Acne. It’s not a particularly glamorous topic, but it often comes up when discussing adolescents. A fairly normal skin condition for teens, it can lead to poor self-esteem, shame,  depression, and (rarely) suicidal ideation.

The onset of acne in adolescents can be chalked up to hormones. Both boys and girls, upon hitting puberty, experience an upswing in testosterone. This causes an increase in sebum, a substance excreted by the skin that can block pores and open a space for bacteria to multiply. A tendency to acne can run in families.

Some things that were once thought to cause or worsen acne, but we now know don’t, include chocolate, caffeine, makeup (as long as it is labeled “noncomodogenic”),and poor hygiene.

Acne can range from a small pimple to serious, disfiguring, painful nodules that need drainage. Acne usually doesn’t lead to medical complications, but it can cause serious psychological stress. If your teen is concerned, it’s time to treat it.

To start with, your teen needs to refrain from touching their face (that includes popping pimples), change their pillow case often, and wash their face with a gentle cleanser twice daily, avoiding scrubbing. They should try to eat a healthy diet without a lot of sugar or processed foods, and keep hair care products off their face.

For mild to moderate acne, the first step is over-the-counter medications. These include:

  • Benzoyl peroxide, which kills bacteria and dries up sebum production. 2.5% is as effective as 10%, and causes fewer side effects. Side effects include redness, dryness, and peeling.
  • Salicylic acid kills bacteria and prevents pore clogging. It may cause redness or dryness.

If your teen’s acne is severe, occurs on their chest and/ or back, or doesn’t respond to over the counter products, it’s time to seek professional help. Primary care providers are able to treat mild to moderate acne, and a few have training to deal with severe, cystic acne. If your teen’s skin is beyond their level of expertise, they will refer you to a dermatologist; or if your insurance doesn’t require a referral, you can start with one. There are many prescription treatments available.

  • Antibiotic creams or lotions are often the next step in treatment after over-the-counter products. They attack the bacteria that cause acne.
  •  Teens with more severe acne may be prescribed oral antibiotics. Oral antibiotics can be quite effective, but may have side effects; discuss them with your provider so you and your teen can watch for them. Some acne bacteria is starting to be resistant to common oral antibiotics, so physicians may want to reserve these for patients who try and fail the creams and lotions.
  • Oral contraceptives, a.k.a birth control pills, can help girls with acne problems. The estrogen they contain can counteract the effects of testosterone. Oral contraceptives are very safe, and have the useful side effect of easing menstruation problems (and, obviously, providing birth control if taken correctly.)
  • Topical retinoids, such as Retin-A, were created as anti-aging creams, but are quite effective against acne. They increase skin cell turnover, which means that pores have less of a chance to be clogged. Usually they cause an initial flareup of acne, followed by diminishing blemishes.
  • The “big gun” for acne is Accutane (isotretinoin).  Initially produced as a chemotherapy agent, it is very effective for severe, cystic acne. If possible, by the time Accutane is being considered, your teen should be under the care of a dermatologist trained in its use.
  • Common side effects of Accutane include very dry skin, hair loss, raised cholesterol levels, joint pain, temporary liver damage, and skin peeling and flushing. In young teens, it may stunt growth, and its use has been linked to depression. If a woman gets pregnant on Accutane, it can cause severe, fatal birth defects. As you can see, this is not a medication to be used lightly! That said, it can cure severe acne that does not respond to other treatments.

No matter how your teen’s acne is treated, remember that it’s a serious issue for them. Their condition may seem like no big deal to you, but in their eyes it can be a hideous plague that will ruin them socially, forever. Acne treatment is usually simple and inexpensive. It produces good results cosmetically, and great results psychologically!