FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER WITH ACNE ON THE BUTTOCKS MAY NEED NEW CHAIR

Question: I'm 35 years old and have recently developed acne on my butt and the back of the upper parts of my legs. I don't have it any place else. I had very little trouble with acne when I was a teenager. Why do I have it now, and what should I do to get rid of it?

Answer: Acne is a very common skin condition. Eighty percent of all teenagers and 5 percent of adults have it. Acne is most common on the face, but is also frequently found on the shoulders, back, chest and even, as you can attest, in more "private" areas.

Acne is caused by infection and inflammation of oil glands in the skin. A normal oil gland produces sebum, the skin oil, which then is distributed over the skin and hair. In acne this process is changed by the influence of hormones and the presence of bacteria. These factors can lead to a blocked gland which forms the common "white-head" pimple. An abnormal gland that is not totally blocked forms a "black-head" pimple. One in which there is inflammation in the gland forms what doctors call "pustular or cystic" acne.

Most teenagers suffer with "white-head" pimples primarily because of hormonal stimulation of oil glands. Most have clearing of the condition by their early 20s as the raging hormones of adolescence settle into adult realms. You, however, have a different cause for your acne. Your condition is undoubtedly due to the changes in normal skin bacteria of the legs and buttocks. This typically results from sitting on vinyl covered chairs for much of the day. The acne occurs in areas where the chair keeps both the temperature and moisture levels of the skin above normal.

Acne treatment, when possible, is directed at correcting the underlying cause of the condition. In your case, changing to a chair with fabric upholstery will be a significant help. Additional medical treatment - which is the same for acne in any region of the body - consists of using drugs to:

help remove the buildup of excess dead skin cells (Benzyl peroxide, sulfur, resorcinol),

inhibit bacterial growth on the skin (Benzyol peroxide, tetracycline, erythromycin, clindamycin),

inhibit growth and inflammation in the follicle (Retin-A),

inhibit the production of sebum (Accutane),

and modify hormone levels to lessen oil secretion (estrogen dominant birth control pill, aldactone)

Most individuals with acne can have good relief from their condition with one or more of these treatment methods. For adolescent acne, treatment usually lasts several years - from junior high to the early 20s. Also, adults with facial acne may require daily treatment for years to keep their acne under satisfactory control. In contrast, you are more lucky and will probably only require a few months of treatment once you change the chair you sit on. Talk to your family doctor or a dermatologist if a month or two of using a non-prescription benzyol peroxide preparation and skin cleanser product fail to give you satisfactory results.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.