Episode 1

A Horror Story

It’s a dark and windy evening. The four friends are sitting in the living room of the old villa. There is rattling and squeaking everywhere, the shutters are flapping against the wall. The only light in the room comes from some candles which throw large shadows across the room. Max wants to read his new horror story to his friends, it’s the one he has been working on for the last few days. This is his first horror story.

Suddenly a clap of thunder is heard. Natalya shrieks. “Oh, my God! I won’t sleep tonight; first a horror story and now a thunderstorm, oh, I hate it!” Natalya doesn’t really like horror stories and is rather afraid of ghosts and creepy things. “But come on, what can happen as long as I am here? I will protect you!” Paolo never misses any opportunity to show his manly superiority. “Do be quiet, you don’t understand,” Natalya retorts, putting the hood of her jacket over her head and withdrawing to a darker corner.
Max starts reading. 

This is Natalya’s chance. What she never seems to manage during the lively camp days, she will try to do now: following a recipe downloaded from the internet she is mixing herself a tincture against her spots. “This is the perfect mixture, your spots will disappear overnight and never come back,” they promised on the internet site . On the way to the villa she had picked the last of the herbs she needs, and now she’ll grind them and put them into the mixture. She opens the glass jar.

“Whoooaaah!”

Thelma is screaming, being carried away by Max’s story. Natalya, who has not heard a word of Max’s story, jumps with fright  and the jar  falls from her hands. It hits the floor with a loud bump and rolls across the room. “What was that?” Heroically, Paolo jumps to his feet and follows the noise. In the dark, he touches something green and slimy. “Eeeeeh! What’s that?”  Natalya covers her face in her hands. The others gather around the thing on the floor. “It’s a jam jar, and there is something slimy and green and awful in it,” Max states matter-of-factly. “Is this yours?” Thelma asks Natalya, the first to guess what this might be about. The boys look at each other bewildered. “Are you trying to poison someone? Maybe some supervisor? But hopefully not us?” Paolo asks interested. Natalya stays quiet for a while, her mind racing. What can she say? Will they really understand, especially the boys? But these are her friends, she owes them an explanation, because what would she do without them in the camp?

“It’s… from the internet…” she stammers, “a recipe… against spots… you know,” she is sobbing now. Thelma puts her arm around her shoulders. “And you thought this would help?” she asks. “They say so,” Natalya is regaining her voice. “Do you know what it’s like to go around with spots all the time? It’s so awful!” She sounds desperate now. “When I get these bouts I don’t want to go out of the house any more and I really hate myself.”

“Of course, I do understand,” Paolo says quietly after a short silence. “My grandma tried all her old recipes on me. Awful stuff – onion and garlic and all kinds of soap and so on, but they were bullshit. In the end, I found out that putting tooth paste on them works rather well. It seems to disinfect or something.” Natalya looks at him, because he seems so much less cool and much more grown-up than usual. “But for some years it was really bad.” He shrugs.

Max, who has been quiet up to now, is asking, a bit embarrassed: “Is it really so difficult to get rid of them ? I thought maybe you just squeeze them, and then they heal and that is that?” Thelma shakes her head. “I have them as well sometimes,” she says, “and they are not that easy to deal with. I went to see a doctor in the end, and his cream helped. But, Natalya, don’t try this poisonous stuff, please. You don’t know what will happen. Maybe you’ll get red spots everywhere, I  had that once.” Natalya looks horrified and stamps the jar with her foot, catapulting it under an old bookshelf. “Okay, okay. Thanks, guys,” she says, still a bit embarrassed. “Why don’t we get on with the real horror story?”

On the way home, Max and Natalya walk together. After a period of silence, Max takes heart and says: “The boys really like you, Natalya, and nobody has ever said  a word about your spots. I don’t think anybody cares.” Natalya starts smiling shyly. “And you know what, if you want to,” Max hesitates a little, “I mean, I can create a story. What do you think if together we write a real “horror story” about acne and being young? I would really like to do that, and maybe we can do it together…?” Natalya smiles more broadly now and she takes Max’s arm . “Yes, why not, that’s a good idea. And I have some horrors to tell!” They walk back to the camp in an understanding.silence.

Interactive

Everything fine with your skin? The latest acne test!

Natalya stands in front of the mirror. It’s already late in the evening. She thinks about the old villa again and the muddle of opinions after her friends had discovered her green „acne potion“. Natalya remembers the typical sayings from Max: “Oh, I thought one should just squeeze the pimples thoroughly, and they are healed the next morning.” And from Paolo: "Squeeze them? Nonsense. Put on tooth paste over night, and the next morning they are gone. A friend of mine does that, and it works fine for him.” And from Thelma: „No, no, guys, are you crazy, that’s all nonsense. You shouldn’t do anything. Or maybe see a doctor?” What do you think?

"What do you know about acne? Are you experts like me because you had to learn perforce? Or are you clueless like Max and Paolo? Or something in between like Thelma? Test yourself. Below you can check your knowledge and have some fun as well! You may choose between three levels (easy, medium, difficult). Try it out."

How to do it: Choose one of the two characters and lend him/her your name. There you go!

		The quiz opens in a new window. So you can always switch between this page and the quiz. Click here to go to the quiz!
		For the quiz, you will need the Flash Player. Download the Flash Player here.
		Everything clear? No? Then read some helpful hints and information here. Then it will be very easy for you. The Hints and Info section also open in a new window. Thus, you will have everything within your view. Press here for the Hints & Info section around acne!

Hints & Info

You all know it: at the age of about 12, with the beginning of puberty, many of you start to get greasy skin, comedones and all sorts of spots and lumps.

Acne is a widespread skin disease that affects especially adolescents aged 12 to 20, but occurs in adults as well. Acne is a disorder of the sebaceous glands caused by the hormonal ups and downs in puberty. Acne affects a very high number of adolescents. You inherit your skin type and other bodily characters from your parents; so how much you are affected by acne may be similar to the level by which your parents were affected in their youth.

For more information: Definition and Origination.

Acne can have unpleasant side effects: it may be painful, for example, and you may have trouble finding yourself attractive for others. And this may really undermine your self-confidence, giving you the feeling of wanting to withdraw from the world and not showing your face any more.
Acne occurs predominantly in the face, the upper body (chest and back) and sometimes also on the upper arms, regions very visible to everyone and difficult to hide.

For more information: Myths and Consequences.

But you can do something against these irksome spots: gentle cleaning and conditioning of the skin are very helpful, and it’s something you can do yourself. Besides you should ask for professional attention by a doctor, a dermatologist or a medically trained cosmetic assistant.
The more you know about the causes and types of acne, the better you can become active and improve your condition.

For more information: Treatment.

One of the most important things, however, is to keep your chin up and strengthen your self-esteem. Who you are as a person is much more important than just your appearance.

Definition

It starts at the age of around 12: the skin becomes greasy and develops comedones, annoying smaller and larger spots and papules. This is called acne. It is one of the most frequent skin conditions in the world. It affects a very large number of adolescents, and adults can get it as well.

Acne is a disease of the sebaceous glands and appears especially on the regions of the body where the most sebaceous glands are located: in the face, on the upper part of the body and on the upper arms.

Sebaceous Glands. The sebaceous glands are located in the dermis and discharge into the hair follicles. They produce an oily secretion (sebum) that is delivered to the skin surface and protects the skin against drying-up. Every sebaceous gland has an excretory duct leading to the skin surface.  The upper part of this duct consists of horn-forming cells.

Acne can occur more or less severely and tends to occur in episodes. Sometimes it is just a bit annoying, but for every third or fourth adolescent it is quite severe, being clearly visible and often leaving scars. Acne starts with the beginning of puberty, i. e. at the age of about 10 to 12, and usually disappears around the age of 18 to 20. Sometimes the acne persists into adulthood or doesn’t occur before that age (e. g. chloracne, acne inversa).

Girls often get spots a bit earlier than boys, as puberty mostly starts earlier in girls than in boys, while boys often develop a more lasting and severe forms of acne. 

Acne types
The word acne summarizes a number of skin conditions that may help to distinguish the different forms of acne: comedones (whiteheads and blackheads), spots (papules, pustules) and sometimes also nodules and cysts located deeper in the skin. More about the acne types:  

1. Acne comedonica
		Whiteheads and blackheads (comedones) appear. The blackheads do not consist of dirt, but it is sebum (oil) that has been colored darkly by the melanine pigments (this is the dark dye produced within the skin). You can imagine comedones like the cork of a bottle: the horny substance blocks the exit of the sebaceous gland.
2. Inflammatory acne
		The blocked exit and the irritation of skin and gland lead to an infection of the sebaceous gland – a spot or papule develops. The infection makes the spots become red and swollen.
3. Nodulous acne
		The infection spreads to the surrounding tissues and leaves scars after healing. Nodules and cysts occur.

Acne can really work on one’s nerves, but there are a lot of things you can do to improve your condition and to reduce the duration of your acne. In this way it makes sense to find out what exactly causes acne and what you can do against it.

Origination

Human skin is a sensitive organ. It reacts to hot and cold temperatures, dirt and dust, sun, stress and touch, internal factors like nutrition and events like hormonal changes and illness.

Hormones. Hormones are chemical messengers that are produced within the human body and sent through the body to initiate certain changes. They are e. g. responsible that we grow, that our heart pounds if we are excited, that boys get a beard and girls get breasts during puberty; and they have an effect on the skin.

In some phases of life, e. g. in puberty, pregnancy, menopause and during the female menstrual cycle, the quantity and the composition of the hormones in the so-called “hormonal metabolism” may change. In puberty it changes remarkably. Especially, more androgens (male hormones) are discharged, in girls as well as in boys.

These hormones cause the maturation of the sexual organs and, as a side effect, stimulate the sebaceous glands of the skin to produce more sebum than usual. At the same time, by effect of the hormones, more horny cells are produced in the excretory duct of the sebaceous glands, and they block the duct like a plug and hinder the increased amounts of sebum from draining off. Thus the sebaceous gland is clogged, the locked-in sebum making it swell.

From outside you can see these horn plugs as white or dark-coloured little domes or points. These are the so-called comedones (whiteheads and blackheads). The dark color is not dirt but results from the dark skin pigment (melanin) within the horny substance.

Bacteria. The skin of every human being is populated by many bacteria that are important to the health of the skin. Among them are the Propionibacteria acnes, a bacterium which is normally harmless on the skin surface.

If comedones develop, this bacterium lives on the increased sebum, multiplies rapidly and causes infections in the clogged sebaceous glands. These start to swell, the skin becomes red and tense, and a white or yellow point becomes visible – a spot has formed (inflammatory acne).

If the infection of the gland becomes more intense, the gland may even burst and distribute its content into the surrounding tissues. Pustules and nodules develop which may be painful and can leave scars after healing (nodulous acne).

Myths

There are a lot of myths about acne that one should know but not take too serious:

Acne is not infectious, in spite of bacteria being involved, as everyone is carrying these bacteria on their skin. Having acne doesn’t mean that one is neglecting one’s personal hygiene. Acne is not an infectious disease and cannot be passed on by hugging or kissing.

It is very important to keep to a regular and gentle cleaning of the skin, according to one’s skin type, but acne is caused by hormonal changes in the body and cannot be removed by good and gentle skin hygiene.

There is also the myth that acne is caused by eating chocolate, sweets, coca-cola and other food. This is not correct. Acne is not caused by diet.
Should you notice that your skin reacts to certain food, please ask your doctor or dermatologist for advice.

"Sinful thoughts" and masturbation don’t cause acne either.

 

 

Treatment

Acne usually disappears around the age of 18 to 20. But that doesn’t mean that you have to sit and endure passively, but you are able to do a lot of things to alleviate the acne, shorten its duration and reduce the frequency of acne episodes. This will improve not only your skin condition but also your emotional wellbeing!

Acne tends to occur in episodes, which means that it may appear and disappear in the course of weeks and months. This is more often the case for girls, and the episodes are usually related to their menstrual cycle. But boys as well have episodes with stronger acne alternating with periods relatively free of skin problems.

You can reduce these episodes if you gently clean your skin on a regular basis and follow the therapy recommendations of your doctor or dermatologist. But it is mostly not possible to avoid the episodes entirely. It’s good to be prepared, and to be aware that you usually haven’t done anything wrong, but that this is simply the nature of acne. After a while, you will develop a fine intuition for your own body, learn to understand the first signs and be able to react to them.

Which are the measures that can you take against the acne?

Adequate skin cleaning is the first step. More...

Consumer promotion tries to make us believe that the main remedy against acne is skin cleaning. This is nonsense. As a matter of course, you should clean your skin one to two times a day (but not more frequently) with a solution of a mild synthetic detergent. This detergent should possess about the same pH value as the skin, i. e. 5.5, to make sure that the natural protective layer on the skin will not be destroyed. This will prevent an additional infection of the blemished skin with bacteria. If you wash your skin very frequently or if you use soap or alcohol-containing cleansers from the drugstore, this may irritate your skin and even lead to the development of comedones. If your skin tends to shine greasily, you may dab it cautiously with cosmetic tissues during the day. Cleansing products should be applied sparingly and washed off afterwards thoroughly. For helpful hints on how to care for acne skin, please read the pages with general information on skin: Skin care.

How do I best take care of my skin? More...

Try to avoid oily products for skin conditioning, as they may clog the pores and reinforce the acne. Try instead to adapt your conditioning to your skin type (dry / oily). For dry skin, mild products containing moisturizer are recommended, to return the necessary moisture to the skin after cleaning, without clogging the pores. Your doctor, dermatologist or medical cosmetician can recommend suitable products to you. Many of the acne medicaments currently prescribed may be produced in base substances with a conditioning effect. For helpful hints on how to care for acne skin, please read the pages with general information on skin: Skin care.

Make-up. More...

Using make-up is completely okay; lipstick, eye shadow etc. are mostly entirely unproblematic. But choose your face cream carefully: if it is too oily, it may clog your pores and cause comedones. If you want to know more about which ingredients of cosmetics may worsen acne, please continue to read here.

Ingredients of cosmetics It can be quite interesting to become aware of the ingredients of cosmetic products. They may contain substances that favour the development of comedones, as e. g. peanut oil that is part of many conditioning creams. The manufacturer is obliged to quote all ingredients of his product on the package. If a product contains one or several of the following substances, you might want to look for another product: Butyl Stearate Cetyl Alcoho Hexyne Glycol Isopropyl Myristate Lanolin Sodium Lauryl Sulfate PEG-12 Sesamum Indicum Stearic Acid Sulfur

Consult a doctor or dermatologist. More...

Acne is a skin disease and as such may and should receive professional medical treatment. Your physician will set up an individual therapy programme with you. The measures will depend on your acne type and your skin type. Please find below an overview of the treatment possibilities: Therapy Treatment External (local) therapy Creams and ointments that treat the inflammatory regions, dissolve the strong hornifications and fight the bacterial infection and the overactivity of the sebaceous glands; deep cleansing by a medical cosmetician; recommendations for skin cleansing and skin care. Internal (systemic) therapy Oral intake of medications to fight the inflammations, the strong hornifications and the overactivity of the sebaceous glands. Girls: possibly intake of a special birth control pill. Besides it can be helpful if you regularly see a medical cosmetician, especially if you have serious acne. Depending on the severity of the acne, it can be helpful to do this one to three times in three months. She will do professional skin cleansing and e. g. remove the comedones to avoid inflammations and treat the affected skin areas. Please ask your doctor or dermatologist for a recommendation.

Medical cosmetics Medical cosmetics is a sensible complementary measure in acne therapy. Privat insurances usually bear the costs, if it is prescribed by a doctor or dermatologist. Statutory health insurances may also often bear the costs in severe cases, if prescribed by a doctor or dermatologist, but sometimes this can be more difficult. Perhaps an appropriate therapy can also be carried out by the dermatologist. It is best to obtain advice from the doctor or dermatologist.

Don’t squeeze your spots. More...

It must be very much recommended not to squeeze your spots. In squeezing, you will very often unwillingly harm the skin around the spot, which can lead to an infection and may leave scars. Besides, most of the sebum will not be discharged to the outside, but will be pressed into the surrounding tissues where it causes further inflammations. Please consult a doctor, dermatologist or a cosmetician instead.

Acne therapy needs some time. Patience pays! More...

Please bring some patience: acne therapy doesn’t usually show its effect immediately, but only after some weeks. Then you will experience a remarkable improvement of your skin condition. Skin is as individual as every human being, so your doctor or dermatologist will have to try out different medications before he/she finds the adequate product for you. It would be good if you could bring up the patience for this process as well. In the end you will notice that it was worth the effort.

Acne and sun. More...

Excessive sunbathing can damage the skin. Enjoyed in a moderate way, however, sunlight can be helpful in acne: Sunlight can have an anti-inflammatory influence on the skin, and on a lightly tanned ski, the acne is less visible. Please inform yourselves on the pages "Skin and sunlight" on how to enjoy sunlight in a reasonable and healthy way.   In the learning module "Sunlight", you can read in detail how you can enjoy the sun in a reasonable way.

Take care of your personal wellbeing. More...

Puberty is a time of transition from childhood to adulthood and a time of development of one’s own personality. This is at the same time an exciting and stressful phase in your life, and especially when you have acne episodes it is very important that you develop a positive relationship to yourself. Pursue hobbies and interests, cultivate friendships and other contacts. Sometimes it really helps to speak openly about your situation and your feelings with your family and friends – you will feel less lonely and ashamed: other adolescents are in the same situation and share your feelings. If you feel very bad, it may be a good idea to consult a professional person, for example to talk to a psychologist about your feelings. This may be very helpful.