Acne Basics for Teens

By: Joseph Mechak, MD
Pimples are the pits! To make things worse, acne peaks during puberty when our teens care most about their appearance and peer acceptance.  It can make this challenging time even more stressful. We want to arm you with some information, tips, and tricks to help navigate these… oily waters (I know… not my best).
What causes acne?
There are two major factors at play in acne.  One is ‘clogged pores’ and the other is a bacteria aptly named, Propionibacterium acnes.  We all have sweat and oil glands all over our body. They are most concentrated on our face, chest, and upper back. These glands are stimulated by hormones. During puberty, hormones are ramped up which can cause overproduction of oil. Excess oil and dead skin cells clog up pores forming open comedones or ‘blackheads.’ Propionibacterium acnes LOVES to feast on these blackheads.  When fed, the bacteria replicate and can cause an infection in the pore.  This process forms closed comedones or ‘white heads’ and larger, angrier appearing pimples or zits.
How can I prevent or limit my acne? 
Well, to prevent or limit acne, we need to focus on controlling these two underlying causes. We can’t turn off our hormones but we can do a few things to help keep things in balance.

  1. Don’t stress! – Easier said than done, I know….  But, stress can manifest in many ways. Studies have shown that stress can increase acne burden and cause outbreaks. 
  2. Don’t pop! – We know it’s tempting but DO NOT POP YOUR PIMPLES!  This just aggravates the skin, causes inflammation, and can make everything worse. It also increases the likelihood of reinfection with Propionibacterium acnes or infection with another bacteria that can cause a much bigger problem.
  3. Establish a hygiene routine – Washing the face 1-2 times daily with mild soap or face wash helps clear out excess oil and dead skin cells. Medicated face washes that contain salicylic acid are particularly useful (more on this below). 
  4. Avoid over-washing! This can cause inflammation and skin breakdown that can actually increase outbreaks.
  5. Don’t fall for the ads – Commercials boasting totally clear skin are unrealistic.  Be patient, don’t compare yourself to others, and have reasonable expectations. Treatments will hopefully make your skin better – but not perfect.

I have acne, what can I try at home?: 
There are hundreds of over-the-counter (OTC) acne products but most of them contain the same active ingredients: Salicylic Acid or Benzoyl Peroxide. These each fight one of the underlying causes of acne to help prevent and treat acne (see, I included all that science for a reason!).  

  1. Salicylic acid works in two ways. First, it is a cleanser.  It helps clear the skin of dead cells and has a propensity for breaking up comedones (blackheads). Second, it has some anti-inflammatory properties that help ‘cool things down’ during outbreaks.  You will usually find this in medicated face washes. It can used 1-2 times per day both for prevention and during flares.  
  2. Benzoyl peroxide is an antibiotic that works very well against Propionibacterium acnes. Unlike Salicylic acid, this should be viewed as a treatment and not as a preventative medication.  Rub a small amount of the medicine on problems spots 1-2 times per day. This medication may cause some mild skin irritation, though this is now common with low dose OTC formulations.

Home treatments didn’t work… what’s next? 
Most of us at Potomac Pediatrics are well-versed in straightforward acne treatment. If the OTC treatments are not doing the trick, make an appointment to talk with any of us. Dr. Kaplan has taken a special interest in acne and recently created a special acne clinic 1-2 times per month! This clinic and her experience are also a great resources!  We may not all follow the same exact recipe, but the foundation of acne treatment is generally the same.  Here are a few things you can expect to discuss at one of these appointments: 

  1. Topical Retinoids (Vitamin A) – Retinoids come in a few flavors (Tretinoin and Differin are the most common), but all work in a similar way.  They work to smooth and strengthen the skin. They help limit the amount of dead skin cell debris which reduces the risk for blackhead formation.  This stops acne before it starts. This is usually one of the first medications we will try for mild to moderate, non-inflammatory acne. It can be used in isolation or in combination with the therapies below.  This medicine causes sensitivity to sunlight, so sunscreen and extra diligence is very important while using it!
  2. Topical Antibiotics –  Sometimes Benzoyl Peroxide is not enough and we have to reach for more powerful antibiotics. The same principles from the BP section apply.  We try to kill the bacteria before it has a chance to infect clogged pores. These are often used in combination with the retinoids to work synergistically to limit acne.
  3. Oral antibioticsIf topical antibiotics don’t do the trick, sometimes we have to switch over to oral antibiotics to help keep infections at bay.  

Should I see a specialist?
Not all acne is created equal.  The sections above are geared towards your simple, straight forward acne.  Severe cases and inflammatory acne can leave scars.  In these cases we don’t want to delay in getting you to an expert.  Similarly, if your acne does not respond to our treatments we may also recommend that you see a specialist. You can always call, send pictures, or make an appointment if your are worried your acne is of this more severe variety.
What is Accutane?
Accutane (Isoretinoin) is a very strong oral acne medication that can only be prescribed by a dermatologist.  It is effective in treating some of the most severe cases of acne but can come with some side effects.  It require close monitoring, so you can expect  blood work and urine pregnancy testing before starting this medicine. The FDA has also linked this medication with depression and suicidal thoughts in some teens. Newer evidence shows this link is less clear originally thought.  You should let your dermatologist know if you have a history of depression before starting the medication.
Helpful and Trusted resources about acne:
HealthyChildren.Org: Teens and Acne Treatment
HealthyChildren.Org: Food and Adolescent Acne
HealthyChildre.Org: What Makes Acne Worse
HealthyChildren.Org: Zits are the Pits
American Academy of Dermatology: 5 ways to help your teenage survive acne