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2B – Daily News – Monday, December 20, 2010 FEATURES Cystic acne difficult to treat DEAR DR. GOTT: My daugh- ter is 18 years old. She has swelling in her left cheek that is now moving into her eye. Her der- matologist says it’s cystic acne. We tried tetracycline and erythromycin, to no avail. What can we do? Your help would be appreciated. DEAR READER: Let’s start with some basic facts about acne. First, despite popular belief, acne can occur to anyone at any age but is most common in teenagers. Because of this, it is thought that hormones may play a role. For some women, the week prior to menstruation, pregnancy or starting/stopping birth control may also cause outbreaks. Dr. Peter Gott the-counter reme- dies. Most are top- ical lotions or oint- ments. These may contain salicylic or lactic acid, sulfur, resorcinol or ben- zoyl peroxide as the active ingredi- ent. Their primary purpose is to dry oil and aid the removal of dry When pores that con- tain hair follicles become plugged by an overproduc- tion of oil, a buildup of bacteria and/or irregular shedding of dead skin cells, acne can occur. It pri- marily affects the face, shoulders, back, neck and chest because these areas have the greatest number of functional oil glands. There are five types of lesion associated with acne. — Papules are small, raised bumps that may be red and tender, and typical- ly signal inflammation or infection of the opening of the hair follicle. — Nodules are large, solid lumps beneath the surface of the skin and may be painful, indicating infection deep within the hair follicles. — Pustules are red, ten- der, pus-filled lesions. — Comedones occur when the hair follicle becomes plugged by oil and dead skin. When the pore is open, the plug becomes dark and is referred to as a blackhead. When the pore is closed, the lesion is referred to as a whitehead because it remains flesh-colored. — Cysts are pus-filled lumps beneath the skin that are often painful. They are boil-like and are the most likely form to cause scar- ring. Because of this, cys- tic acne is the most severe form of acne and the hard- est to treat. In most cases, a physi- cian doesn’t need to treat acne. If the lesions resist over-the-counter remedies, cover a large area, or are adversely affecting your social interactions or self- esteem, referral to a der- matologist may be benefi- cial. There are several over- skin. Some prescription topicals work similarly to OTC products but are more potent, while others include topical retinoids and antibiotics. Antibiotics (oral and topical) are used to treat infection that may be present and are most commonly used by those with moderate to severe forms. Topical ointments are often used simultane- ously. Oral contraceptives can be considered, espe- cially if menstrual-cycle irregularities are also pre- sent. Chemical peels and microdermabrasion may be helpful. Laser and light therapies may be recom- mended for people who can’t tolerate acne medica- tions. When cystic forms do not respond well to other options, isotretinoin may be considered. It is highly effective but carries some potentially serious side effects, so users must be closely monitored. Women of reproductive age must participate in an FDA- approved monitoring pro- gram in order to receive the drug because of the high risk of birth defects should the woman become pregnant. These effects can last for several weeks after stopping treatment. Home remedies and prevention include using a mild cleanser and warm water to wash the affected areas no more than twice a day. Scrubbing or using strong cleansers may worsen the condition. Avoid touching the areas, using oily or greasy cos- metics or sunscreens, and picking or squeezing the lesions. Remove all make- up before bed, keep appli- cators clean, and don’t use outdated products. If the back, chest and/or shoul- ders are affected, avoid wearing tightfitting cloth- ing. Dr. Peter H. Gott is a retired physician and the author of several books, including “Live Longer, Live Better,” “Dr. Gott’s No Flour, No Sugar Diet” and “Dr. Gott’s No Flour, No Sugar Cookbook,” which are available at most bookstores or online. His website is www.AskDrGottMD.com. 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I can Repair/Remodel, Build Practically Anything FREE ESTIMATES 530 949-6162 CA LIC#914460 Septic IT’S NOT SO PLUSH WHEN YOU CAN’T FLUSH! Septic and Leach Field problems? Call Bill (530) 526-2216 Pastor’s prayer position perturbs parishioner Dear Annie: My husband and I belong to different churches. He’s been a member of his for 50 years, and I’ve been with mine for 30. He was recently hospitalized, and someone from his church came to visit, as did my pastor. But when I spoke to my pastor, she said she did not think it was good church ethics to pray for a non-member, so she didn’t pray for my husband during his illness. Yet, when someone from his church visited me when I was hospitalized, they had no problem praying for me. I am a choir member and the church secretary, and I do whatever I can to help my community. I was disappointed to hear my pastor’s words. No wonder people don’t want to attend church. How do I get over this? — Disappointed Church Member pastor, and explain how upset you were that she could not bring herself to pray for your husband’s health and recovery because of his church affiliation. That isn’t church ethics. It’s church politics. And a Dear Disappointed: Talk to your Annie’s Mailbox by Kathy Mitchell and Marcy Sugar Dear Annie: My 30-year- old sister is mentally ill and currently lives with my mother. ‘‘Stacy’’ used to live in her own place, but in the past six years, she has become gradually more dependent. She refuses to go anywhere alone and will no longer use the telephone or Internet at all. She has no interaction with anyone outside the immediate family. I’m concerned about Stacy’s well-being, but I’m also worried about my mother, who has become her caregiver. Mom works 80 hours a week and has health issues and needs all the sleep she can get. Stacy shares a room with her and wakes her up frequently during the night to tell her about the voices she’s hearing and the symptoms she’s having. She’s very demanding and won’t leave Mom alone for five minutes. I don’t know what to do. I fear for my sister’s future. My mother says she will eventually live in a group home, but anytime the subject is brought up, Stacy gets angry and says she’ll never go. She doesn’t recognize that she has an pastor should know the difference. illness and is always going off her medication. She’s been in the hospital repeatedly. There are no other family members to take care of Stacy, and even if someone offered, she would refuse. Any advice? — Blame the Disease, Not the Person Dear Blame: It is not uncommon for those with mental illness to prefer to be unmedicated, and sometimes this reluctance can be eased with an adjustment in dosage or change in prescription. Your mother should talk to Stacy’s doctor. Also, please contact the National Alliance on Mental Illness (nami.org) at 1-800-950-NAMI (1- 800-950-6264). They can provide information, referrals and support, and their Family-to-Family program offers education and coping strategies for those caring for a loved one with mental illness. Annie’s Mailbox is written by Kathy Mitchell and Marcy Sugar, longtime editors of the Ann Landers column. Please e-mail your questions to anniesmailboxcomcast.net, or write to: Annie’s Mailbox, c/o Creators Syndicate, 5777 W. Century Blvd., Ste. 700, Los Angeles, CA 90045.