DEAR DR. DONOHUE: I have a gorgeous 19-year-old daughter who has acne. We hear it is due to heredity and hormones. We go to a dermatologist and get fair results. Tetracycline doesn’t work. We hear birth-control pills are good. Any suggestions? — J.P.

ANSWER: An attack on acne centers on oil production, clogged skin pores and the bacterium P. acnes. Heredity has a hand, but heredity has an influence on most medical conditions. Oil production is linked to the production of male hormones. Women do make them. Puberty is the age at which all hormone production goes into high gear. Acne pretty well peaks between the ages of 15 and 19 and usually is gone by age 25, but not always.

The skin pore is the home of oil glands and hair. The hair can be so delicate that it’s not seen. Male hormones increase the production of oil. The excess oil solidifies in the pore and plugs it. As the production of oil continues, the pore bursts and spreads oil material and bacteria into the adjacent skin. A pimple is born.

Mild acne often yields to topical treatment. “Topical” indicates that medicine is applied directly to the skin. Benzoyl peroxide, an over-the-counter liquid, has an antibacterial effect and can be applied twice daily. It’s often used in conjunction with retinoids. Retin-A is such a drug and comes as a cream, gel or lotion.

For more-severe acne, topical antibiotics like Cleocin and erythromycin are added to the program.

The birth-control pill is an excellent idea. It cuts down oil production.

In resistant acne, oral antibiotics are prescribed. Tetracycline is one, but not the only one. Doxycycline in a 20-mg dose, far lower than used for bacterial infections, controls the inflammation of acne and is quite useful and safe.

One aspect of female acne is worth considering. If female acne doesn’t respond to medicines and if a girl is in or approaching her 20s, the girl should be checked for the level of male hormone in her blood. She could have a separate condition that’s causing its overproduction.

DEAR DR. DONOHUE: Two days after Christmas I developed a slight sore throat. The next day it disappeared. However, I felt tired and in a few days I had a cough, which got better on its own. I had been with my grandson the day before I felt sick. However, about nine to 10 days later he got a cold and fever. My doctor said it was not from me. My daughter-in-law believes I transmitted it to the youngster. I am upset by this. She and my son are first-time parents and are obsessed with the child, 18 months old, not getting sick again. — R.C.

ANSWER: People love to track down the miscreant who spread a cold. It’s a process that almost never identifies the correct source. It makes the accused feel like a felon, deserving of the guillotine.

The incubation period for a cold, the time from infection to the appearance of symptoms, is 24 to 48 hours. Your grandson didn’t catch the cold until nine days after you left. You didn’t transmit it to him.

Your son’s and daughter-in-law’s obsession with protecting their child from all sickness and infections is not realistic. It could be unhealthy. Exposure to a variety of bacteria and viruses is the way we develop immunity to them.

DEAR DR. DONOHUE: I am 70 and a recent CT scan of my abdomen revealed I have intestinal malrotation. It’s the first I learned about it. Does it subject me to any health risk? — N.S.

ANSWER: Malrotation, the position of parts of the digestive tract on the opposite to normal side of the abdomen, can lead to two complications: twisting of the intestine (volvulus) and obstruction of the tract. Both require immediate surgical correction. Most occurrences of these complications occur in infancy. You have live 70 years with malrotation and haven’t had a single symptom. You are not likely ever to have any trouble from it.

Malrotation occurs during fetal life.

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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