DEAR DR. DONOHUE: My grandson, age 20, has had a serious problem with acne since the age of 17. He has seen a dermatologist and tried prescription drugs. He also has tried products advertised on television. Nothing has helped. I fear his face will be badly scarred. Can you suggest anything? — J.K.

ANSWER: A surge in the production of male hormones in the teen years, an excess of skin oil, plugging of skin pores and a growth spurt of skin bacteria all work in cahoots to produce acne. Your grandson is approaching an age when acne begins to disappear for many, but not for all.

A couple of mistakes people with acne make are vigorously scrubbing their face with harsh soaps and squeezing pimples. Your grandson should use a mild soap like Dove and gently wash his face twice a day. Squeezing pimples forces inflammatory material from the skin pore into adjacent skin. Both of these worsen acne.

Standard acne treatment includes medicines that unplug pores, diminish oil production and kill off skin bacteria.

Retin-A, Retin-A combined with the antibiotic clindamycin (Ziana), Differin (an alternative to Retin-A) and Tazorac (another Retin-A substitute) clear clogged pores, and the antibiotic takes care of skin bacteria.

A combination of benzoyl peroxide and Retin-A delivers a one-two punch of unplugging pores and controlling bacteria.

Other antibiotic ointments and creams are available. So, too, are oral antibiotics given in doses that are lower than those used for most infections. Not only do they eliminate skin bacteria, but they also stop the production of irritating materials that aggravate acne.

If your grandson isn’t making headway with his current dermatologist, he ought to consult another.

DEAR DR. DONOHUE: Is it possible to have good blood pressure and good cholesterol, yet have a failing heart?

My husband, 67, had long had problems with swelling of the legs and feet. You have indicated several times in your column that it can be the cause of heart failure. — R.P.

ANSWER: It is possible to have good blood pressure and good cholesterol readings yet develop heart failure. High blood pressure and high blood cholesterol are only two of many causes of heart failure. They are, however, common causes of it.

Problems with heart valves, inherited heart conditions and past heart infections are some of the other reasons why hearts fail.

Swelling of the feet, ankles and legs is called edema. It doesn’t cause heart failure; it’s a sign of it. A failing heart pumps blood so feebly that the fluid part of blood oozes out of blood vessels and into the tissues of the legs, ankles and feet.

Heart disease is only one cause of edema. Your husband has to see a doctor to find out the exact cause of his swelling so that appropriate treatment can begin.

DEAR DR. DONOHUE: 1. Does taking calcium help osteoporosis? By how much? 2. When can a woman stop getting Pap smears? — W.B.

ANSWER: A bone’s strength depends on its content of calcium. Calcium is standard treatment for osteoporosis. Calcium is hard to come by in most foods other than dairy products. Older people — the ones who are victims of osteoporosis — often take in little dairy foods. Calcium supplements are needed for those people. And vitamin D also is needed; it’s required for calcium absorption. How much does calcium contribute to osteoporosis treatment and prevention? I can’t give you an exact figure, but it contributes a lot.

A woman can forgo Pap smears between the ages of 65 and 70 if she has had three consecutive normal Pap smears and has had no abnormal smears in the past 10 years. This presupposes that the woman doesn’t have multiple sexual partners.

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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