Acne in Teens: What Helps and When to See a Doctor

Almost every teenager gets some pimples, and many get more than a few. Acne is not a sign that your child is dirty or eating the wrong snacks. It is a common skin condition tied to the body changes of puberty, and it can be treated. Knowing what is going on under the skin makes it easier to pick a routine that helps instead of one that makes things worse.

What causes acne

Hair follicles (pores) on the face, chest and back each have a small oil gland. During puberty, hormones tell those glands to make more oil. When oil and dead skin cells clog a pore, you get a whitehead (closed) or a blackhead (open). The dark color of a blackhead is not dirt. It comes from the plug reacting with air.

A type of bacteria that lives on everyone's skin can grow in a clogged pore. The body reacts with swelling, which turns a plug into a red bump, a pus-filled pimple, or a deeper, painful lump. Deep lumps are the kind most likely to leave scars.

Things that can make acne flare include family history, heavy or oily skin and hair products, rubbing from helmets, chin straps or backpack straps, stress, and for some girls, the days before a period. Research on food is mixed. Some studies link sugary, high-glycemic foods or a lot of milk to more breakouts, but food is rarely the main cause.

A gentle daily routine

Teens often scrub hard when they break out. That irritates the skin and can make redness worse. A simple routine works better:

• Wash the face twice a day and after sweating with a mild cleanser and lukewarm water. Use fingertips, not a rough cloth.
• Pat dry and use a moisturizer labeled "non-comedogenic" or "oil-free," which means it is less likely to clog pores.
• Use sunscreen every day. In the strong San Antonio sun this matters even more, because several acne treatments make skin burn more easily.
• Wash hair regularly and keep hair oils and gels off the forehead.
• Shower after sports and wash pads, headbands and pillowcases often.
• Do not pick, pop or squeeze. It pushes the clog deeper and raises the risk of dark marks and scars.

Over-the-counter ingredients to know

Drugstore shelves are crowded, but most products rely on a few active ingredients. Look for the name on the label:

• Benzoyl peroxide lowers acne bacteria and helps clear pores. It comes in washes, gels and creams. It can dry the skin and will bleach towels, sheets and clothing, so white pillowcases are a good idea.
• Adapalene is a retinoid, a vitamin A relative, that keeps pores from clogging. It is now sold without a prescription. It is usually applied as a thin layer at night. Dryness and mild peeling in the first few weeks are common.
• Salicylic acid helps loosen dead skin so pores stay open. It is often found in cleansers and pads and is gentler for some teens.

Start with one product, use a small amount, and follow the package directions or ask your pharmacist how to use it. Using several strong products at once mostly leads to red, stinging skin. Give a product six to eight weeks before deciding whether it works. Acne often looks a little worse before it looks better.

Myths that get in the way

• "Washing more will fix it." Over-washing strips the skin and can trigger more oil.
• "The sun clears acne." A tan can hide redness for a while, but sun damage and burns are not a treatment.
• "Toothpaste dries out pimples." It can burn and irritate the skin. Stick with real acne products.
• "They will just grow out of it." Many teens do improve with time, but waiting can mean scars that last for life. Treatment is worth it.

The emotional side

Acne can hurt more than the skin. Teens may avoid photos, sports, swimming or friends. Some feel anxious or down about how they look, especially with filtered images all over social media. Take their feelings seriously, even if the acne seems mild to you. Avoid comments about their face at the dinner table, and let them know help is available. If your teen seems withdrawn, sad most days, or stops doing things they used to enjoy, mention it to the pediatrician. That deserves a conversation of its own.

When prescription care helps

See the pediatrician if over-the-counter care has not helped after a couple of months, if acne is painful or deep, if it is leaving scars or dark spots, or if it is affecting your child's mood or confidence. Your pediatrician can look at the type of acne and suggest a plan, which may include:

• Stronger prescription retinoid creams or gels
• Combination products that pair benzoyl peroxide with a topical antibiotic
• Antibiotic pills for a limited time for more widespread, inflamed acne
• For some girls, hormone-based treatment such as certain birth control pills
• Referral to a dermatologist for severe or scarring acne, where a strong medicine called isotretinoin may be an option. It requires close monitoring and strict pregnancy prevention.

Bring a list of everything your teen has tried and for how long. That helps the pediatrician choose the next step. You can read more about acne on MedlinePlus and from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

When to call us

Call your A thru Z Pediatrics office if your child's acne is not improving after two to three months of steady care, is painful or leaving scars, started before about age 8, or comes with other changes like rapid body hair growth or irregular periods. Also call if a product causes a lot of swelling, burning or a rash, or if acne is weighing on your teen's mood.

Call 911 or go to the ER if your child has trouble breathing, swelling of the face, lips or tongue, or hives after using a new skin product, or if your teen talks about wanting to hurt themselves.

Ready to talk about a plan? Request a visit.