DEAR DR. DONOHUE: You published a letter regarding a case of severe acne. I misplaced the article. My 18-year-old grandson has an extremely bad case of it. I would appreciate it if you would reprint that article. My grandson has tried many things but gets no relief. — S.O.

ANSWER: Your grandson is my grandson. I’ll write a new acne article for him and you.

Three factors work in concert to produce acne. The first is overproduction of oil by skin glands. The overproduction occurs from the stimulus of male hormones that surge at puberty. The oil, along with dead skin cells, plugs the skin pore. Enter here the second acne villain, a bacterium known as Propionibacterium. In the plugged pore, it feasts on the oil, and its population grows. It produces irritating substances that are the third ingredient of acne. An attack on all three usually can control outbreaks.

Your grandson needs to wash his face twice a day with mild soap. Overzealous scrubbing irritates the skin and aggravates the problem. He must not squeeze pimples. Squeezing causes a rupture of the pore with release of noxious material into adjacent skin.

Has your grandson used benzoyl peroxide? It’s in many over-the-counter acne products. He should not expect overnight results. Medicines do nothing for pimples that are broken out. It prevents the formation of new ones. A change for the better takes place in about six weeks. If nonprescription items are not working, then he has to see a doctor. More powerful medications require a prescription. Retinoids are the first step in prescription preparations. Tretinoin and Retin-A are examples. The combination of a retinoid with a skin-applied antibiotic is a one-two punch for resistant acne. An antibiotic frequently incorporated with a retinoid is clindamycin. Oral antibiotics along with skin-applied medicines might become necessary. Doxycycline and minocycline are two oral antibiotics often used for difficult cases.

Either the family doctor or a dermatologist can help your grandson get over a case of acne that has resisted so many other treatments.

DEAR DR. DONOHUE: There are several terms used for damaged back disks. I wonder what the difference in meaning is. Herniated disk, slipped disk, bulging disk, ruptured disk and prolapsed disk are some of the terms I’ve heard. Which are more serious? Can any be left alone?

I’ve been told I have a bulging disk, but am not sure if I need to do anything about it. — M.S.

ANSWER: A back disk (intervertebral disk) is a round affair placed between adjacent backbones to absorb the many shocks that these bones take every day and to increase back motility. The disk has a central core of gelatinous material surrounded by a ring of tough fibers. It’s like a jelly doughnut — sort of. If the encircling ring of fibers is torn, the inner core protrudes through it. That’s a bulging, ruptured, slipped, prolapsed or herniated disk. All those terms are the same thing.

If a bulging disk causes no problems, nothing need be done. Even one that is producing back pain can be left alone to see if the pain resolves by itself. It often does.

DEAR DR. DONOHUE: Something has puzzled me for a long time. I greatly admire Stephen Hawking. How has he lived so long with Lou Gehrig’s disease?

ANSWER: Amyotrophic lateral sclerosis — ALS, or Lou Gehrig’s disease (named for the famous baseball player who came down with it) — is a neurological illness in which nerves that control muscle movement disappear. In time, an affected person is confined to a wheelchair and is unable to talk. Survival usually is a handful of years.

Stephen Hawking was born in 1942. He developed the first signs of ALS in 1962. By 1969, he was wheelchair-bound. He can no longer speak but has a machine that he uses to communicate. His mind is crystal clear, and he still is productive after living with the illness for 48 years. How this has happened is inexplicable. The world is fortunate to still have him and his brilliant mind.

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.

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