The Bumpy Road to Adulthood

For most of my teen patients, acne is as inevitable as algebra as a fact of life. At puberty, hormones from the gonads and adrenal glands migrate and fundamentally change the nature of the sebaceous (oil) glands. These hormones passing through the body stimulate the oil glands to wake up and party, which can result in bumps of varying sizes and qualities on the skin. Some kids get by with just a sprinkling of the annoying skin irritation called acne, while those on the opposite extreme can experience painful and disfiguring nodules and cysts.

How do overactive oil glands lead to a lumpy landscape on the skin? When oil glands are behaving themselves, they produce just enough oil to properly lubricate the hair and skin. When the glands overproduce, they can create plugs of oil (also called sebum) and skin cells under the skin’s surface that sit there like unwelcome guests forming bumps called comedones. Blackheads are comedones that are open and exposed to the air—the air oxidizes the oil plug creating the dark color. Inflamed and pus-filled bumps or pimples arise when bacteria (called propionibacterium acnes) that live in the skin, chomp on the oil, causing irritation. Cysts, a more deeply planted and painful form of acne, happen in those individuals whose oil glands really don’t know when to stop. Some people only get acne on their face—others get it on other areas of the body, such as the neck, chest, and back.

For my patients with mild acne, the initial treatment I recommend is often familiar to the parents of these kids. Benzoyl peroxide—which comes in many forms and under many brand names over the counter—zaps bacteria, dries oil, and promotes the clearing of dead skin cells. Salicylic acid treatments work in a similar manner. Both treatments can be drying. Preparations containing benzoyl peroxide can bleach fabrics—you may want to have your teen use old or white towels and pillowcases if they use this treatment.

When the severity of the acne increases a little, there are a lot of other medications in my toolkit such as tretinoin (Retin-A is a brand name), topical antibiotics, and oral antibiotics.

I tell patients that the medications won’t work unless they’re used properly and regularly, and it can take some time—typically it will be quite a few weeks of use before they’ll notice a change. My experience is that if the acne bothers the parent more than the teenager the teen won’t use the medication, as it requires some motivation to use something for many weeks before getting a return on the investment.

I advise teens to try not to pick at pimples. This only ups the irritation and potential for scarring.  And there’s no need to scrub affected areas—acne is largely hereditary and hormonal. I generally advise patients to gently cleanse their skin with a mild soap and their hands or a soft washcloth.

When a patient has a more severe form of acne such as cystic acne, I recommend they see one of our specialists. My colleague Virginia Sybert, MD, is an expert in pediatric dermatology. Dr. Sybert sees patients for whom acne is not only a nuisance; it can cause severe physical pain and emotional scarring. Additionally, even though most general pediatricians or family practitioners can treat mild to moderate acne, sometimes seeing the specialist is beneficial to help teen patients stick to a treatment routine.

As Dr. Sybert says, “No one ever died from acne, but it can be a painful, debilitating, and scarring disease that deserves treatment.”

For those with severe, cystic acne, Dr. Sybert says the best treatment is Isotretinoin, which you may know as Accutane. She explains that this is a highly effective treatment, working for 60 to 65 percent of patients in the first course of treatment. She says that though the treatment has been surrounded by some controversy, it has been shown to be safe in studies when taken as prescribed. “Isotrentinoin is not a drug for mild acne, and each patient needs to weigh the risks and benefits of taking this route for treatment,” she explains.

Both Dr. Sybert and I find great satisfaction in helping teens with acne feel better both physically and emotionally. We know that there are many treatments and recommendations out there for fighting acne, and we’ve probably heard them all. Does eating chocolate and fatty foods lead to bumpy skin? Does light therapy help improve skin clarity? Studies don’t yet prove that they do, but for some teenagers, there clearly is a relationship. We recommend those treatments for which we have documented evidence of success, but we also know that individuals have found some relief with their own approaches.

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