If there is one word guaranteed to strike dread into the heart of a teenager, it has to be acne. As children grow closer to puberty, there are anxious glances in the mirror. Has it come? Will it come? Will I be able to bear it when it comes? There are myths and legends, each new generation reinventing the same terrible warnings of doom as the biological clock ticks on. Everyone is at risk. Who will be first? For a condition that is not a disease, it inspires the level of fear associated with an epidemic likely to wipe intelligent life off the face of the planet. It is as if, somehow, a natural part of growing up has been redefined as a major life crisis. Worse, people can only survive this crisis by the application of science and the consumption of some fairly powerful drugs. Money, sometimes in considerable amounts, is required to ride out this health storm. All this is a significant victory for the pharmaceutical industry. If you go back one hundred tears, teenagers were a little spotty but they lived fairly normal lives. It is true that children have always been unkind to each other, but there was nothing life-threatening. Lives were not destroyed. But somehow this innocence has been lost. A natural feature of growing up has been medicalised. It has been converted into a medical emergency requiring urgent and expensive treatment. And all for the profit of the pharmaceutical companies.

So what is this thing called acne? It all begins with the humble spot, pimple or zit. You pick the word that best captures the reality. The medical profession prefers to rename these little bumps in the skin as lesions. A wonderful word suggesting that those who have the problem are somehow cut or damaged in a more serious way. Well, no matter what you call them, these pesky things are annoyingly persistent. What should be here today and gone tomorrow, hangs around and is a blemish on otherwise smooth skin. Healing is slow and even when one group of eruptions does start to clear up, another lot bursts through. So it is that self-esteem is damaged as the world looks on in judgement. Frustration that appearance is being damaged can turn into depression. A very small number of teenagers have committed suicide.

Are people right to be concerned? It is true that, if those affected do not take some care, there can be permanent scarring. Obviously, this is undesirable. It is also true that the conditions can extend into adulthood or affect adults. Older people deserve some help because their problem is more unusual and so more obvious. Thus, there are some effective drugs on the market, the strongest and most powerful being accutane. So, alongside the usual self-help requirements for keeping the skin clean, the prescription-only accutane waits as a last resort for those who have tried all the other remedies and still have a serious problem. This is the "line in the sand". Acne does not survive.