Acne Basics For Teens

What Can I Do About My Acne?

McKenzie Pediatrics 2019

What Is Acne?

Acne is a part of growing up. Nine out of ten teenagers will face acne (pun intended!). While acne can be embarrassing, it usually doesn’t last into adulthood. Only rarely does it cause scarring. Girls and boys suffer from acne equally, though it usually starts in girls at an earlier age.

Acne usually occurs on the face, neck, shoulders, and sometimes the upper back. It is usually worse in the winter. Acne cannot be scrubbed away!

Acne is caused by overactive oil glands in the skin that become plugged, due to an increased level of hormones during the teen years once puberty begins. When the glands are plugged they often also become infected by bacteria called Propionibacter.

Acne has no cure, but there are many things teens can do to reduce the number of zits, and limit or prevent the formation of scars.

Acne Is Not Caused By:  Junk foods, poor hygiene, dirt, sexual activity (or lack of!)

Acne Is Made Worse By:  Oil-based cosmetics, picking your face, stress, anabolic steroids, long oily hair, skin lotions & creams, greasy hands & air (fast food restaurants), lanolin, sesame oil, avocado oil, cocoa butter, coconut butter, vegetable oil, and sunscreens.

Young women will often notice that their acne worsens just before their menstrual periods.

What Are The Different Kinds of Zits?

• “Blackheads”….also known as Open Comedones, these are not black from dirt, but from melanin (a pigment in your skin)
• “Whiteheads”…also known as Closed Comedones, these may initially be flesh-colored, or turn red & tender
• Nodulocystic Lesions...these are the large, hard, red, and often tender and painful lesions. They are very small abscesses, and must be treated with antibiotics.

Is My Acne Mild, Moderate or Severe?

• Mild: About one-fourth of your face has acne (especially your forehead), and there are only a few red, tender zits. There are no nodules or scarring.
• Moderate: About one-half of your face has acne. There are many red, tender zits, and possibly a few nodules or scars. Your acne may also have spread to your chest & back.
• Severe:Three-quarters or more of your face has acne. There are many red, tender zits and nodules, and often scarring is present.

The Must-Do’s of Daily Acne Care:

• Be patient! It may be up to 6-8 weeks before improvement is noticed!
• Wash skin twice a day without scrubbing, using a gentle soap (Dove, Purpose, Caress, and Phisoderm are a few examples)
• Wash hair daily using oil-free shampoo & conditioner
• Use Benzoyl Peroxide 5% or 10% Gel at bedtime every day. Wash your face first, then wait 10-20 minutes before applying. A pea-sized amount should cover your whole face. Benzoyl Peroxide helps to open pimples and unplug blackheads, and kill the bacteria. At first, it might lead to dryness, irritation, or tingling. If your skin becomes red or peels, you are using too much, using it too often, or using too high a concentration. Brands include Benzagel™, Clearasil™, Clean & Clear™, Neutrogena™, OxyBalance™, and others.

What’s The Next Step?

If Benzoyl Peroxide alone isn’t helping, a topical retinoid will be prescribed. Tretinoin is the usual first choice, but if the use of Tretinoin causes intolerable redness, peeling, burning, and/or itching your prescription may be changed to Retin-A Micro™ (0.04% or 0.1%) or Differin™ (0.1%...generic name Adapalene). Instructions for retinoid use are as follows:

• Tretinoin is usually started as a 0.01% gel. The strength may be increased to 0.025% if needed. It is also available in a cream form (0.025%, 0.05%, and 0.1%) but the gel usually works better, although it may cause moreskin irritation in the first 1-3 weeks of use. This usually gets better!
• A maximum of a pea-sized amount of the gel is all that is needed for the entire face. Apply it to all areas of your face, not just on top of the acne. Your face must be dry before applying it.
• Apply it before bedtime. Continue applying Benzoyl Peroxide daily, but in the morning. Avoid salicylic acid scrubs or astringents while using a retinoid.
• Over 2-5 months, Tretinoin will almost always improve acne, though it will NOT make your skin perfect. If after 1 to 2 months no improvement is seen, your doctor may increase the strength of the medication.
• You may use a gentle moisturizer meant for skin with acne if needed to counteract the extreme dryness that may result from the topical retinoid therapy.
• Finally, avoid prolonged exposure to sunlight for greater than 30 minutes while on this medication. You should use a water-based sunscreen for sun exposure less than 30 minutes.

What Else?

If your acne is clearly heavily infected, with lots of nodulocystic lesions, your physician may recommend that in addition to your topical retinoid therapy that in place of just Benzoyl Peroxide you use a prescription combination product of BP with an antibiotic. Brands include Benzaclin™, Duac™, and Benzamycin™. These must be used twice daily. On occasion, an oral antibiotic will be prescribed, such as Minocycline, Doxycycline or Tetracycline, to be taken twice daily in addition to the retinoid and BPO, for no longer than 8-12 weeks.

If nothing is working, and your acne is severe, you may be referred to a dermatologist for more advanced (and more risky) treatment, such as Accutane™. Females may also be considered for oral contraceptive therapy, which can help improve severe acne.