Dr. Bob: My 12-year-old son and 14-year-old daughter are in the midst of developing acne. At times things seem to be under control and other times the flare-ups are quite frustrating. I had bad acne myself as a teenager, and I would really like to treat this the best way possible. I know how frustrating and embarrassing it can be.
Answer: I understand your situation. I was an affected teenager and had two sons affected with acne. It is estimated that 85% of teens have acne. So, it is a normal part of growing up. That doesn’t make it any easier for a teen that is upset with their acne. Let’s remember a few basics –
- Acne is caused by excess oils in the hair follicles that can then get plugged up. Then some normal bacteria in the skin can cause a localized irritation with redness and swelling.
- The hormones of puberty lead to the excess production of the excess oils (called sebum).
- Acne can occur in multiple locations on the body (face, neck, shoulders, upper back and chest) but most of the time, the face is the area of concern.
- Acne, medically referred to as comedones, can be seen in multiple forms – blackheads (skin pores with extra sebum that looks darker than the surrounding skin [open comedone]), whiteheads (pores that are plugged, closed and bulging slightly [closed comedone]), pimples (closed comedones that have become slightly infected and bulge more because they are deeper in the skin layer) and nodules or cysts (larger and often painful acne that is deeper in the skin).
- It is important to try and understand what type of acne is present in your child because blackheads, whiteheads, pimples and nodules/cysts might need different intervention. For example, nodules or cysts are more likely to lead to scarring and deserve extra medical attention.
Since most teens want to try to clear up their acne to boost self-esteem, some basic treatments should be used –
- A gentle cleansing of the skin twice a day. Scrubbing does not help and might make things worse.
- Various over-the-counters skin preparations are available. The active ingredient is benzoyl peroxide. Start with a lower concentration.
- Avoid oily skin applications what will be pore-clogging.
- Avoid stress. While stress doesn’t necessarily cause acne, reducing stress can be beneficial. Regular exercise, good nutrition and sleep are key here.
- There is no hard and fast correlation between diet and worsening of acne. Cutting back on high sugar foods (like candy) is a good basic health issue but will not necessarily eliminate the acne.
- Sun protection is important, especially if they are on medications.
Please discourage your child from picking or squeezing their acne. This can lead to worsening of the acne and even scarring. It is so tempting to pick pimples, but it is not healthy. Sometimes infection can occur.
Your pediatrician is a valuable resource in the management of your teen’s acne. More advanced therapies such as topical antibiotics, oral antibiotics and retinoids can be very powerful and are only used under the guidance of a physician. If the medications are around the house for another family member, do not use them without the guidance of a pediatrician. Sometimes referral to a dermatologist will be necessary.
Remember that acne affects the vast majority of teens. Anticipate it, support your teen and be alert to their sense of self-esteem or well-being. It will not go away immediately with treatment. Some teens might be more affected and need extra support.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.