DEAR DR. DONOHUE: I am a 15-year-old girl with less-than-perfect skin. My back, chest and face break out constantly. My mom suggested taking birth control pills, but I am hesitant. Fifteen seems too early. My mom was recently hospitalized for a blood clot, and the doctors said it could have been caused by the birth control pill. I currently am taking minocycline, but it doesn’t always work. What should I do? – H.F.

Fighting acne involves conducting warfare on many fronts. One front is the overproduction of male hormone that occurs in puberty and at other stages of life. Male hormone stimulates the production of oil – another front. It also causes thickening of skin cells that clog skin pores – another place where you have to battle. In time, the skin pore ruptures and releases irritating oils onto the skin. A skin bacterium, Proprionibacterium acnes, has a role in acne, and it too has to be fought.

You wage war on these forces by gradually escalating the treatment against them. Over-the-counter medicines with benzoyl peroxide or salicylic acid are turned to first. They can unplug clogged skin pores.

The next step is medicines related to vitamin A, the retinoids. Retin-A, Adapalene and Tazorac are examples. They’re applied directly to the skin.

Next are antibiotics in cream, lotions or gels that are put on the skin. Erythromycin and clindamycin are examples. They kill off Proprionibacterium, and they counter the irritative effect of fatty acids in skin oils. Oral antibiotics like your minocycline are the next level. The skin bacterium can develop resistance to antibiotics, and that might be where you now are. A switch to another one could turn the tide in your favor. Furthermore, combining treatments applied to the skin with oral antibiotic medicines is a strategy that often succeeds.

Birth control pills work by blocking the action of male hormone. I understand and appreciate your reluctance to take them now. A change in your program, however, isn’t unreasonable.

DEAR DR. DONOHUE: Enclosed is a preoperative letter from a cardiologist. I have underlined the words I don’t understand. What do they mean?

“He is asymptomatic. His EKG shows LAFB. An ECHO shows evidence of moderate calcific aortic stenosis.” – G.W.

“Asymptomatic” means you have no symptoms. “LAFB” is “left anterior fascicular block.” It’s a glitch in the heart’s cables that transmit the electrical signal coming from the heart’s pacemaker. The glitch is in one of the smaller cables, the left anterior fascicle. If a person with LAFB has no symptoms, as holds for you, an LAFB calls for no treatment. “Calcific aortic stenosis” means your aortic heart valve, the valve that prevents blood from leaking back into the heart after it is pumped out, is narrowed and is infiltrated with calcium. Since you have no symptoms and since your heart is working fine, nothing need be done other than follow you to see if the valve continues to narrow or stays just as it is.

The booklet on heart valve diseases explains them in detail. To obtain a copy, write: Dr. Donohue, No. 105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I want to ask about my liver report. I think the bilirubin and SGOT are high and cause my urine to be pale and my eyes yellow. I had jaundice at age 12. What should I do? – W.B.

ANSWER: All your liver tests are perfect. Shake hands with your liver and congratulate it on doing a great job. Pale urine isn’t a sign of liver disease. It’s a sign that you are well-hydrated. Yellow eyes can be a sign of liver trouble. If it happens again, get your blood drawn when your eyes are yellow. If it’s a transient occurrence, it might only be Gilbert’s disease, a condition that shouldn’t be called a disease. It’s an innocuous, inherited lapse in processing bilirubin, a pigment coming from the processing of worn-out red blood cells.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible.

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