Dear Doctor,

I develop pimples sometimes after or before my periods. What is the cause? What can I do?

Nashiba

Dear Nashiba,

Pimples are small skin lesions occurring due to inflammation of the skin. They present as  small pustules or papules (small eruptions). The eruptions may be black, orange or red. They are itchy and / or painful.

Pimples occur when sebaceous glands become overactive and block skin pores. Sebaceous glands are oil producing glands located at base of hair follicles. They produce an oily/waxy substance for lubrication. The sebaceous glands swell up and become filled with bacteria, swell up and then fill with pus. Parts most vulnerable to develop pimples are the face, chest, back and shoulders, as there are plenty of sebaceous glands here.

Blocked glands contain propionibacterium acnes, a bacteria linked to acne. This microbe is normally present over the skin and is harmless, but under favourable conditions it can multiply rapidly causing inflammation of the skin. Foods with high glycemic index like candies, chocolates, chips, bacon, beef, dairy products, are also linked to pimples. Those with oily skin are also prone to this problem. Using greasy make up can aggravate the pimples. They are also known to be exacerbated by anxiety. Hereditary factors also play a role. Pimples may be present intermittently in some individuals, as in some women they occur around menses and then clear off. This could be due to changes in hormonal balance of body. In some, it is chronically present. Frequency and severity of pimples depends on type of skin, diet, emotional and hereditary factors.

Pimples give an ungainly look and  lower the self-esteem of a person. There is also risk of secondary bacterial infection, causing boils. Scratching or pricking the pimple can lead to permanent scarring.

A person of any age can develop pimples, but they are more common in teenagers as more sebum is produced at this age. Both genders are equally affected. Prevention consists of washing the face at least 2 to 3 times daily, avoiding heavy greasy make up, oily, fatty  food and stress. Some herbs like  basil leaves, margosa leaves, aloe vera turmeric, etc. are useful in treating pimples. The fresh leaves or  powder can be  chewed directly or made into a paste and applied over  the pimples.

Over the counter anti-pimple products contain salicylic acid, benzoyl peroxide,sulphur and alpha hydroxyl acid among others. These products act by removing excess oil and or removing dead cells thus preventing blocking of skin pores. One should be cautious as these can cause allergies in vulnerable people.

Medical treatment of acne consists of antibiotics, laser therapy or derm abrasion. Frequent use of antibiotics for pimples is implicated in causing  antibiotic resistance because  they are used frequently and for long periods. This is a growing concern for the World Health Organisation.