Acne
What Is Acne And What Causes It?
Acne is a condition that affects a majority of teenagers (around 85%). Our skin has what we call pilosebaceous units. These contain a hair follicle (pore) surrounded by a gland that produces oil. In puberty, hormones cause oil production to increase, clogging pores and encouraging acne-causing bacteria to multiply. This causes inflammation, which can show up in a variety of ways.
Blackheads: A combination of dead skin cells and oil that are open to the surface of the skin.
Whiteheads: Made of the same stuff as blackheads, though trapped deeper within the skin. You’ll see a small bump filled with a yellow or white substance, usually non-tender.
Pimples: These are the classic “red” and inflamed bumps where acne-causing bacteria have flourished. They sometimes have a white pustule near the tip.
Cysts: These are pimples that are embedded deepest within the skin and are very painful. They tend to cause long-term scarring / pitting of the skin and subsequent self-esteem issues, so we’re more aggressive with treatment.
Are There Lifestyle Factors That Affect Acne?
Yes! While they don’t cause acne completely on their own, they’re worth trying to address in case they help control your acne more quickly or effectively.
Diet: A diet that’s high in refined sugars (ice cream, white rice / bread / pasta, chips, fries, potatoes) is more likely to cause acne than one that incorporates more natural sugars (fruits, beans, vegetables, whole grains and oats). Another association that’s been found is cow’s milk, so you can try cutting down or switching to a low-refined sugar, lactose-free alternative for a few weeks to see if that helps! Cheese and yogurt are OK.
Stress: You’ll likely notice more breakouts during stressful times (e.g., during final exams, a breakup, family discord, a death, job struggles). Making sure to have other therapeutic outlets for stress management like family/friend support, therapy, or meditation can help.
Skin Care: You want products that are non-comedogenic (it should say this on the label). If they aren’t, they can clog pores, worsening the existing issue causing acne.
How Long Does Acne Last For?
After starting in early adolescence, it usually lasts for years, unfortunately. Many will have acne until their late 20s/early 30s, though it can sometimes last even longer. However, know that it can be controlled with the right treatments, so that your skin is mostly clear except for rare breakouts.
What Should A Starting Skincare Regimen Look Like?
A good skin care regimen will always include three things: a cleanser, moisturizer, and sunscreen. That’s your foundation! We can always add medicated products for your teen on top, which we’ll go into in the next section, but that’s where I like to start.
What Are Medication Options With My PCP (Or Even OTC)?
Topical Creams:
Benzoyl Peroxide: Benzoyl Peroxide is an anti-inflammatory agent that helps control the bacteria that causes acne and tame oil production. It’s actually available OTC in many cleansers (you can choose one that’s 2.5%-5% to start), and may be used on areas outside of the face (such as the back). Know that it bleaches fabrics, so if you have dark-colored towels, that’s something to be mindful of.
Clindamycin / Dapsone: Clindamycin is an antibiotic cream often prescribed in combination with Benzoyl Peroxide, assuming insurance coverage. It’s prepared by the Pharmacist (mixing them together at home won’t have the same effect). If prescribed separately, apply Benzoyl Peroxide in the AM and Clindamycin at night. If you have sensitive skin, Dapsone is an alternative antibiotic cream that’s often used.
Tretinoin / Adapalene: This is the most effective topical option we have for acne, though it’s a more drying medication, so needs extra moisturizing with sensitive skin. It helps with skin cell turnover, wrinkles and fine lines, and reduction of scarring. Always wear sunscreen with this medication.
Oral Medications:
Doxycycline: This is an oral antibiotic that’s usually given on a short-term basis (3 months) alongside topical creams to help with acne, especially on non-facial areas.
Spironolactone: This is a medication that’s helpful with hormonal acne in females. This type of acne is usually cystic, stubborn in spite of the above therapies, and worsens with menstrual cycles. It requires routine lab monitoring.
Accutane: When acne is severe, Accutane can be a very effective option. It’s only prescribed by Dermatologists due to its side effect profile (liver inflammation, lipid abnormalities, skin dryness, and harmful effects on a fetus if a teen were to become pregnant). It’s usually a 4-6 week course with routine lab monitoring, and in spite of the risks, can really have a dramatic improvement on skin and self-esteem. If you’re having trouble with the therapies listed above, ask for a referral to have this conversation.
If I’m Using Tretinoin, Is There Anything To Be Aware Of?
What About Pimple Patches?
These are OK as spot treatment (e.g., Hero Patches). They usually use hydrocolloid, which helps with keeping the zit covered (so that it doesn’t get exposed to more bacteria and your teen isn’t tempted to pick at it, which usually causes even more swelling) and decreasing inflammation.
Acne can have impacts on self-esteem and mood, so don’t feel like it’s too silly to discuss with your PCP. We’re here to help!
How Long Does Acne Treatment Take To Work?
At least 6-8 weeks after starting a treatment! Usually, initial follow up visits are done at the 2-3 month mark to assess improvement. It’s important to be patient with acne medications and give them time to work. I always recommend that teens take photos weekly so that they don’t lose sight of how things are changing. Often, when they look at Week 1 compared to Week 6, they’ll breathe a sigh of relief that things have actually gotten better. And if they haven’t, it’s good data to show your PCP so that they know it’s time to switch up treatment.
