One of the tell-tale signs your child is starting puberty is the emergence of little pimples on their face. Of course this is assuming they aren’t advertising the other bodily changes that are taking place. Parents may notice changes in their child’s skin as early as 10 years of age and since acne can last well into the late teens, it’s good to get started on healthy skin habits as soon as the pimples appear.

Before we get to treatment options, let’s review what acne is and why we see it in teens.

ACNE is the most common skin condition seen in the United States and consists of multiple types of blemishes. These blemishes occur at a time when hormones released during puberty cause increased sebum production by oil glands. This excess oil, in conjunction with bacteria and dead skin cells, clog the pores.

  • Blackheads are plugs in the pore that are close to the surface. The pore is open so dead skin cells and skin pigmentation are seen.
  • Whiteheads are plugs that are deeper in the skin and can vary from small bumps to red irritated bumps to pustules (pus comes to the surface).
  • Cysts are very deep, creating a large, often painful, bump or nodule.

Why treat acne?

While acne may appear to be a superficial condition, it can actually have longstanding consequences. On the skin, the most common complication of acne is scarring and dark spots. Scars typically form after having deeper nodules. Scars also form from picking, so DON’T PICK! Acne can also cause dark spots on the skin which, like scars, can persist into adulthood. More serious complications of acne are low self-esteem and depression. Some teens have such severe acne that they don’t want to go to school and some even consider suicide.

What are treatment options?

Treatment of acne will vary as the acne itself will change throughout adolescence. The treatment will also depend on the severity of the acne. Very mild acne, which we might see in younger teens and tweens, is best treated with mild medications that help layers of skin peel off and break open the pimples. These medications can be found over the counter.

Friedman acne blog tweet1

OTC benzoyl peroxide (BPO) or salicylic acid are easy to find and often well tolerated, although a small number of people may be allergic to the BPO. If you find that after 6-8 weeks these treatments are not working or the acne is getting worse, it may be time to move on to prescriptions.

  • Retinoids work by accelerating skin cell turnover, reducing the amount of dead skin cells, which clog pores. They also help to break up existing pimples. Common retinoids include Retin A and Differin. (Adapalene, generic for Differin, is a well tolerated retinoid and is now available over the counter.)

Friedman acne blog adapalene cream

  • Topical antibiotics kill the bacteria on the surface of the skin. Signs of bacterial involvement may be pimples that are red and inflamed or have pustules. Because of antibiotic resistance, this is best saved for acne in which other treatments don’t work. It is also necessary to use topical antibiotics in conjunction with topical BPO.
  • Oral antibiotics are very helpful when deeper, inflamed nodules and cysts are present. They can also help clear up acne that is present on the chest and back. Use of oral antibiotics needs to be done in conjunction with topical BPO as well, and should be re-evaluated every 3-6 months. It’s best to have treatment options to fall back onto once oral antibiotics have helped so that they can be easily removed.

Friedman acne blog tweet2

  • Accutane is oral acne medication called isotretinoin. It has a lot of side effects and should only be used in severe cases of acne and should be prescribed by a dermatologist.
  • Birth control pills are very helpful in girls because the hormone in the pills reduce the hormones in the body that increase sebum production. This is a good option for older teen girls who need to be weaned off of oral antibiotics.

What are the side effects of treatment?

Acne medications can cause dryness, redness and sun sensitivity. Therefore, it is very important to follow your doctor’s directions. These usually include allowing the face to dry for 20 minutes before applying medication, starting treatment every other night and gradually building up to nightly, moisturizing, and wearing sunscreen every day. Furthermore, if you are prescribed oral antibiotics, do not take them right at bedtime and be sure to take them with a large glass of water. The pills can get stuck in the esophagus and cause irritation. Finally, don’t wash more than twice per day, clean the skin after sports or sweating, and don’t pop the pimples.

I haven’t seen any consistent data on the relationship between specific foods in the diet and acne. Some people believe that dairy products or other foods make their acne worse. Teens are growing and need all the categories of food and a variety of nutrients, so if you feel you need to cut certain types of foods out of the diet because of acne, please talk to your doctor first. It may be safer to use some acne medication instead of cutting out nutrition. As always, a diet rich in fruits, vegetables, whole grains, calcium and lean protein is best for the whole body, including the skin. And don’t forget to drink lots of water!

Posted on Jul 13, 2017

Over the past year politics has taken over our lives. Our news, social media, conversations and, for some, our anxieties. As a pediatrician, my concerns with regards to lawmaking lie with how children and families will be affected by any given policy. I am an…

Posted on Jun 20, 2017

As a pediatrician, the safety and well-being of all children is my primary concern. When I counsel families on sleep safety, car safety, sunscreen, baby proofing, choking risks and even preventative care like healthy eating and vaccines, it is because my ultimate goal is for…

Posted on May 30, 2017

There are many things that new parents need to do while preparing for their baby to arrive. One that frequently gets overlooked is choosing a pediatrician. Pediatricians are doctors who specialize in the care of children from birth to 18 years of age and are…

Posted on Apr 2, 2017

If you have a young child, especially one in daycare or preschool, you have probably had some type of experience with conjunctivitis, otherwise known as pink eye.  Either your child has had it, you’ve received the dreaded notification that it is going around the class…

Posted on Mar 23, 2017

If you’ve ever had a urinary tract infection, you know it can be very uncomfortable. Pretty much anyone who has had one would say that it’s not very fun, so prompt treatment is desired. Most moms will understand this as pregnancy increases your risk of…

Posted on Mar 1, 2017

With spring around the corner, we can finally look forward to longer and warmer days. And thanks to all of the rain, this year is shaping up to be quite the year for outdoor allergies.  Seasonal allergic rhinitis, more commonly known as “hay fever,” affects…

Posted on Feb 22, 2017

In honor of National Childhood Dental Health Month, I have decided to partner with my good friend and pediatric dentist, Chris Pham, DDS, to bring you a series of posts about dental health. For our first post, we will discuss taking care of baby teeth….

Posted on Feb 7, 2017

Teething is one of the great mysteries of childhood. There have been so many symptoms associated with teething over the years that at this point it can be really confusing to know when your baby is getting a tooth. At various points in time, teething…

Posted on Jan 26, 2017

Picky eating is extremely common during childhood and a common source of parental frustration. While parents may react to picky eating in many different ways, I recommend adopting what I refer to as a “picky-free parenting” approach. With this approach, a parent sets the stage…