Pimple (acne) is so common that it is considered to be a normal physiological reaction unless and until it develops into a boil. Over 80% of teenagers and 1 in 5 newborns have pimples of various forms with varying degrees of severity. Severe pimples can leave behind a trail of blemishes and in some labile persons can affect the self-image. A ‘simple pimple’ therefore can be ignored only at one’s peril.
Diet and dirt as believed by some to be the cause of pimples is not simply true. The skin oil wells (sebaceous glands) start producing lubricating oil (sebum lipid) from teenage years onward. These oil wells are plenty, about 700/cm2 in the face and upper body. It keeps the skin soft and supple and also inhibits some skin germs. When oil glands are overactive as happens in some people, the excess oil (seborrhoea) blocks the pores and ducts of the skin. Moreover, the pore lining cells become sticky in the presence of oil, and they get stuck up further plugging the pores. Thus, the oil products start to swell up in the form of white head (closed comedone) and black head (open comedone).
Another cause of pimples is the skin germ, Propionibacterium acnes which can transform oil into oil acid (free fatty acid). This acid damages the wall of pores allowing it to escape into surrounding deeper tissue causing untold damage in its wake. The resultant painful soft swelling pimple (cystic acne) often ends up in a pit, scar and blemish.
Some cosmetic agents notably old cream, soap and drugs give rise to pimple-like eruptions (acneiforms). Fat, grease, lubricating machine oil, tar, pomade and hair oil also can aggravate pimples by irritating and preventing the escape of sweat and body fluid onto the surface. This type is usually seen in individuals with oily skin.
The oil gland is also vulnerable to the effects of heat and humidity, a life-stress situation, lack of sleep, tension and a sumptuous lifestyle. For this reason, we see pimples flaring up during examination, menstruation, public festivity and upheaval.
Last but not least, it has been found that 50% of the pimple cases gave history of first-degree relative pimple affection. This family propensity is usually observed in severe types of pimples.
The approach to pimple management has to be multi-pronged. Great care a to be taken in choosing the type of medication as its effect on pimples can be damning. One approach is to explain and educate the person about his condition. This will give confidence, motivation and rapport to both the care receiver and provider. General measures as under will benefit the person. Rinse the face morning and evening with water using mild soap and dab the face gently after each rinse to retain moisture. Do not scrub your face as it removes the oil that the skin needs to be healthy and supple. Do not pick pimples. This may damage the skin and leave scars. Avoid facials since they sometimes aggravate the pimple. Carry out moderate exercise every day. Sleep 6-7 hours per day as lack of sleep may open up sleeping pimples. Avoid in-between meals and heavy snacks. Avoid hair oil and pomade. Use shampoo regularly. Drinking not less than 2 litres of water will help open up pores to clear pimples.
It is to be stressed that self-medication and manipulative measures will do more harm than good. Indeed, the affected person overestimates the severity of his pimple, while the physician underestimates its impact on the client.

-Dr. Zamzachin Guite