Factitious (‘person’-made) Acne

Factitious acne, or facial dermatitis with acne-like spots, is another common modern skin problem which occurs particularly among young women with genetically dry skin. It is most common over the age of sixteen or seventeen (past puberty) in people who may have either had the odd pimple at puberty which then settled down, or have had no previous acne. Its onset coincides with the increased use of soaps, shampoos and time spent in airconditioned offices, centrally heated buildings and airconditioned cars. This type of acne is often itchy and is present on the central parts of the cheek, forehead and jaw line. It sometimes spreads to the shoulders and down the back and does not usually respond well to the accepted treatments for acne. Indeed, it’s often made worse by drying or exfoliating agents, although it may respond temporarily to antibiotics and even to treatment with Roaccutane. However, even after this type of treatment it usually recurs within six to twelve months unless the causal factors are eliminated.

In people who suffer this condition, it’s not unusual to find that they are overheating at night, often sleeping poorly, sometimes extending their hands and feet outside the bed covers during the night, waking up feeling tired, and having uncomfortable eyes (itchy, swollen, scaly, sleepy). When they get up in the morning their hair is often lank, greasy and dull. It can smell and feel ‘damp’ and the scalp can often be itchy and covered in dandruff. People with these problems have usually tried many ‘cures’, but mostly without success.

 

An enzyme system, the fi ve reduction system, which can potentiate the effects of hormones (progesterone/testosterone) on the grease glands, can be increased by recurrent rubbing of the facial skin as occurs during overheating. Hence the cycle of overheating, rubbing and then washing, cleansing and drying can be the unseen perpetuator of the problem.

 

Factitious acne, so called because it is truly something with a lifestyle-based cause, has been found to respond well to cooling at night, avoidance of soaps and shampoos, the use of effective moisturisers (i.e. sorbolene and glycerine) all over the body, and more potent moisturisers (emulsifying ointment with 2–3 per cent salicylic acid—prescription required—mixed with a little water in the hands until creamy) on the upper body, face and scalp. This usually results in the rash settling down and the hair improving, as well as a general improvement in wellbeing and restedness after waking in the morning. The face may be irritable in the early stages, and this may be alleviated by the frequent application of 0.5 per cent hydrocortisone cream mixed with a little water in the first week or so and then slowly reduced.

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