I recently ran into a friend I hadn’t seen in about 5 years. We were catching up on each other’s lives when her teenage son joined us. The last time I saw “John” he was about 11 years old and full of pre-teen energy and curiosity. This time however, he was quiet and kept his head down when he said hello. When he finally looked up, I saw why he had been avoiding full-face eye contact. “John” had a pretty severe case of acne. Not a few pimples, but entire areas on his face that were red and dotted with large pustules and cysts. It looked painful.
Typically, acne isn’t a serious medical condition. It comes and goes throughout life and is more of an annoyance than anything else. For some though, acne can cause emotional distress and lead to scarring of the skin and psyche.
Fortunately, there are many over-the-counter (OTC) medications that when combined with a consistent face cleaning routine, keep breakouts to a minimum.
But for some people, teens in particular, acne can progress to the point where OTC medications don’t control the problem. Pediatricians are often called upon to help teens come up with a plan of treatment.
There is a range of medications that can clear up even severe cases of acne, according to the American Academy of Pediatrics (AAP). Writing in the May issue of its journal Pediatrics, the group throws its support behind new guidelines from the American Acne and Rosacea Society that detail how to treat acne in children and teens of all ages.
That "all ages" part is important because acne is becoming more and more common in pre-teens, too, said Dr. Lawrence Eichenfield, the lead author of the AAP report. One study of 9- and 10-year-old girls found that more than three-quarters had pimples.
A possible reason for why kids are experiencing breakouts at a younger age is that, on an average, boys and girls are starting puberty earlier than in past generations says Eichenfield.
According to the AAP, milder cases of acne can be managed with OTC soaps, washes, lotions or gels containing benzoyl peroxide. Another common ingredient used to battle acne is salicylic acid. Department stores now have sections of aisles filled with these types of products making them easy to find.
But what if the OTC medications do not help clear up your teen’s acne? The AAP recommends going to the next step of trying a topical retinoid. Retin-A, Avita and Differin are the most commonly prescribed treatments. They are vitamin A derivatives and work by speeding up skin cell turnover, which helps unclog pores.
The main side effects of all the topical treatments are skin irritation and dryness, the AAP said.
If the acne is considered moderate to severe and other treatments have failed to work, the next step may be oral antibiotics. When pores become clogged with oil and skin cells, bacteria can grow in the pore and cause inflammation. Antibiotics help by killing bacteria and soothing inflammation.
But, Eichenfield said, "it's important to use antibiotics appropriately."
Antibiotics can have their own set of problems and should be used with caution. The overuse of antibiotics has made some acne causing bacteria more resistant. Other side effects can be stomach upset, dizziness and, in girls - yeast infections.
When all else fails and acne is severe, the prescription drug isotretinoin may be an option. Brand names include Roaccutane (formerly known as Accutane) and Claravis.
The drug is very effective, but it can cause birth defects, so girls and women have to use birth control and get regular pregnancy tests if they go on the medication. Isotretinoin also has been linked to inflammatory bowel disease, depression and suicidal thoughts in some users, although it's not clear the drug is to blame, the AAP said. (Severe acne itself can cause depression and suicidal thoughts, for example.) Other side effects can include sun-sensitivity, dry eyes, mouth, lips nose and skin as well as itching, nosebleeds and muscle aches.
Why do we get acne?
Acne occurs when hair follicles become plugged with oil secretions, dead skin cells and sometimes bacteria. The most common areas on the body where acne erupts are the face, neck, chest, back and shoulders. It takes time for acne lesions to heal and quite often another breakout will appear as one is finally clearing up.
Hormones and certain medications can play a role in triggering acne. Whether diet is a factor is still up for debate. "The idea that food plays a role became relegated to myth," Eichenfield said. But recently, he added, some researchers have been revisiting the issue. There is some evidence that a sugary diet may promote acne, for example. But for now, it's not clear whether any diet changes will actually help keep kids' skin clear, Eichenfield said.
Stress may not cause acne but it can aggravate it.
Keeping skin pores open and unclogged is the key ingredient to preventing acne. While it may seems that scrubbing your face, using astringents and drying masks would help do that, they aren’t generally recommended. Too much washing and scrubbing can irritate the skin.
It's best to wash your face gently twice a day, with a soap-free pH-balanced cleanser, the AAP said. Facial toners -- which commonly come in pre-packaged acne regimens -- can help clear away oil. But the group suggested going easy on toners, since they can irritate the skin.
One myth that seems to never go away is that tanning and more time in the sun is good for acne. A sunburned face may look better to you because your whole face is red instead of just certain areas. Too much sun can actually make acne worse for some people. It also ages your skin and can cause skin cancer. Certain medications (including some for acne treatment) can make your skin very sensitive to the sun’s rays. Always use a “face-friendly” sunscreen that doesn’t clog the pores.
I really felt bad for my friend’s son when I saw how miserable he was. To me he’s still handsome and has a bright and interesting future ahead of him. I’m not so sure that he thinks that, at least not until his acne is under control.
The bottom line, Eichenfield says, is that many treatment options are available. "There's no reason that children have to live with acne that is severe and troubling to them.”