Acne can be an extremely difficult medical challenge for children, teens, and adults. And let me be straight here: there is almost always something we can do to make it better. You don’t have to accept untreated acne as the end game. If you think acne is an issue of vanity, I urge you to read on. Acne can have enduring emotional and psychological consequences. Doing something now to support someone you know and love with acne can be powerful advocacy.

I’ve seen teens who worry about their acne be errantly categorized as having a concern for an appearance issue or be questioned about their “vanity” … when in reality, acne commonly causes real self-esteem issues and significant stress. Acne is a medical condition and many teens can use affordable, regular treatments that improve appearance, health, and well-being. Rarely, acne can cause disfiguring acne lesions, pox, or leave life-long scars. So approaching a plan for acne always makes sense. As long as anyone around a teen (or even an adult) treats acne as a vanity issue we’ll be under-supporting people and patients who don’t like the acne on their face or chest or back (or all of the above). No question early treatment of acne can prevent emotional distress. No question this is a medical condition.

Our face, and the skin on it, can at times feel like our largest presentation to the world despite how much stronger who we are — at the level of our soul — really matters. Practically speaking though, the biggest organ in our body is our skin and it does play the lead role at times in our life, especially when it’s not what we want it to be. When we have acne it can at times cause us to feel uncomfortable physically (big pimples really do hurt!) but also, emotionally.

The good news is that although the far majority of teens (75-80%) have acne lesions at some point, there are lots of ways to treat and even cure acne.

Here is a lively podcast I did with pediatric dermatologist, Dr. Markus Boos. He’s an awesome and super smart dermatologist. We bust myths, review Pediatrics guidelines, and highlight ways to treat teen acne.

What Causes Acne?

  1. P acne: bacteria that live and grow in our pores and cause inflamed red bumps. They just live and thrive in the skin and cause the follicle around hairs in our skin to get angry and reactive.
  2. Hormones: signal to oil glands to produce more oil which leads to acne.
  3. Hyperkeratinization: causes thickening of the skin that clogs pores leading to white & blackheads.

Dispelling Acne Myths

  1. Foods like chocolates and sweets do not cause acne.
  2. Acne isn’t a hygiene issue or caused by a lack of face-washing. AND washing your face more than 1-2x a day will not make your acne better. In fact, it will dry out your skin and its strip natural protective layers. TIP: Don’t use a washcloth and over-scrub your face. Use a face soap and wash your face gently with your fingertips. Face washes that contain salicylic acid and/or benzoyl peroxide can help with acne (they work as both a mild anti-inflammatory and as a drying agent). SAY NO to scrubs or microbeads, they will just aggravate your skin and likely cause more inflammation and redness. And environmentalists…the microbeads go into runoff and are bad for the fish.
  3. Wearing (most) makeup is okay and does not cause clogged pores/acne. Look for non-comedogenic preparations – they WON’T cause or worsen acne. In fact, make-up can cover up redness and make some of us more comfortable and less distressed by the acne in the first place. That’s a win!

Ways To Treat Acne

There are many different medicines and medicine regimens and combinations you can use to improve acne. Mechanisms of action and some quick examples are here and look at the algorithms at the bottom of the post for even more detail:

  • Reduce hyperkeratinization – medicines in a class of drugs called retinoids help the skin turn over more often and prevent the clogging that comes from too “thick” a layer of skin that can set you up for acne. They can work very well with teen acne. Consider using a topical retinoid to help your skin turn over and avoid clogged pores ( they are now over-the-counter:  for example, Differin). Use it at night, on dry skin (wait a 1/2 hour after washing face), and only use a pea-sized drop every 3rd night. More isn’t better for reducing acne, just better at giving you more side effects. If you tolerate it every 3rd day, then progress to every other day. If you see ongoing improvement, and you tolerate the redness okay, then try using daily. Initially, as the skin turns over more rapidly, some of the acne will “blush” and come out about 4-6 weeks into treatment, then the new skin thereafter will likely have far fewer pimples and inflammation.
  • Kill bacteria and kill inflammation – (antibiotics — topical or oral) may be options that exist, so talk with your doctor. Using topicals first is always a good step to avoid all the side effects that come from treating your entire body with oral antibiotics.
  • Change hormones & their effect on skin – prescribed oral contraceptive pills (OCP*) can sometimes improve acne, especially in girls who have acne that fluctuates with their menstrual cycle. There are a couple of OCP pills approved to treat acne. *OCP do carry a big list of hearty side effects so talk with your doctor about all the options before starting.
  • Washes to reduce inflammation – try using salicylic acid and/or benzoyl peroxide face washes (Over-the-counter) along with your fingers once daily, before bed. You can also use benzoyl peroxide washes in the shower on acne on the chest and back and some come by prescription. Using these once daily can be really helpful and is a cheap and easy way to help reduce inflammation.

Things That Do Sometimes Worsen Acne

  • Hair products – if your hair gel, mousse, or hair spray gets on your skin, it can sometimes clog your pores. Some people will have worse acne along the hairline. It’s true!
  • Headbands – can cause clogging and congestion on the skin underneath. It’s a local effect, so obvs, it’s not the headband causing the pimples on your nose.
  • Stress – it’s true – stress can worsen acne lesions.
  • Menstruation – changing levels of hormones can change acne lesions and pores. You’re NOT imagining this, Ladies.
  • Picking & popping! – A dermatologist friend of mine once told me that when it comes to popping zit there are two types of people: poppers and then there are liars. HA!!! Refraining from picking acne is so tough, but do your best to leave it alone as it can make things worse and lead to scarring. If you must pop, try a comedone extractor that you can purchase at your local drug store. Dr. Boos explains why it is much better in the podcast….
  • Not getting enough sleep – sleep deprivation is just another form of stress and can lead to break-outs.

What To Know About Isotretinoin

If the above treatments aren’t working to manage acne well or a teen or adult has disfiguring, cystic, or pustules causing scars, isotretinoin can be an amazing option. I have co-managed teens on isotretinoin with remarkable success. But treatment is arduous and does come with side effects. Dermatologists often typically prescribe isotretinoin alongside pediatricians. But I will say it does work so well when tolerated and has a profound effect on tough-to-treat acne or severe acne. At times isotretinoin used correctly can be curative for teens, meaning it will reverse and cease acne for the duration. A little more info:

  • When you have hard to treat acne or disfiguring, cystic, painful, deep lesions, you can consider using isotretinoin which can be transformative.
  • It belongs to a class of drugs known as retinoids. It works by decreasing facial oil (sebum) production. High amounts of sebum can lead to severe acne. By decreasing the oil production you decrease the ability for acne to begin in the first place. But the side effects are almost universal: dry lips, dry scalp, dry skin as a consequence. Sometimes the side effects are severe (bleeding dry skin or even depression or joint problems).
  • For females, there is a lot of monitoring and testing that has to be done if a patient decides to move forward with isotretinoin because there is an extremely high risk that severe birth defects will result if pregnancy occurs while taking isotretinoin in any amount, even for short periods of time. So if you’re a teen girl, you need monthly monitoring while on it. A huge commitment and one to talk with your doctor about!