DEAR DR. ROACH: How do pimples form? Why do they itch? How can I remove them? — B.B.
ANSWER: Acne is caused by plugged hair follicles, which are associated with sebaceous (oil-producing) glands. These are more likely to be plugged under control of androgenic hormones; with increased oil production; in the presence of the bacteria Cutibacterium acnes; and with inflammation. These are in turn affected by many factors, such as skin trauma, stress, amount of body fat and diet. Acne is very common in adolescents, but can continue to be a problem in women and men in their 50s and older.
Itching is not common with acne, but tenderness is. Itching is more common with drier skin, and I often see itching in people who are treating their acne with excessively drying treatments. This includes washing your skin with too much heat, too often or with too-harsh a soap. People who have allergic reactions to acne medications or skin creams may also have dry, itchy skin. Sunlight and heat (and the associated sweating) can be triggers for itching. You really want to avoid scratching or squeezing because this can rupture the acne, causing scarring and potential spread of bacteria. All these worsen symptoms.
Acne is better prevented than removed, since the follicles are a normal part of the skin. Your general or family doctor or a dermatologist can help design a program to reduce acne. Vitamin A derivatives, topical antibiotics and benzoyl peroxide may all be part of a treatment regimen depending on your skin and type of acne.
DEAR DR. ROACH: I am a 68-year-old woman recently diagnosed with hearing loss, and I am devastated, to say the least. About a year ago, my doctor told me I have very narrow ear canals — first time I have heard that! — and that it can contribute to hearing loss. I was also told our ear canals narrow as we age. Does that mean my ear canals will continue to narrow and in 10 years I will be completely deaf? — J.B.
ANSWER: The causes of hearing loss are divided into those that cause loss of conduction of sound to the cochlea, which is the organ of hearing, and those that affect the nerves from the cochlea to the brain, called sensorineural hearing loss.
Conductive hearing loss can be caused by a blocked ear canal, usually by buildup of excess ear wax. The ear canal itself can swell due to chronic inflammation or infection. It may also be blocked by tumors, such as bone tumors (osteoma) or a cholesteatoma. The small bones of the middle ear may develop a condition called otosclerosis, which is a very common, and familial, cause of hearing loss.
Unless you have chronic inflammation of the ear canal or a tumor, progressive blockage of the ear canal is quite a rare cause of hearing loss.
Nerve damage, commonly caused by excess loud noise or by aging, is a whole separate cause of hearing loss. Some people have elements of both conductive and sensorineural hearing loss. However, essentially all causes of hearing loss can be treated. An ear, nose and throat specialist, working with an audiologist, are the experts in diagnosis and treatment of hearing loss.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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