- Treating Teen Acne
- Blackheads (or open comedones)
- Whiteheads (or closed comedones)
- Papules and pustules
- Cysts or nodules
- Skin care and treatment
- Tips to care for acne
- Isotretinoin patient safety
- Acne In Teenagers
- How can I help care for my teen’s acne at home?
- Why Do I Get Acne?
- Prevent, Treat and Overcome Teenage Acne
- Puberty, hormones and glands
- An issue for 85 percent of teens
- Options for persistent or severe cases
Treating Teen Acne
It’s a fact of teenage life: When puberty hits, acne often does, too.
Just about every teen will find at least one blackhead or whitehead on his or her skin by age 17, and some teens will develop more severe acne, which can leave scarring.
The prime culprits of acne, experts say, are heredity and hormones. At puberty, the sebaceous or oil glands around the hair follicles on the skin enlarge. Oil production also increases. Then, the ducts surrounding the follicles become clogged, and a whitehead or blackhead—called a comedo—results.
Most cases of pimples, blackheads, or whiteheads will clear up quickly, but for some, acne can cause extremely painful, cystlike lesions. Acne can continue for years, but typically vanishes when a person reaches his or her early 20s. For some, however, acne can continue well into adulthood.
Determining which type of acne lesions a teen has is the first step in directing treatment. There are four common types:
Blackheads (or open comedones)
These are caused by pores clogged by debris on the skin surface. Blackheads typically show up on the face, nose, and forehead, and on the neck, chest, and back. (Blackheads have a black center, which is not caused by dirt, but rather, by cells and oil in the follicle that oxygen in the air oxidizes.) Teens can sometimes open the clogged pores by using a benzoyl peroxide gel applied sparingly four to seven times a week. If this doesn’t help after a couple of months, then your doctor may prescribe a different medication. Teens also should gently clean their skin twice a day. Girls who wear makeup should use face products that won’t encourage blackheads to form. (These products are called noncomedogenic.)
Whiteheads (or closed comedones)
When a plugged follicle remains under the skin, a small white bump or whitehead results. They can sometimes be treated by over-the-counter benzoyl peroxide cream or with prescription medications.
Papules and pustules
Papules are small bumps on the skin that are inflamed. Pustules (pimples) are papules that are filled with pus. Topical medications such as benzoyl peroxide or a retinoid (prescribed topical medicine) can often help. An oral antibiotic, oral contraceptive, or other prescription cream may be needed.
Cysts or nodules
These are deeper, painful lesions that occur when the infection within the sebaceous gland causes the gland and the area around it to become distorted as the infection spreads below the skin surface. An oral antibiotic or other acne medication like isotretinoin is often necessary to treat these types of lesions to help prevent scarring.
Skin care and treatment
A starting point for good skin care includes thorough but gentle cleansing at least twice daily. Vigorous scrubbing will irritate the skin, making acne worse. Be aware that products that include alcohol or other astringents or harsh detergents can irritate the skin and constrict the pores, often making acne worse. Your teen should wear an oil-free or noncomedogenic sunscreen when outdoors.
Occasionally, nodules or deep bumps of acne persist. Then, the doctor may prescribe topical antibiotics. Oral antibiotics, or other acne medicines like isotretinoin, are sometimes required, but you should talk with your child’s doctor about the risks and benefits before using them.
Tips to care for acne
Keep all skin areas prone to acne very clean. Use soap and lots of water; pat areas dry; don’t rub the skin.
Avoid washing acne prone areas with very hot or very cold water. Lukewarm water is best for not aggravating skin conditions.
Don’t cover acne with bandages or tight-fitting clothing.
Isotretinoin patient safety
News of lawsuits and frightening side effects can make one wonder why a dermatologist would prescribe isotretinoin (eye-soh-tret-in-OH-in)1. Furthermore, why would anyone take it to treat acne? There really is more to the story.
Effective when nothing else works
Dermatologists prescribe isotretinoin for severe acne. Severe acne is often very painful. When the painful cysts and nodules of severe acne clear, they leave permanent scars. Many people who have severe acne feel depressed. Some feel anxious. Low self-esteem often develops. Grades can plummet, and job performance can suffer.
Clearing severe acne greatly improves many people’s lives. Most acne treatments, however, have little effect on severe acne.
Isotretinoin can clear severe acne when other treatments fail. With just one treatment, isotretinoin can permanently clear the skin. One treatment typically lasts four to five months. If a dermatologist prescribes a lower dose of isotretinoin, the treatment may last longer. Treatment with isotretinoin often results in prolonged clearance of acne, which can be permanent for some patients.
Isotretinoin is strong medicine. It has the potential to cause some serious side effects. That’s why dermatologists carefully evaluate each patient. They weigh the pros and cons before prescribing isotretinoin. They carefully monitor every patient taking this medicine.
Dermatologists carefully evaluate patients
Before prescribing isotretinoin, dermatologists ask questions about the patient’s physical and mental health. They ask what medicines, vitamins, and herbal supplements the patient takes. If everything looks OK, the patient must get a few medical tests. Everyone needs a blood test. Women who can get pregnant must have pregnancy tests. Women need 2 negative pregnancy tests before isotretinoin can be prescribed.
Before prescribing isotretinoin, the dermatologist looks at the test results. If the results are okay, the dermatologist will discuss possible side effects of isotretinoin. After learning about isotretinoin, a patient must decide whether to take this medicine.
If the patient wants to take it, the patient must agree to the strict terms of the iPLEDGE program. iPLEDGE was created to help patients take this medicine seriously. The terms that the patient must agree to include:
See the dermatologist every 30 days
Take the necessary medical tests
Patients carefully monitored
The office visits and medical tests allow a dermatologist to look for early warning signs of possible side effects and determine how well the medicine is working. The dermatologist will look for signs of depression, inflammatory bowel disease, and other possible side effects.
Before writing the next prescription, the dermatologist must be convinced that the patient is doing well and following iPLEDGE.
Depression and isotretinoin
Many people worry that isotretinoin can cause mental health conditions. There have been reports of patients developing depression, seeing and hearing things that are not real, and having thoughts of suicide while taking isotretinoin. You may have heard such reports in the news.
Isotretinoin and depression
Some patients have suffered from depression while taking isotretinoin, but more research is needed to determine if the drug is the cause.
Dermatologists take these reports seriously. That’s why dermatologists are conducting research studies to find out whether isotretinoin is directly responsible. Proving or disproving this is not as easy as it sounds. One reason is research shows that people who have severe acne often become depressed. This is true for people who have never taken isotretinoin.
Because we do not have enough evidence to tell whether this medicine can cause depression and other mental health conditions, dermatologists carefully monitor their patients for warning signs of depression and other mental health conditions.
Dermatologists also recommend taking precautions. If a person taking isotretinoin has any symptoms of depression or another mental health condition, the person must stop taking isotretinoin right away.
Inflammatory bowel disease and isotretinoin
Inflammatory bowel disease (IBD) is another concern. There have been reports of patients developing IBD while taking isotretinoin. Again, there is not enough scientific evidence to determine whether isotretinoin is actually the cause. More research is needed.
If a patient develops any of the following signs or symptoms of IBD, the patient must stop taking isotretinoin and see a doctor:
Severe stomach or bowel (intestines) pain
Bleeding from rectum
Yellowing of skin or eyes
Patient safety is the first priority
Isotretinoin is an important medicine. It can clear severe acne that does not respond to any other treatment. As acne clears, a patient’s quality of life often greatly improves. Dermatologists are committed to the safe and responsible use of this medicine. Patient safety is a dermatologist’s first priority when prescribing isotretinoin.
1 Isotretinoin is the generic name for this drug. Many people know this drug by the brand name Accutane, which is no longer available. Isotretinoin is available through other brand names.
American Academy of Dermatology and AAD Association, “Position Statement on Isotretinoin, (last update November 13, 2010).
American Academy of Dermatology, “AADA introduces updated isotretinoin position statement.” News releases issued November 22, 2010.
Chiu V, Cheng A, Oliver D, “Isotretinoin and association with depression.” Presented as a poster (P704) at the 68th Annual Meeting of the American Academy of Dermatology, March 2010; Miami. (Commercial support: None identified).
Hodgkiss-Harlow CJ, Eichenfield LF, Dohil MA. “Effective monitoring of isotretinoin safety in a pediatric dermatology population: A novel “patient symptom survey” approach.” J Am Acad Dermatol 2011; 65: 517-24.
Crockett SD, Gulati A, Sandler RS et al. “A causal association between isotretinoin and inflammatory bowel disease has yet to be established.” Am J Gastroenterol 2009; 104: 2387-93.
Goldsmith LA, Bolognia JL, Callen JP et al. “American Academy of Dermatology Consensus Conference on the safe and optimal use of isotretinoin: summary and recommendations.” J Am Acad Dermatol 2004; 50: 900-6.
Magin P, Pond D, Smith W. “Isotretinoin, depression and suicide: a review of the evidence.” Br J Gen Pract 2005; 55: 134-8.
Strauss JS, Krowchuk DP, Leyden JJ et al. “Guidelines of care for acne vulgaris management.” J Am Acad Dermatol 2007; 56: 651-63.
U.S. Food and Drug Administration (FDA), “The iPLEDGE Program Patient Introductory Brochure” (pdf), December 2007.
Wysowski DK, Beitz J. “Methodological limitations of the study: Isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide.” Arch Dermatol 2001; 137: 1102-3.
Wysowski DK, Pitts M, Beitz J. “An analysis of reports of depression and suicide in patients treated with isotretinoin.” J Am Acad Dermatol 2001; 45: 515-9.
Acne In Teenagers
How can I help care for my teen’s acne at home?
There is no instant or permanent cure for acne, but it is possible to control it. Proper treatment of your teen’s acne will help to prevent permanent scars. Below are some suggestions to help them take care of their skin.
Even though dirt does not cause acne, taking care of the skin with good hygiene is important. The darkness of a blackhead is not dirt, but is due mostly to dried oil and shed skin cells in the openings of the hair follicles. Your teen should wash their face with a gentle, pH-balanced soap-free face wash and warm water twice a day. It’s important not to wash too often as this may aggravate their acne. Regular shampooing of your teen’s hair is also a good idea, especially if their hair is oily and rests against their forehead.
When buying makeup, make sure it’s non-comedogenic or non-acnegenic. This means the cosmetic should not cause whiteheads or blackheads. Encourage your teen to remove makeup every night with face wash and water.
Many non-prescription acne lotions and creams can help mild acne and are available over the counter at your local pharmacy. But, many of these products will make your teen’s skin dry if they use them too often or if they use more than one of them at the same time (such as using an acne wash and an acne cream). If your teen uses these products, make sure they follow the instructions carefully. Using the wrong products can irritate your teen’s skin and make their acne worse. Ask your pharmacist for advice on the best product to use.
Your teen shouldn’t pick, scratch, pop or squeeze their pimples themselves. If your teen squeezes their pimples, it may cause more redness, swelling, inflammation and scarring.
If your teen shaves their face and has acne, encourage them to try both an electric and a safety razor to see which is more comfortable. If they use a safety razor, encourage them to soften their facial hair thoroughly with soap and warm water. To avoid nicking pimples, tell them to shave as lightly as possible. They should only shave when necessary and always use a sharp blade.
Food does not generally cause acne. Research has shown acne can sometimes improve after reducing the amount of processed food in the diet. Following a strict diet will not clear your teen’s skin by itself.
Acne may improve after your teen has been out in the sun, but sunlight only helps for the short term. In the long run, sunlight may worsen acne. Too much sun over many years could also cause early ageing of the skin and skin cancer.
Why Do I Get Acne?
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If you’re a teen, chances are pretty good that you have some acne. Almost 8 in 10 teens have acne, as do many adults.
Acne is so common that it’s considered a normal part of puberty. But knowing that doesn’t always make it easier when you’re looking at a big pimple on your face in the mirror. So what is acne, and what can you do about it?
What Is Acne and What Causes It?
Acne is a condition of the skin that shows up as different types of bumps. These bumps can be blackheads, whiteheads, pimples, or cysts. Teens get acne because of the hormonal changes that come with puberty. If your parents had acne as teens, it’s more likely that you will, too. The good news is that, for most people, acne goes away almost completely by the time they are out of their teens.
The type of acne that a lot of teens get is called acne vulgaris (the meaning of “vulgaris” isn’t as bad as it sounds — it means “of the common type”). It usually shows up on the face, neck, shoulders, upper back, and chest.
The hair follicles, or pores, in your skin contain sebaceous glands (also called oil glands). These glands make sebum, which is an oil that lubricates your hair and skin. Most of the time, the sebaceous glands make the right amount of sebum. As the body begins to mature and develop, though, hormones stimulate the sebaceous glands to make more sebum.
Pores become clogged if there is too much sebum and too many dead skin cells. Bacteria (especially one called Propionibacterium acnes) can then get trapped inside the pores and multiply. This causes swelling and redness — the start of acne.
If a pore gets clogged up and closes but bulges out from the skin, you’re left with a whitehead. If a pore gets clogged up but stays open, the top surface can darken and you’re left with a blackhead. Sometimes the wall of the pore opens, allowing sebum, bacteria, and dead skin cells to make their way under the skin — and you’re left with a small, red bump called a pimple (sometimes pimples have a pus-filled top from the body’s reaction to the bacterial infection).
Clogged pores that open up very deep in the skin can cause nodules, which are infected lumps or cysts that are bigger than pimples and can be painful. Occasionally, large cysts that seem like acne may be boils caused by a staph infection.
To help prevent the oil buildup that can contribute to acne, wash your face once or twice a day with a mild soap and warm water. Don’t scrub your face hard with a washcloth — acne can’t be scrubbed away, and scrubbing may actually make it worse by irritating the skin and pores. Try cleansing your face as gently as you can.
If you wear makeup or sunscreen, make sure it’s labeled “noncomedogenic” or “nonacnegenic.” This means it won’t clog your pores and contribute to acne. And when you’re washing your face, be sure you take the time to remove all of your makeup so it doesn’t clog your pores.
Acne isn’t really helped by the sun. Although a tan can temporarily make acne look less severe, it won’t help it go away permanently — and some people find that the oils their skin produces after being in the sun make their pimples worse.
If you use hair sprays or gels, try to keep them away from your face, as they also can clog pores. If you have long hair that touches your face, be sure to wash it often enough to keep oil away. And if you have an after-school job that puts you in contact with oil — like in a fast-food restaurant or gas station, for example — be sure to wash your face well when you get home. It also can help to wash your face after you’ve been exercising.
Many over-the-counter lotions and creams containing salicylic acid or benzoyl peroxide are available to help prevent acne and clear it up at the same time. You can experiment with these to see which helps. Be sure to follow the instructions exactly — don’t use more than you’re supposed to at one time (your skin may get too dried out and feel and look worse) and follow any label directions about allergy testing.
Some people do find that they notice their breakouts get more severe when they eat too much of a certain food. If you’re one of them, it’s worth trying to cut back on that food to see what happens.
What if I Get Acne Anyway?
Sometimes even though they wash properly and try lotions and oil-free makeup, people get acne anyway — and this is totally normal. In fact, some girls who normally have a handle on their acne may find that it comes out a few days before they get their period. This is called premenstrual acne, and about 7 out of 10 women get it from changes in hormones in the body.
Some teens who have acne can get help from a doctor or dermatologist (a doctor who specializes in skin problems). A doctor may treat the acne with prescription medicines. Depending on the person’s acne, this might mean using prescription creams that prevent pimples from forming, taking antibiotics to kill the bacteria that help create pimples, or if the acne is severe, taking stronger medicines such as isotretinoin, or even having minor surgery. Some girls find that birth control pills help to clear up their acne.
If you look in the mirror and see a pimple, don’t touch it, squeeze it, or pick at it. This might be hard to do — it can be pretty tempting to try to get rid of a pimple. But when you play around with pimples, you can cause even more inflammation by popping them or opening them up. Plus, the oil from your hands can’t help! More important, though, picking at pimples can leave tiny, permanent scars on your face.
Reviewed by: Patrice Hyde, MD Date reviewed: June 2014
Prevent, Treat and Overcome Teenage Acne
Acne comes upon each person differently; some go through life with few issues and others feel burdened by the condition. Acne is fairly common—three-fourths of all Americans ages 11 to 30 have acne and 17 million Americans have acne at any given time. It can persist into adulthood too. It shows up most commonly on the face, neck, chest, back and shoulders.
What is Acne?
Acne normally starts in the pubertal or adolescent years when the body increases production of a hormone called androgen. This hormone stimulates production of an oily substance called sebum, which mixes with dead skin cells and hair in skin openings known as hair follicles. This buildup of skin cells, oil and hair all clumped together causes pressure, which can burst open and cause skin inflammation. A bacterium called propionibacterium acnes or P. acnes, also gets involved and creates more inflammation. Other causes of acne include:
- Certain medications
- Oil-based make up
Types of pimples in a breakout include:
- Whiteheads—small and under the skin
- Blackheads—visible and black on the surface. The dark color is not dirt and cannot be scrubbed away.
- Cysts—clearly visible, painful, full of pus and can cause scars
Things to Know Before Treating Acne (Tweet this)
Since there are varying degrees of acne, there are different treatment recommendations. The degree of acne varies from person to person and can come and go, getting better or worse without prediction. Before deciding on an acne treatment, consider these tips:
- The goal of treatment is to reduce breakouts, prevent new breakouts and limit acne scarring.
- Treatment plans are gradual and take time and patience.
- Being dedicated to the treatment plan is important, so you can see if the treatment is working or causing side effects.
- Do not pick at or irritate acne because this can cause more inflammation.
- Laser hair removal, waxing and exfoliating should be avoided during acne treatment.
Treating Mild and Moderate Acne
Over-the-counter topical medications (applied directly to the skin) may be all that is necessary. Many of these products contain resorcinol, benzoyl peroxide, salicylic acid and sulfur. These ingredients are responsible for:
- Breaking down blackheads and whiteheads (resorcinol, salicylic acid and sulfur)
- Killing bacteria, slowing oil production and a peeling agent to clear pores (benzoyl peroxide)
- Fighting inflammation (salicylic acid)
Other treatment tips
- If you have dry or irritated skin, creams work better.
- If you have oily skin, they may prefer a gel-based acne product.
- Treatment is best done at night and requires patience; make sure to read instructions on the product package completely.
- If the cream or gel treatment is not showing improvement, your doctor may prescribe oral antibiotics (Oral antibiotics are the same medication that treats MRSA, another skin issue)
- It is important to take what the doctor prescribes for as long as it is prescribed.
- A combination of treatments (topical and oral) may be required to see what works and what doesn’t work for each individual. Attention and patience is needed.
- It may take six to 12 weeks to see results.
- Try an over-the-counter topical treatment first and if you don’t see any improvement, contact your doctor.
- You may need to use topical creams or gels for a long time and use antibiotics during acne flare-ups.
- If you are on antibiotics, take what the doctor prescribes for as long as it is prescribed.
- Some antibiotics have side effects or stain teeth, so check with your doctor or nurse practitioner about how to take the antibiotics and what the side effects are.
NOTE: If you are using a product containing a retinoid, it can cause skin irritation and sensitivity to sun. Retinoids reduce inflammation and prevent new outbreaks.
Treating Severe Acne
Severe cases of acne should be treated by your doctor. A cosmetic doctor or plastic surgeon can provide treatments to prevent or reduce scarring.
General Tips for Controlling Breakouts (Tweet this)
- Wash face twice a day using mild soap and warm water (do not scrub).
- Don’t burst or pop pimples, this may cause acne to get worse. (Easier said than done, but it works!)
- Clean eyeglasses regularly.
- Let skin breathe. Don’t wear tight headbands, caps or sleeves unless they are newly cleaned.
- Keep hair clean and away from the face.
- Avoid prolonged sun exposure.
- If you shave your face, be careful and use warm water to soften the beard and a sharp, clean razor.
- Try to avoid stress.
- Hot and humid climates may cause or make acne worse.
- Avoid oil-based makeup and greasy hair products.
It is estimated that 85 percent of teens get acne, usually starting at age 11 for girls and a couple years later for boys.
Don’t let acne ruin those important teenage years
By Philina Lamb, M.D.
It’s one of nature’s ironies that acne hits people at the time of life when they are most concerned about their appearance. Teens, who may spend hours primping in front of the mirror, often have to contend with more skin problems in these years than they ever will again.
The bad news is that acne can still be a part of growing up. The good news is that doctors have a few more tricks for treating it than they did when the parents of today’s teens went through adolescence.
Puberty, hormones and glands
About the author
Dr. Lamb is an assistant professor of dermatology with UC Davis Medical Group.
Acne (which includes pimples, whiteheads, blackheads, cysts and pustules) occurs at tiny pores associated with hair follicles on the face, chest and back. Tiny oil (sebaceous) glands around these follicles are stimulated by hormonal changes during puberty to produce an oily sebum.
In acne, the opening of the follicle gets blocked, preventing the sebum from escaping normally. The resulting blocked pore is commonly called a whitehead. Blackheads occur when whiteheads are exposed to the air. Sometimes bacteria multiply within the plugged pores, causing tender, red pimples. If they also become filled with pus and fluid, painful cysts result.
An issue for 85 percent of teens
Those who don’t develop acne as a teenager are in a lucky minority. It is estimated that 85 percent of teens get acne, usually starting at age 11 for girls and a couple years later for boys. Acne can last throughout the teen years and into the early 20s. Older adults may also continue to be bothered by it. Many women note that it worsens just before menstruation and disappears during pregnancy.
Many “don’ts” our parents handed down to us about treating acne still apply. Don’t pick at, squeeze or roughly scrub pimples. Fortunately, chocolate, the food that many in my generation were told to avoid, is an innocent bystander. No special diet has been found helpful in controlling acne.
No special diet has been found helpful in controlling acne.
Simple treatment of acne involves keeping the skin clean, which promotes the shedding of old skin.
- I recommend washing the face twice a day with warm water and a mild soap.
- It’s also a good idea to keep hair clean and free of oily pomades to avoid acne around the scalp.
- Twice daily use of over-the-counter medications that contain benzoyl peroxide or salicylic acid can also be helpful. This promotes skin shedding and is mildly anti-bacterial.
- Many teenage girls ask me if it is okay to use cosmetics. While lipstick and eye makeup are fine, I prefer they use blushes and foundations that say “non-comedogenic” on the label. All the major brands should have such products.
- The use of mineral-based make-up powder should be avoided as these powders can worsen, or even cause, acne.
People often note that their acne improves in the summer, and this is probably because sun exposure increases skin shedding. However, the risk of skin cancer far outweighs the benefits to acne. I advise patients to wear a sunscreen outdoors and never to “treat” their acne with sunbathing or tanning parlors.
Options for persistent or severe cases
Consult your primary care doctor or a dermatologist (a physician who specializes in skin care) if the acne is severe, with cyst development or scarring, or if an acne problem does not improve after two to three months of treatment with over-the-counter preparations. They may recommend medications that more strongly promote skin shedding, such as those based on vitamin A, including Retin A. One such medication, the orally taken Accutane pill, is an effective medication, but can cause side effects, as well as serious birth defects if a woman uses it during pregnancy. For this reason, I monitor patients closely for side effects and do not prescribe this medication for women who are sexually active unless they are using reliable contraceptives.
With so many good treatments for acne available, there is no reason to merely suffer through this problem until it goes away.
Doctors may also prescribe antibiotics, either taken by mouth or applied directly to the skin. Steroid injections can also be helpful for patients who scar severely. Some acne lesions, such as cysts, may benefit by surgical drainage. For those with acne that leaves scars, chemical peels, dermabrasion, and laser techniques can even out the skin after the stage of active acne is over. One very new treatment available in dermatologist’s offices uses “blue light” to eradicate the bacteria that can aggravate acne.
The teenage years are a time so important to forming a positive social identity. A teen’s appearance becomes closely intertwined with his or her self-esteem. With so many good treatments for acne available, there is no reason to merely suffer through this problem until it goes away. I encourage parents to take acne seriously and treat it. Also, adults who continue to have moderate to severe acne problems should not hesitate to seek professional advice.