Why does that big pimple always appear the first week of school, the night before prom, picture day, her sweet sixteenth birthday party, or any other important event in your teen’s life?
A rite of passage, acne is caused by a combination of genetics and bad luck. The perception of acne as a problem depends on the eye of the beholder. When I see a teenaged patient in my office for acne, the first question I ask is, “Who is more concerned about the acne? The parent or the patient?” Some kids have very mild acne, yet those kids perceive their pimples are the size of golf balls. Other kids are oblivious, and the parents are more upset than the teen. When you’re a teenager, everything to you seems bigger than it actually is.
Even if your teen starts to break out with what she perceives are huge blemishes but are really the size of pin pricks, do take her seriously. For anyone dealing with acne, to them one spot can seem like many.
Many effective, safe products can diminish mild acne and thus greatly help self-esteem in a self-conscious teen. Also, make sure to probe to see if a negative perception of her appearance extends to an overall poor body image. Sometimes distress over minimal acne can be an early sign of body image disorders such as anorexia nervosa or bulimia.
The categories of acne medicines are:
-Topical antibiotics such as benzoyl peroxide or clindamycin, applied directly to skin- works to kill the bacteria that lead to acne
-Topical medications called retenoids such as tretinoin (Retin A) and adapalene (Differin) stop acne formation mainly by penetrating into the deep layers of the skin to loosen acne causing pores
-Topical creams which combine both a retenoid and an antibiotic also exist such as the adapalene and benzoyl peroxide product called Epiduo.
-Oral antibiotics, such as minocin, clindamycin, or erythromycin also kill the bacteria that lead to acne formation
-Accutane, an oral medical reserved for severe, scarring acne. Can cause significant birth defects and so girls who take it must also take birth control pills and have periodic pregnancy tests. Chemical imbalances may occur, so blood work is required for both sexes.
-Hormonal therapy (birth control pills)- works best for females who break out near their periods, smooths out the hormonal fluctuations which fire up acne.
I always remind my patients that most treatments take six weeks to work. For kids who experience dry skin from the topical medications, use noncomedogenic (non acne forming) moisturizer liberally. Pediatricians usually schedule follow up visits for acne at 4-6 week intervals. If your teen has mild acne but truly doesn’t want to bother with treatment, just encourage washing with a mild cleanser (for example Dove or Cetaphil soap) once or twice a day. No scrubbing, and stay away from alcohol containing astringents. You don’t want him irritating already irritated skin. Also ask him not to use the same smelly germy cloth after every wash. Instead dry off with a clean washcloth or soft paper towel . Applaud his self-confidence and lack of obsession with a skin condition which almost always improves with time.
Myth buster: eating chocolate does not cause acne. The chocoholic in me is greatly relieved by this knowledge.
Truth: arranging hair to hide the face tends to make acne worse. Avoid oily hair gels and sprays. In addition, touching and picking at the skin also causes irritation in an already irritated area.
Finally, what to do on prom night? Cosmetics work wonders, and parental reassurance, even if your teen waves it aside, can take care of the rest.
Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
Updated from the original post of July 22, 2010