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How to deal with bad acne

Okay - acne, spots, zits ... This is a page about how to deal with them. When I was younger, this was a big problem for me, and one thing I discovered was that gibes were more common than sympathy or advice. Also, lots of people regard this as a bit of an icky subject, so it has somewhat taboo. This is my attempt to redress the balance.

I have mainly written this page for people who have a lot of spots, rather than people who get one when there's a disco coming. If you fall into the latter category, you're still very welcome to read this, but some of the solutions might be a bit too drastic for you. I should also point out that some of the advice I give here tends towards the gross side, so if you are squeamish, this might not be the page for you. If you're still with me, onwards ...

Basically, there are three types of spot:

  1. Blackheads.
  2. Whiteheads. Actually, there are two sub-categories here - the little whiteheads, which are a couple of millimetres across, and the ones which sit on top of type (3) below.
  3. Your standard "baked bean" variety - the red lump.

There are three steps to getting rid of spots:

Damage control

Yes, spots look bad. However, you can lessen this to some extent. One way is by choosing appropriate colours for your clothing. As I understand it, the human eye tends to match up things that look the same. This is probably the theory behind eye shadow. Anyway, if you wear red clothes, this will draw attention to the red areas on your face. What you want to do instead is divert people's attention elsewhere. For example, if you have blue eyes, try wearing blue shirts (in the same shade).

Here is an interesting side note. While I still had my spots, I went to Italy for a week on a school trip, in their summer. The other students were using sun tan oil, but I opted against it, on the grounds that I had enough grease on my skin already, and didn't want any more. The result of this was that I firstly got sunburnt, but then the burns turned into an extremely good tan - better than anyone else's. More importantly, my spots temporarily went into remission. My theory is that the grease on my skin acted like sun tan lotion, and was used up by giving me a tan. Excellent! This may be worth trying if you are in a similar situation. On the other hand, I am aware of all the health warnings that say you'll get skin cancer if you don't protect your skin. So far I haven't seen any ill effects, but if I turn up dead then you may wish to reconsider this... The other alternative is that spots are stress related, a theory I've heard. Since I was very relaxed on this trip, that could explain the remission.

Short term techniques

Contrary to popular belief (including mine until recently!), blackheads are not caused by dirt. Rather, they are caused when excess oil blocks pores and then oxidises in the atmosphere. Washing the relevant area will help to remove excess oil from the skin. I have recently heard of a tool you can get to remove them, as advertised in "Home Free" catalogues. This is a vacuum action pump. I have no experience of it myself, but you may wish to give it a go. If you do, please let me know what the results are, and I'll update this page accordingly. There is another tool that dermatologists recommend, called a "Comedone Spoon" ("Comedo" is the medical term for a blackhead) which is made out of metal.

Blackheads are the smallest type of the three, so are less obvious than the others.

Whiteheads contain a build-up of pus, but are still quite easy to get rid of. If they fall into the first category (i.e. they are directly on your face, rather than on top of a red zit), you can burst them with a fingernail. At this point, I should make one thing very clear:


I mean it - never, ever, do this. Believe me, I understand the temptation, but this leads to scarring. As I said, when I was at school I had incredibly bad acne. Nowadays, some people don't believe me, because I don't have any scars on my face. Scars might be better than spots in the short term, but in the long term I'm very glad that I don't have any. Okay, lecture over.

So then, how do you burst them without squeezing? You push them. The idea is that you put your fingernail at the base of the whitehead, and just to one side of it, at about a 45 degree angle. You then move your finger along horizontally, as if you were trying to slide the spot across your face. Since the base of the spot remains fixed, you find that the side nearest to you gets lower, and the side furthest gets higher, as all the pus gets pushed into the far corner. As you keep pushing, it runs out of space, and bursts. Due to the way it is now pointing, you'll get a little jet of white pus that shoots up against your fingernail. I have never seen it get high enough to get onto your finger, so don't worry about touching it. You can then just rinse off your nail under the tap. The whitehead is now gone, and the skin will heal over.

I've been talking about using your finger nail a lot - I've found that the index finger of your writing hand works best for this. You don't have to have huge talons or anything - I keep my nails quite short, and this hasn't been a problem.

Now the tricky bit - the red spots. If it is just a lump, without any whiteheads, you just have to grin and bear it - there's no way to get rid of it immediately. Eventually, you will get a whitehead on it, and you can proceed as below.

If it has a whitehead on top then you can remove it. Basically, you use the same procedure as for mini-whiteheads that I described above, except that you start out with your nail on the red spot, rather than on your face. When you burst the whitehead, you will get the white jet of pus as before, although there will be a bit more of it this time; after all, it is a bigger spot. Whereas you only need to do this once for the smaller variety, you need to do it repeatedly for the red lump type. After you have burst the whitehead, there is a hole in the top of the red spot, so you can push against the side of this. After the first couple of jets, you will notice that instead of being pure white, the stuff coming out is mixed with red. This is your blood. Don't panic! Contrary to what you might think, this is a good thing. I'm not quite sure what this pus stuff is, but I know it replicates itself like rabbits. If you leave any left, the spot will just bloom back up again. You need to get rid of it all. Keep pushing, until you just get blood coming out, without any white in it. You have now eradicated this zit for good! Rinse off your finger, and the broken skin. The blood won't be gushing out, and will clot quite quickly. If you do have problems with your blood clotting (haemophilia?), this may not be the right approach for you...

Long term techniques

First up, you can try the various things that you buy off the shelf at your local chemists, such as Clearasil, Biactol, etc. I tried Clearasil for a while, and it didn't have any effect. I then went for Clearasil Ultra, maximum strength, with the 5 day difference (TM). There wasn't one. According to their adverts, they are always coming out with new, improved, versions, so things might be different now - thankfully I'm no longer in a position to test them.

If this doesn't work, go to your doctor, and ask for antibiotics. I went on a course of oxytetracycline, taking 1 gram per day, two 250mg tablets in the morning, and two in the evening. One thing to beware of is changing doctor mid-course. I was at boarding school when I took these tablets, but I was prescribed them in the school holidays by my doctor at home. When my supply ran low, I went to renew the prescription from the school doctor, who said that the dosage was too high, and halved it. When it ran low again, it was the holidays, so I went back to my home doctor. He said that the dosage was now too low, so I'd have to start the course again; I wasted three months by doing this.

This didn't work for me either, which is quite unusual. I then went to a dermatologist - this is a doctor who specialises in skin. She did an analysis, and found that I had a hormone imbalance. Basically, everyone has male and female hormones. Boys/men have more male ones, and girls/women have more female ones, but everyone has both. It is the male hormones which cause acne, which is probably why this is more of a problem for boys than girls. In my case, although as a boy I should have more male hormones, I had a bigger majority than normal. The doctor said that one option would be to try hormone treatments to correct this imbalance, but this would involve giving my female ones, which would have certain side effects (i.e. I'd start growing breasts). We decided to leave this as a last resort.

The interim plan was some experimental drugs. Well, they were experimental in 1991, when I tried them - they may be more established by now. At the time, they had a success rate of 2 out of 3. These were called roaccutane (the most commonly prescribed kind of isotretinoin). If you get to this stage, you will have to decide for yourself whether you want to risk taking these - don't let anyone else make the decision for you. In my case, they worked, and I have no regrets. However, there was a downside. First up, I had to have a blood test before I started, and then at one month intervals through the course, and afterwards (four months in total). They were checking for the fat levels in my bloodstream, to see whether my liver was still working properly, or whether it had been damaged. The doctor was very explicit in saying that I couldn't drink any alcohol while I was on this course; if my liver was damaged, and I went boozing, I would probably die. In my case, this wasn't much of a sacrifice, as I'm not a regular drinker, but this is something that varies for each individual. Next, there were side effects. The basic idea was that since my skin had all this grease around, in the form of spots, the tablets would dry it out. Unfortunately, they weren't able to focus on the problem areas, so my entire face got very dry, to the extent that I had skin flaking off. I think I had to put up with every leprosy "joke" under the sun ... If one of your reasons for ditching spots is that you don't like being teased, things will get worse before they get better. I would strongly recommend getting a lip-salve stick thing from a company called Neutrogena. They do various products to moisten skin, and are very good. I think they designed their stuff for Norwegian sailors who are out in pretty severe weather, so they are significantly more powerful than your average product. Anyway, the upshot was that these drugs worked, and I ditched my acne. I get the occasional spot nowadays (I'm now 29), but nothing major, and certainly nowhere near as bad as before.


Anyway, I hope that my experiences are able to help someone else. If you have any thoughts on this page, please email me, and I can form a central repository of knowledge.

Update: some of the information here has been kindly provided by CARES (Carers of Acne, Rosacea & Eczema Sufferers). They used to have a very useful website, with some clear illustrations, but it now seems to have sadly disappeared.

Disclaimer: I am not a doctor, so you might want to talk to one - you'll need to get lots of the stuff I've mentioned on prescription anyway. Everything I've said here is true, and has worked in my case; however, I can't guarantee that it will work for you.

This page was last updated on 2003-12-29 by John C. Kirk

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