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:


  • 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.


  • 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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Meet our Teen Advisory Council

Say hello to our inaugural class of teen advisers.

The CHOC Children’s Teen Advisory Council is made up of outstanding teens who are active in their community, committed to academic success, and support CHOC’s mission to nurture, advance and protect the health and well-being of children.

Being a teenager isn’t easy. There’s peer pressure, academic pressure, hormones, and college applications to think about. Sometimes it’s helpful to get advice from a parent or trusted mentor, but sometimes as a teenager you just want to hear straight from other teens, especially about topics that may be hard to talk about.

You’ll see these faces on our blog, and hear them on our podcast, discussing how they and their friends deal with common issues teens face, from bullying to healthy eating to stress management, and everything in between. From time to time they may be joined by a CHOC Children’s clinician or other staff member.

Today, they’re giving us a sneak peek inside their summer plans.


Alyssa Mercado, 14

This summer I am keeping busy babysitting for family and friends. I will be staying active by going to the gym, and training for the upcoming volleyball season. I am also maintaining my social life by meeting up with friends and hanging out on my free time.


Layla Valenzuela, 12

This summer, I will be playing volleyball, participating in a fun theater camp, hanging out with friends and traveling to Alaska with my family. Playing volleyball during the summer will prepare me for the next club season and help keep me in shape. Performing arts is near and dear to my heart, as is hanging out with my friends and traveling with my family. It’s going to be a busy, but very fun and engaging summer!


Heather Bisset, 14

I plan to keep busy this summer by playing tournaments with my club volleyball team, going to the beach and spending time with my friends, and studying for my upcoming AP European History class. I also hope to find a volunteer position at an animal shelter.


Carina Alvaro, 14

This summer, I will be taking geometry to advance in math my sophomore year. I will also be participating in several softball recruiting tournaments in hopes of getting committed to a university on a softball scholarship. For fun, I will be hanging out with my friends at the beach and going to concerts.


Cameron Macedonio, 15

Since I have no mandatory commitments over summer like summer school, I am keeping busy by socializing and having fun. We like going to the movies, going out to eat, and going to amusement parks.


Sanam Sediqi, 16

This summer I am keeping up quite a busy schedule. I am currently taking summer college courses including American Sign Language. On the weekends, I work as a body artist for face paint at Disneyland.


Zoe Borchard, 14

This summer, I’m working hard to get the most out of my break. I’m enjoying my camp counseling position. When I’m not a counselor, I’m busy working on my online health  course for high school next year. I’m also traveling to Montana to visit family. Whatever free time I can get is spent reading, sketching or adventuring with friends.

Submit a question for our teen advisers

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HIV Symptoms and HIV Prevention

By Dr. Sora Song, pediatric resident at CHOC Children’s and Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

HIV (Human Immunodeficiency Virus) is a virus that can spread through certain body fluids eventually attacking the body’s immune system and because of its potential severity, everyone who is sexually active should be aware of HIV symptoms and how to prevent HIV. HIV is a life-long illness, but people living with HIV have many different treatment options. Anyone who is HIV-negative and at risk of contracting the virus should know what they can do to decrease their chances of becoming infected PrEP and PEP, in addition to practicing safe sex, are options available for preventing HIV infection.

HIV symptoms in men and HIV symptoms in women

How long it takes for HIV/AIDS symptoms to appear can vary from person to person. Some people could look and feel healthy for years while they are infected. It is possible to infect others with HIV even if you have no symptoms. This means that getting tested regularly is important, even if you feel fine.

When a person’s immune system is overwhelmed by AIDS, they might notice:

  • Extreme weakness or fatigue
  • Rapid weight loss
  • Frequent fevers that last for weeks with no explanation
  • Heavy sweating at night
  • Swollen lymph glands
  • Minor infections that cause skin rashes and mouth, genital and anal sores
  • White spots in the mouth or throat
  • Chronic diarrhea
  • A cough that won’t go away
  • Trouble remembering things
  • Severe vaginal yeast infections that don’t respond to usual treatment
HIV prevention: PrEP

PrEP stands for pre-exposure prophylaxis. PrEP can stop HIV from infecting your body and spreading throughout your body. It is not a vaccine. PrEP is a pill that is actually a combination of two HIV medicines (tenofovir and emtricitabine) under the trade name Truvada®. This medicine has been approved for daily use. PrEP can cause side effects like nausea in some people but these generally improve over time. These side effects are not serious or life-threatening.

PrEP is taken before HIV exposure. It is taken every day. This is for people who don’t have HIV and are at very high risk for infection. It is recommended for those who:

  • have a sex partner who is HIV positive
  • have sex with a partner whose HIV status is unknown
  • are not in a mutually monogamous relationship with a partner who tested HIV-negative
  • have injected drugs or have shared needles in the past six months

For those at very high risk for HIV infection, PrEP can greatly lower your risk of infection if taken daily.

When used as directed, daily PrEP pills can reduce the risk of getting HIV from sex by more than 90 percent and from injection drug use by more than 70 percent. PrEP can be very effective if used as directed but is much less effective if not taken consistently. PrEP can only be prescribed by a health care provider. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other methods of prevention. PrEP should be used daily and for as long as there is risk for HIV infection.

HIV prevention: PEP

PEP stands for post-exposure prophylaxis. It is a method of HIV prevention after possible exposure. It should be started within 72 hours (three days) after possible exposure to HIV. PEP has little or no effect in preventing HIV infection if it is started later than 72 hours after HIV exposure.

Someone using PEP will take a combination of medicines, usually all in one pill, that fights HIV infection. This pill can cause some side effects like nausea, in some people. These side effects are not serious or life threatening. PEP is only used for 28 days after possible HIV exposure. It is not a substitute for other HIV prevention methods, such as pre-exposure prophylaxis (PrEP). Someone can switch to PrEP right away after completing PEP for continued HIV prevention.

PEP is for people who are HIV-negative or don’t know their status and, in the last 72 hours, may have been exposed to HIV:

  • during sex
  • at work through a needlestick or other injury
  • by sharing needles
  • during a sexual assault

PEP can help prevent HIV infection when taken correctly, but it is not 100 percent effective. If you may have been exposed to HIV in the last three days, or if you aren’t sure if you have been exposed to HIV or not, talk to your healthcare provider immediately. Start PEP as soon as possible to give it the best chance of working. Individuals should continue to use condoms with sex partners and practice safe drug injection practices (for example, using your own sterile needles) while taking PEP. These different methods can reduce the chances of transmitting HIV to others if you do become infected while you’re on PEP.

Testing while Preventing HIV

Anyone who uses PrEP or PEP needs to have close follow-up with their medical provider to get testing for HIV and other sexually transmitted infections. PrEP users should have repeat testing done on a routine basis because if someone becomes HIV positive, they need additional blood tests as well as different medications for HIV treatment. PEP users need to see their providers more often to ensure the medication is working.

Talk to your health care provider about whether PrEP or PEP is right for you.

Learn more about adolescent medicine at CHOC.

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Rising Rates of Children’s Hospital Visits for Suicide Thoughts, Attempts

The percentage of patients seen at U.S. children’s hospitals each year for suicidal thoughts or attempts has increased steadily, according to a recent study published in Pediatrics, the official journal of the American Academy of Pediatrics.

Suicide is the second leading cause of death in children and young adults ages 10-24.

Rising rates for suicide thoughts, attempts infographic

Learn the warning signs of suicide in children and adolescents

Mental Health Inpatient Center

Our Mental Health Inpatient Center, which opened in April 2018, is the only center in Orange County that can accommodate children younger than 12. The 18-bed Center is designed for patients ages 3 to 17.

ASPIRE® Intensive Outpatient Program at CHOC Children’s

This intervention (four afternoons/evenings per week for eight weeks) is intended to prevent psychiatric hospitalization and re-admission in high school teens ages 13-18. CHOC opened the IOP in early 2018.

Mental health screenings in primary care settings and the Julia and George Argyros Emergency Department at CHOC Children’s Hospital

One-third of all visits to pediatricians are solely for psychological reasons. To support immediate assessment and intervention in primary care, CHOC is providing depression screenings in its own clinics and promoting embedded mental health care in pediatric practices. We also provide depression screenings in the CHOC emergency department.

Mental health triage at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital

Implemented in fall 2016 with public and private funds, the innovative family-based crisis intervention model helps families address mental health crises and is already reducing psychiatric hospitalizations (25 percent reduction) and time spent in the emergency department (17 percent reduction).

CHOC Children’s is taking a leadership role in tackling the pediatric mental health crisis in Orange County. Half of children with symptoms of mental health disorders have conditions that cause significant impairment in daily life. In Orange County, 20 percent of youth reported needing help for mental health problems, while less than a third actually received that help.

Learn more about CHOC’s commitment to mental health

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  • Depression and Suicide Prevention: Know the Warning Signs
    Dr. Heather Huszti, chief psychologist at CHOC Children’s, offers insight on the warning signs of depression and suicide in children and adolescents.
  • Preventing Suicide in Children
    Suicide is the third leading cause of death for people ages 10 to 24, which underscores the importance of recognizing depression and warning signs in youth, CHOC Children’s chief psychologist ...


Teens and STIs: A Check-up on Sexually Transmitted Infections

By Dr. Kristen Kurtz, pediatric resident at CHOC Children’s

It’s important for parents to educate themselves on the prevalence of teens and STIs, and what they can do for prevention. Sexually transmitted infections (STIs), also known as STDs, are infections that can be passed from person to person during sexual contact including oral, vaginal and anal sex. Some of the most common STIs include chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus (HPV) and HIV. About half of all new sexually transmitted infections are diagnosed in teenagers each year. It is important for all sexually active people, including sexually active adolescents and young adults, to be tested for these infections each year. Early detection is critical because some of the infections do not cause symptoms. The CDC and AAP recommend annual screening for ghonnerea and chalamydia for people who are sexually active. We recommended regular HIV screening for anyone who is sexually active.


The most common STI is caused by a bacterium that is passed from person to person in bodily fluids. Most people who are infected do not have any symptoms, but symptoms can include:

  • discharge (abnormal fluid) from the vagina or penis
  • pain or burning with urination
  • abdominal pain
  • pain during intercourse
  • swelling or pain in the testicles

Serious consequences include chronic abdominal pain, infertility and abnormal pregnancy that can be dangerous for mother and child. Chlamydia is curable with a single dose of antibiotics. If any symptoms appear, it’s important to seek medical attention immediately.


Gonorrhea is caused by a bacterium that lives in warm, wet body parts (such as the mouth, anus and reproductive tracts). It is passed from person to person during contact between these body parts, and does not require a transfer of bodily fluids (ejaculation) to be spread. Most people who are infected do not have any symptoms, which may include:

  • discharge from the vagina, penis or anus
  • pain or itching during urination
  • abdominal pain
  • pain during intercourse
  • swelling or pain in the testicles

Serious consequences can include chronic abdominal pain, infertility and abnormal pregnancy that can be dangerous for mother and child. Gonorrhea is a little harder to treat but is curable. Treatment is often given in the doctor’s office and includes an antibiotic injection plus a single dose of antibiotic tablets.


Bacteria spread by direct contact (touching) with an open sore can cause syphilis. Syphilis bacteria can even infect healthy skin. Sores most commonly occur on the external genitals, vagina, anus or rectum, but they can also occur on the mouth or lips and be spread during oral, anal or vaginal sex.

Symptoms of syphilis appear in three stages:

  • Stage 1: a painless, reddish-brown sore on the genitals, mouth, anus or rectum
    • Sometimes the sore is in a place that is hard to see on your own. This makes it more important to have routine medical exams.
  • Stage 2: flu-like illness with fever, decreased energy, rash and sore throat
  • Stage 3: complications occur, including brain damage, mental illness, heart disease, and/or death

Syphilis is curable with a single dose of an antibiotic injection if caught early enough. More prolonged treatment is needed for stage 2 or 3 syphilis. This means that getting tested routinely is important, even if you feel fine. Getting additional testing immediately is important if any symptoms appear.


Genital and oral herpes are caused by a virus that is passed from person to person during direct skin contact, usually during sexual contact. It can be transmitted even when there are no visible sores. Genital herpes causes itching at first, followed by the appearance of painful blisters that can cause burning in the genitals. There is no cure for herpes. The herpes blisters will go away without medication, but the infection is not gone and will be spread during unprotected sex, even if no blisters are present at the time.

To help manage herpes, an antiviral medication can be taken to prevent or shorten outbreaks (recurrence of herpes bumps). The medication also helps prevent viral shedding – the process by which someone with herpes but no bumps can pass it to others. The medication can be used for oral or genital herpes.

Human Papillomavirus (HPV)

HPV is a virus that is passed from person to person during skin contact. It can cause genital warts, cervical cancer, penile cancer and anal cancer. HPV is the only vaccine-preventable cause of cancer. There is no cure for HPV, but there is a vaccine available to help prevent infection with the most common cancerous strains of the virus. Learn more about the HPV vaccine.


HIV (human immunodeficiency virus) is a virus that suppresses the immune system, and ultimately leads to AIDS (acquired immunodeficiency syndrome). HIV can cause a wide variety of symptoms, from those of the common cold to severe infections and mental illness. It is very important for sexually active individuals to be tested for HIV regularly, due to the variable nature of its symptoms and progression. Although there is medication available to manage symptoms, the is currently no cure for HIV.

Tips for preventing infection with STIs

It is important to know that some forms of birth control (the pill, patch, ring, implant, shot and IUD) all work to prevent pregnancy, but do not protect against STIs. There are, however, several ways to help prevent STIs.

First, talk to your partner about how you want to practice safe sex. This can include waiting to have sex until you both get STI testing. Once you’re both negative, use condoms with every sexual act. Using condoms is the most effective way to prevent the spread of STIs during sexual contact, including oral, anal and vaginal sex.

It is important to remember that condoms only protect against:

  1. infections that are transmitted in bodily fluids, and
  2. infections that are transmitted by direct contact only if the area is covered by the condom.

If a person has bumps or sores on a body part that is not covered by a condom, the infection can spread to another person. One other option available to prevent STI spread is the dental dam. The dental dam is a sheet of latex that can be used to cover the vaginal or anal area during oral sex to prevent spread of infection.

Learn more about adolescent medicine at CHOC.

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