat it or refer him to a dermatologist.
Mild acne can be treated with benzoyl peroxide or topical antibiotics. Moderately severe acne can be treated with antibiotics such as tetracyclines. For severe acne, roaccutane is seen as a wonder drug. However, it can only be administered by a dermatologist and its side effects need to be carefully monitored. Excision of cysts can work well as also can chemical peels, but deep chemical peels must be performed by an experienced professional.