Acne is part and parcel of adolescence. But many young people with acne feel ugly, self-conscious, unpopular and unhappy. Their parents may have suffered with acne, but acne now can be effectively treated.
At least 90 percent of adolescents have acne, which is the most common disease of the skin. Acne occurs when pores or oil ducts (sebaceous follicles) on the face, chest, neck and back are clogged. Material called sebum fills the oil glands, in response to the hormones of puberty. Clogged pores are called either closed comedones (whiteheads) or open comedones (blackheads). Open comedones are black, not because of dirt, but because of pigmented material at the opening of the pore.
Some teens have only a few comedones. Comedones easily become infected with Propionibacterium, a common skin bacterium, which results in tiny pink bumps or abscesses (pimples). And in some young people, deep painful infected cysts can develop. Attempting to rid themselves of these unattractive bumps, adolescents often resort to scrubbing, squeezing and popping, all of which result in more skin irritation and, eventually, to tiny pits and scars on the face.
What causes acne? Contrary to what your mother might have told you when you were a teen, eating french fries, hamburgers and chocolate (or any food, for that matter) does not cause acne, or make it worse. In early adolescence the adrenal glands and the testes or ovaries produce androgen (male-type) hormones, in both boys and girls.
In some young people, facial oil glands become over stimulated by these puberty androgens, and acne results. Boys have higher amounts of androgen, of course, and boys also tend to have worse acne than girls. Many girls notice a breakout of acne right before or during their menstrual periods. And about 5 percent to 10 percent of adolescent girls produce more androgens than usual and may have severe acne. The tendency to develop acne runs in families.
What can be done about acne? First, don’t make it worse. Ask your adolescent not to pick at or squeeze acne sores, which will result in infection spreading and comedones becoming more inflamed. Don’t wash the face more than twice a day, and don’t scrub with irritating soaps. Avoid bangs and hats on the forehead; these will cause more comedones. Noncomedogenic lotions and makeup (which do not promote acne) are commercially available.
Over-the-counter acne products can be very helpful in mild acne. Be sure your teen doesn’t overuse them, as they can cause irritation or dryness. Start with a lotion or cream containing benzoyl peroxide in a 2.5 percent, 5 percent or 10 percent strength, and apply it in a thin coat at bedtime or as the label suggests. If the skin gets too dry, apply the product only every other day.
If the acne doesn’t improve in 2 to 3 months, arrange a visit with your child’s pediatrician or adolescent medicine physician. The doctor can prescribe other medications for treating acne, and can also refer your teen to a dermatologist if the acne doesn’t seem to be responding. Girls with severe acne may be tested for excess androgen production, which can be treated easily with estrogen and progesterone-like medications.
Medications that may be prescribed for acne include
* Antibiotic solutions applied to the skin, such as erythromycin or clindamycin, which reduce propionibacterium.
* Benzoyl peroxide gel, which is often combined with the antibiotic erythromycin (Benzamycin).
* Tretinoin cream or gel (Retin A), which helps unplug oil glands.
* Antibiotic tablets taken orally, which reduce propionibacterium (tetracyclines such as doxycycline, minocycline; erythromycin; others).
* For girls, a combination of estrogen and progesterone hormones, prescribed in the form of birth control pills, which reduce androgen production (many brands are effective; OrthoTricyclen has FDA approval specifically for acne in adolescents).
* For very severe cystic acne, isotretinoin (Accutane), given daily for 4 to 6 months, unclogs oil glands very effectively. Accutane can be a “miracle drug” for acne, but it has important side effects and requires careful monitoring by a pediatrician or dermatologist experienced in its use. Accutane produces birth defects when taken by a pregnant adolescent or adult woman. Accutane for girls must be prescribed along with birth control pills.
Today, acne is entirely treatable, and young people can be relieved of the embarrassment and emotional and physical scars of previous generations. Let your adolescent know that his or her doctor has treatments that work.