DEAR DR. DONOHUE: My daughter, who is now 55, has had a serious acne problem since her early teens. About 12 years ago she tried Accutane, which worked for a while but then stopped. Her acne is now so severe that it erupts all over her face. She has just begun a new treatment where her skin is bathed with a blue light. Is it safe? Any advice you can give would be appreciated. – J.W.

ANSWER: About 12 percent of women older than 25 must still deal with acne, so it’s not something limited to adolescents. Your daughter, however, is an exception to the general acne rules in two respects. Female adult acne most often tapers off as women approach menopause. And her acne far exceeds the severity of most.

Acne is due to plugging of oil ducts together with the action of a skin bacterium that thrives in oil. The ducts become distended with oil and eventually break and release oil and bacteria into the surrounding skin. Acne pimples then pop up on the skin surface.

Acne treatments aim to unplug the plugged oil ducts or to reduce the number of skin bacteria involved with acne outbreaks. Creams, gels or lotions like Retin-A, Differin, Tazorac, Azelex and benzoyl peroxide unclog oil ducts. Similar preparations with antibiotics such as clindamycin or erythromycin act on the acne-causing bacteria.

Oral medicines are used when the above medicines, which are applied directly to the skin, aren’t getting the job done.

Medicines that counter the action of male hormones are also useful for acne control. It’s the male hormone that promotes oil production. Birth-control pills are frequently prescribed. Spironolactone, a medicine originally designed as a water pill, has an anti-male-hormone effect and can help rein in acne.

Accutane (isotretinoin) is a powerful acne drug, reserved for the most resistant cases. It’s surprising it didn’t work for your daughter. It has serious side effects and has to be used with utmost caution. It can cause birth defects and is under investigation as possibly contributing to depression and suicide.

Facial peels, which are most often used for acne scars, can sometimes resolve resistant acne. Narrow-band blue light destroys the acne-causing skin bacterium. It’s safe. Its place in acne treatment is being evaluated.

DEAR DR. DONOHUE: I am 77, and I have a bunion that doesn’t hurt. But my hammertoe does. Two doctors have suggested two different surgeries. Through the grapevine, I have heard that lasting pain always follows foot surgery. I would like your opinion. – B.W.

ANSWER: The second toe, the one next to the big toe, is the one that most frequently becomes a hammertoe. The middle joint bends upward, and the tip of the toe bends downward. It looks a bit like a hammer – if you have a good imagination. To me, it looks more like an upside-down V.

A hammertoe won’t shorten life, but it can make it unpleasant. The shoe rubs against the bent portion and creates a callus that can be most painful. Shoes that give the toe clearance provide relief. Pads also help.

If such simple measures don’t work, then a number of surgical procedures can correct the situation. The grapevine is wrong. Seldom does foot surgery leave a person in chronic pain. Most often it completely eliminates it.

DEAR DR. DONOHUE: Maybe you can answer something that I’ve never seen in print. Red wine is said to be beneficial for one’s health. Is there any correlation between the price of the wine and the benefit it confers? Most days I drink a glass of economical table wine that suits my taste just fine. I’m not a wine connoisseur. Would I benefit from pricier wines? – M.W.

ANSWER: The cheap stuff is just as good as the more expensive kinds.

Although many say that red wine is the only alcoholic beverage that serves to prevent heart attacks and strokes, others say all alcoholic drinks – in moderation – confer the same protection. Moderation is one drink a day for women and two for men.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.