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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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