Tips for treating acne from a pediatric dermatologist

Many teens suffer from acne.  Acne can have significant negative effects on confidence and self-esteem.  The good news is that we have very effective medications for the treatment of acne.

It is important to understand the basic factors that cause acne in order to understand how acne medications work.  The four main factors causing the formation of pimples are:

1. clogged pores
2. hormonal changes
3. bacteria on the skin
4. inflammation

Acne is not caused by dirt or inadequate washing of the skin.  Dead skin cells fail to shed properly and clog the pores, leading to inflammation. Acne lesions include non-inflammatory open and closed comedones (“blackheads” and “whiteheads”) and inflammatory papules, pustules, nodules, and cysts.

Acne medications are chosen based on the types of lesions present (non-inflammatory vs. inflammatory) and overall severity.  Some medications unclog the pores and some reduce inflammation. 

Commonly used topical medications include:

• benzoyl peroxide
• benzoyl peroxide-antibiotic combination products
• and retinoids (e.g., adapalene, tretinoin, and tazarotene).

For more moderate to severe cases, oral antibiotics or isotretinoin  may be needed. In general, benzoyl peroxide and retinoids unclog the pores, while topical and oral antibiotics kill bacteria and reduce inflammation. 

Isotretinoin is used for more severe cases of nodulocystic acne.

All medications have potential side effects.  Your doctor should counsel you regarding the most common side effects and steps you can take to minimize them.  All pills should be taken with plenty of water to avoid irritation of the GI tract and many antibiotics should be taken with food to reduce the risk of nausea.  Topical retinoids typically cause some dryness and irritation of the skin, particularly during the first few weeks of regular use.  They may also cause increased sensitivity to the sun.  Your doctor should review proper application of topical medications, review daily skin care, and recommend appropriate products for cleansing, moisturizing and sun protection.  

Acne medications will only work if you use them.  You must be patient.  It takes at least 6-8 weeks of consistent use of medications to see significant improvement in acne.  Remember that residual discoloration (i.e., red, purple and/or dark spots) is not permanent scarring and will gradually resolve over time.  Daily use of a good sunscreen is helpful.