Let’s start off with a definition of a myth. Essentially, it’s a lie we tell ourselves to hide our fear. Suppose we’re frightened of lightning. No problem! We’ll invent a god who walks around the sky and, if he gets upset with anyone, he lets go a bolt or two. Why is this a good idea? As a priest in this new religion, all you have to do is keep the god happy by worshiping, giving me offerings and buying my comic books. So long as the god is happy, you will then be safe. No more fear! Thor rocks! Now let’s apply this to acne. As parents, we feel the need to prepare our children for all the bad stuff that’s likely to happen to them. So we tell them the story of acne. This is a disease so terrible that most affected end up looking like a toad with warts – obviously you want to keep the fear to Disney animation level so mention Princes turning into them and Princesse Fiona secretly being a green-skinned ogre at night. All this recognizes the new social reality. Only those with a perfect skin are acceptable. Everyone else is out of the magic circle in school and only allowed to mix with goths and nerds. To cushion the blow of having unattractive friends, we then tell them the really big lie – that they soon grow out of it and it will never affect them as adults.

The current estimate is that about 15% of the adult population suffers acne. That’s millions of people. Fortunately, the majority of sufferers are women and there’s a big market for selling concealer makeup, i.e. heavy foundation creams and a powder to put on top. Even metrosexual men are reluctant to wear obvious makeup. So why is acne affecting more adults? Here we get into yet more myths as self-appointed experts muscle their way on to television and radio stations to sell their miracle products or latest book detailing Obama’s acne and his loss of popularity. Their explanations range from too much stress in our lives to the diet we eat. This would be helpful if there was any scientific evidence to link either stress or diet to acne. Except there’s no such evidence. It’s all just more myths.

So what can or should we do as adults. For men, washing twice a day with an unmedicated soap is enough to clear the pores. If you want a cheap alternative to soap, use benzoyl peroxide in small amounts. Using too many products to clean your skin can dry it out and make acne harder to beat. For general health and the improvement of your skin, you should also drink less alcohol, quit smoking and avoid a smokey atmosphere. For women, using an oral contraceptive can reduce the hormone level. If this is not acceptable on moral grounds, then the usual self-help approaches to keeping the skin clean are the best. If all else fails and your appearance is so important, Accutane is available. As a woman, remember to take the strongest possible measures to prevent pregnancy. There’s very clear evidence Accutane does cause birth defects in the majority of cases. No one can pass this medical consequence off as a myth.

Thanks to Sarah Palin, we can now put verbs on either side of “baby” and still make perfect sense. In this case, we consumers all want there to be thousands of attorneys around to protect our interests when capitalist corporations sell us products that injure us. It can be a car that just will not stop no matter how hard we put our foot on the brake or a tomato that tries to kill us with salmonella. Just recently, even though we’re nowhere near Thanksgiving, 36 million pounds of turkey meat had to pulled from supermarket freezers around the country because it was dangerous. Cargill’s factory, where the meat was processed, has been closed down. Without attorneys to sue and get damages to cover the cost of our medical treatment, loss of earnings, and so on, we would pay for the product and then pay for our losses. Attorneys are wonderful human beings who deliver a great social service. Unless, that is, you listen to the GOP. To Republicans, attorneys are the spawn of the Devil who threaten to put good profit-earning companies out of business. The right wing believes attorneys are out of control and there must be limits placed on our right to sue those who injure us.

This is particularly hotly debated when it comes to the medical profession and the drugs they prescribe. The GOP wants limits on claims of professional negligence, and even suggests restricting the right to sue should people be injured by drugs or medical devices approved by the FDA. As to the latter, the argument goes that the FDA rigorously tests drugs and devices, and only licenses those that help more than harm patients. On the other side of the fence, we’ve recently had some interesting cases where attorneys have argued patients should be allowed to sue even though they ignored all the safety warnings in the leaflets sent out with the drugs. In one case, the patient acted as a complete idiot and not only took an outrageously high dose but did so for nearly a year. When he found the drug had damaged his stomach, he persuaded an attorney to sue. No one, he argued, can be expected to read and understand warnings put out by manufacturers. Everyone should be allowed to self-medicate and then sue if it goes wrong. Attorneys, you gotta love ‘em – always prepared to take on hopeless cases, gambling there will be prejudiced juries prepared to award damages against pharmaceutical companies.

All of which brings us to Accutane. There have been some cases involving celebrities who, fearing they would no longer be considered beautiful people, used the drug excessively and then tried to complain. At this point, we should note some of the research from outside the US which finds this drug effective and perfectly safe if taken at low dosage. The trials have lasted for up to a year without there being any adverse side effects. So the moral of all this should be clear. Follow the foreign research, take very low doses of Accutane and your acne will disappear. Abuse the drug by taking too much for too long and you will end up with serious problems. Fortunately, if you are injured, there will always be attorneys prepared to take on your case.

It would be wonderful if life could always be fair. We could plan our future, confident we would always get our just deserts. Unfortunately, the world can be uncaring, if not actually cruel. No matter how carefully we plan for the best outcomes, there’s always a chance for things to go wrong. Worse, even if everything goes right, we can end up the victims of jealousy or even hate for our success. Whether it’s at school or in the workplace, people can seize on the smallest things as justifications for treating us badly. It should not be this way, but even the way our body works can end up a trap. We can grow too tall or put on too much weight. We can be too pretty or have a physical disability.

One of the most common excuses for wanton cruelty is acne. As the hormones kick in, the majority of children and young adults find themselves the victims of abuse. Twenty or thirty years ago, this was mostly a problem for teens. Now it’s affecting younger children and lasting longer. That this is unfair could not be clearer. Everyone has the same bacteria growing on their skins and so has the same chance of suffering acne. Yet, no matter who shows the first signs, the others are always waiting to sniff the air to detect body odor and hint at the unwillingness to wash or make even more unkind suggestions for the cause of the emerging spots. At a time when most people lack self-confidence, these personal attacks are extremely hurtful and many suffer psychological damage.

It would be good if acne was a one-time event. We could put the trauma behind us and get on with our lives. But several million women are now discovering acne can return as they pass through the menopause. It should not be unexpected because the same hormonal changes that cause acne during puberty are repeating themselves. As it stands, the medical profession has been slow to respond and so the cosmetics industry has been making excessive profits with products to clean the skin and cover up the spots. For better or worse, our society has placed a burden on women to appear perfect, no matter what their age. So what action should the older woman take? It starts with the use of exfoliates. During and after menopause, skin erosion grows more uneven and so it’s always better to gently remove the epidermis or outer layer of skin to produce a more even appearance and clean out the pores. In turn, this helps control the acne. But only use the most gentle products to avoid drying out the skin. If this is not effective, you can move up to a retinoid cream. Should the menopause continue, using an oral contraceptive will usually calm down the hormone production.

Should all these simple steps fail, Accutane remains as the ultimate cure. Always remember pregnancy must be avoided at all costs so, if you are still sexually active and able to conceive, you must take comprehensive steps to prevent conception. As an older woman, you are in a high risk category for babies with birth defects. Use Accutane and birth defects become a certainty. Take advice before using this drug.