Teen acne: Don’t scrub, don’t pick and try not to stress

In medical school we had a joke:  What is the biggest organ in the body? The answer, “skin,” made us chuckle.  Little did I know that skin would end up being the cause of so much distress to my teenage patients.   

Why do teens get acne? Here’s what my teen son says: “It’s a ball of pus caused by hormones going crazy.” Interestingly, he’s right. The “ball of pus” is a pilosebaceous unit (sebaceous gland and hair follicle) that has become blocked with sebum (an oily substance), dead skin cells and the bacteria Propionibacterium acnes.  These changes are induced in normal puberty by “hormones going crazy”—the increase in testosterone seen in both boys and girls. 

Acne is common in teens: 80 percent have had it at some point. Unfortunately, “misery loves company” doesn’t make a teenager feel better about his or her own acne.  In fact, one study found that teens with severe acne were two to three times more likely to think about suicide than those with little or no acne.  

For many, acne is more than an occasional pimple.  It may be difficult to cover up as it may occur on the face, neck, back, chest and shoulders.  Acne is classified as mild, moderate or severe; and treatment is based on severity. Some people may be genetically predisposed to severe acne; that is, acne with nodules and cysts that can cause scars.

“Patience is a virtue” in treating acne. Even with treatment, it may take weeks to show significant improvement. Medical researchers continue to search for the most effective treatments. In May, a panel of pediatricians and dermatologists published their recommendations for acne treatments based on a review of many medical studies. Here are their recommendations:

Topical (applied to the skin) retinoids...are helpful for mild or moderate acne. Chemically related to vitamin A, retinoids work by clearing up existing acne and preventing new lesions. Side effects are dry skin and sunburn if exposed to the sun (photosensitivity). Tretinoin, adapalene and tazarotene are available by prescription.

Benzoyl peroxide...is a topical antimicrobial. It can be used by itself for mild acne or in combination with other drugs for moderate or severe acne.  Benzoyl peroxide treats acne by killing the acne-causing bacteria. Side effects may include peeling, dryness, and skin irritation.  Some benzoyl peroxide products are available over the counter, while others are by prescription.

Antibiotics...can be used topically or taken orally. Antibiotics decrease the number of bacteria in the acne lesions and reduce inflammation. Topical antibiotics are indicated for mild inflammatory acne whereas oral antibiotics are used for moderate or severe acne. Topical medications include clindamycin or erythromycin.  Minocycline and doxycycline are the most commonly used oral antibiotics.

One of the problems with antibiotics is that the acne bacteria can become resistant over time. Long-term antibiotic use is not recommended due to this problem. Using topical benzoyl peroxide in addition to antibiotics can help minimize resistance. Oral antibiotics may cause upset stomach, photosensitivity and other side effects. Antibiotics for acne need to be prescribed.

Topical combination treatments...combine two skin treatments in one, and are helpful for mild, moderate, or severe acne.  They are convenient, making it more likely that a teen will keep using them as directed. They have the same side effects as the individual medications. All topical medications should be applied in a pea-sized amount to the entire face — not just the pimples — because it is important to treat the invisible early lesions of acne known as microcomedones. Popular combinations available by prescription are:

  • ‘BenzaClin’ and ‘Duac’ (both contain benzoyl peroxide and clindamycin)
  • ‘Benzamycin’ (benzoyl peroxide and erythromycin)
  • ‘Epiduo’ (benzoyl peroxide and adapalene)

Birth control pills...that contain both an estrogen and a progestin may be prescribed for females with moderate or severe acne. Used only for girls, the pill decreases the testosterone involved in acne-production. Birth control pills are prescribed by a doctor and they may have minor side-effects.

Oral isotretinin...or ‘Accutane’ is like an antibiotic. It is prescribed only for severe acne that does not respond to other treatments and has the potential to scar. It decreases sebum production, normalizes skin peeling, decreases inflammation, and kills the bacteria. Side effects include dry, cracked skin at the corners of the mouth, high cholesterol and depression. If a pregnant woman takes Accutane it can cause birth defects, so in 2007 the FDA started iPLEDGE, a program to prevent this risk.

Truth or myth: Do certain foods cause pimples? Maybe and maybe not. But doctors and scientists agree that high-glycemic diets, dairy foods, chocolate, zinc and iodine need further study.

Truth or myth: Does stress cause acne? Truth! Doctors and scientists agree that stress can trigger acne. So here’s my prescription:

  • Exercise every day
  • Eat a healthy diet
  • Sleep well

And your teen may find this prescription helpful as well!  

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