Teens and Acne

By Dr. Stephanie Lee, pediatric resident at CHOC Children’s

Teens and acne is a common struggle. Acne is the most common skin disorder in the United States. Although it is more common in teenagers, it can affect people of all ages.

Acne is not purely a cosmetic problem. The skin is the largest organ and should be kept healthy. Acne can lead to dark spots and scars if left untreated. Psychological side effects can come alongside teens and acne, including low self-esteem, depression and anxiety.

What is acne?

Acne occurs when a pore (also known as a hair follicle) becomes clogged. We normally shed dead skin cells, but they get trapped by an oily substance known as sebum, produced by glands near the hair follicles. Bacteria can also get trapped and cause inflammation.

Hormones increase sebum production, which is why teenagers are commonly affected by acne. Teens going through  puberty may have acne due to hormonal changes they’re going through. Girls may develop acne worsened by their periods.

There are different types of acne:

Non-inflammatory:

  • Whiteheads are closed pores with dead skin cells and sebum.
  • Blackheads are open clogged pores that darken due to a chemical reaction, rather than the common misconception that it’s dirt.

Inflammatory:

  • Papules are clogged pores infected by bacteria, leading to red raised bumps.
  • Pustules are pus-filled bumps.
  • Nodules are larger, hard bumps.
  • Cysts are clogged pores that break under the skin causing bigger areas of inflammation. These can be quite painful.

Acne is often located on the face, neck, chest, upper back and upper arms because these are where the sebaceous glands are more abundant.

Acne may also be seen in other health conditions that require further work-up with labs or imaging, such as polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia (CAH), or tumors. It can also be a side effect of certain medications. Other skin rashes may be confused with acne. If you aren’t sure whether your acne is due to hormones or another health condition, ask your pediatrician.

Teens and acne: treatments that work

Acne is categorized by severity, and treatment is prescribed based on this grading scale. There are many options for medications, and your pediatrician can help you find the one that is right for you. Some are available over-the-counter and do not need a prescription, which are typically helpful for mild acne. Common topical medications include benzoyl peroxide, adapalene, and antibiotics (clindamycin, erythromycin). Usually, you’ll try one of these first for mild to moderate acne. Benzoyl peroxide and adapalene are available over the counter without a prescription. Oral medications used to treat moderate to severe acne are usually antibiotics such as doxycycline, minocycline or tetracycline. For females, hormonal therapy such as oral contraceptives or spironolactone can be very helpful for treating acne. If you have more severe acne that does not respond to initial treatment, your doctor may consider prescribing isoretinoin (brand name Accutane).

Some of the medications can have anti-inflammatory, pore-clearing, and/or anti-microbial properties. Side effects for topical medications may include dry, irritated skin. Side effects for oral antibiotics may include upset stomach and/or sensitive skin, especially in the sun. These side effects can be minimized by using a facial moisturizer with SPF30 or more to keep your skin hydrated, prevent sun damage, and promote healing. Ask your doctor or pharmacist about possible side effects for specific medications. It may take two to three months to see improvement in acne with medications.

Teens and acne: dos and don’ts

There are many common misconceptions surrounding acne.

  • Frequent washing or scrubbing does not prevent acne; it can make it worse.
  • Popping pimples will not help get rid of them faster, but can push infections deeper beneath the surface of the skin and boost your risk of scarring.
  • There is limited evidence that acne gets worse if you eat greasy foods.
  • Stress may worsen acne but does not necessarily cause it.
  • Non-comedogenic (sometimes called acne formulation) products are better for acne-prone skin, which are often water-based.

It is best to talk with your doctor about your acne to get recommendations and treatment tailored to your needs.

Learn more about adolescent medicine at CHOC.

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Acne Myths

Lots of kids and teens have to cope with acne. Because it’s so common, acne is the subject of much discussion — and many myths. By clearing up some of the common tales about acne, you can help your son or daughter get through it. Check out the following facts from Kids Health, an online resource for parents on choc.org.

Myth: Getting a Tan Helps Clear Up Skin.
Fact: Even though a tan may temporarily cover the redness of acne, there’s no evidence that having tanned skin helps to clear up acne. People who tan in the sun or in tanning booths or beds run the risk of developing dry, irritated, or even burned skin. They’re also at increased risk of premature aging and developing skin cancer.

Encourage kids to keep skin safe by wearing protective clothing, hats and sunglasses when outdoors. They should also wear a sunscreen with a sun protection factor (or SPF) of at least 30 that’s labeled “noncomedogenic” or “nonacnegenic,” which means the product won’t clog pores. Discourage the use of tanning beds or booths. It’s especially important for kids who use prescription acne medications (including oral contraceptives, which are often prescribed to help clear up acne) to stay out of the sun and away from tanning beds. These drugs can make skin extremely sensitive to sunlight and the rays from ultraviolet tanning booths.

Things that may aggravate acne:
• Irritants such as pollution, hair products, and makeup that’s not labeled noncomedogenic or nonacnegenic
• Pressure from hats and headbands
• Friction caused by touching or rubbing the face
• Changing hormone levels
• Overzealous scrubbing
• Popping pimples
• Sun exposure

Myth: Washing Your Face Often Prevents Breakouts.
Fact: Hygiene isn’t related to the development of acne, either. Washing the face each day gets rid of dead skin cells, excess oil, and surface dirt, but too much cleansing or washing too vigorously can lead to dryness and irritation — which can actually make acne worse.

Dermatologists usually recommend gently washing — not scrubbing or rubbing — the face no more than twice a day with a mild cleanser and patting the skin dry. Kids should steer clear of harsh exfoliants or scrubs, which can actually irritate blemishes. Toners containing high concentrations of alcohol can dry out the skin and should be avoided.

Myth: Popping Pimples Makes Them Go Away Faster.
Fact: Though popping a pimple may make it seem less noticeable temporarily, popping can cause the zit to stay around longer. Popping a pimple pushes bacteria from the zit further into the skin, making the area around the acne even more reddened and inflamed.

If your child is bummed because a huge zit arrived just in time for a special event, apply a dab of benzoyl peroxide gel to dry it. A dermatologist may also be able to recommend treatments for a teen with severe scarring.

Myth: For Clear Skin, Don’t Wear Makeup or Shave.
Fact: Kids don’t have to forego cosmetics as long the products used are labeled noncomedogenic or nonacnegenic, which means they won’t cause breakouts. Some concealers now contain benzoyl peroxide or salicylic acid, which help to fight acne. Tinted acne-fighting creams may also help to fight pimples while hiding them. However, if any product seems to be irritating the skin or causing breakouts, have your child stop using the product and call your dermatologist.

Cosmetics labeled “organic,” “all natural,” or those containing herbs have gained popularity, but they may contribute to clogged pores and acne, so it’s best for kids who are prone to breakouts to steer clear of them.

Teen boys who have acne and shave can use either safety or electric razors, but should shave lightly around blemishes to avoid nicking the skin and causing irritation and infection.

Myth: Use More Acne Medication to Prevent Breakouts.
Fact: When it comes to over-the-counter acne medication containing active ingredients such as benzoyl peroxide and salicylic acid, more isn’t better. Using too much medication can actually worsen acne because it leads to dryness, irritation, and more blemishes. A dermatologist can suggest acne treatments if your child:

• Has tried over-the-counter acne treatments with little or no success
• Has developed acne scars
• Has painful, large pimples
• Is dark-skinned and has acne that’s causing dark patches to form
• Has low self-esteem or a reduced enjoyment of life because of acne

Prescription acne medication may take up to eight weeks to have a noticeable effect, so remind kids to use the medication exactly as directed. If the acne doesn’t improve within six to eight weeks, talk to the dermatologist.

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