Treatment of Teenage Acne: Myth vs. Fact

What Causes Acne

Acne is a very common and well understood condition, affecting up to 85 percent of teenagers. Yet, this age group may be reluctant to seek out treatment or disclose how bothersome it may actually be. Acne is a highly visible condition, and when left untreated it can lead to permanent scarring. Acne can also have a significant impact on a teenager’s self esteem and well-being, as it can lead to anxiety, depression, and withdrawal from social situations.

There are many common beliefs and myths surrounding what causes acne. Acne has nothing to do with dirt or oil on the surface of the skin and cannot be scrubbed away. Washing the skin more than twice daily or with harsh soaps/cleansers can actually make things worse by irritating the skin.

Rather, acne is a condition arising from the pilosebaceous unit, which includes the hair shaft, follicle, oil (sebaceous) gland, and muscle. Teenage hormones alter the production of an oily substance (sebum) produced from sebaceous glands under the surface of the skin. A bacteria known as Propionibacterium acnes feeds on the excess sebum, resulting in an inflammatory cascade. This translates to pimples appearing on the surface of the skin. Alternatively, the follicles can get clogged, causing  blackheads and whiteheads (comedones).

Diet and Acne

The role of diet remains controversial in acne. Consuming excess chocolate or fried food is more myth than causal factor for acne. Studies do suggest that diets rich in high glycemic foods (such as white bread and potatoes), dairy products, meat, and poultry can promote acne. However, there are people with poor diets who don’t have acne, and people with healthy diets who have significant acne. For that reason, the proper treatment of acne takes precedence over restricting or eliminating foods from one’s diet.

Treatment of Acne

Trying to navigate your local acne aisle can be overwhelming, as numerous over the counter (OTC) remedies and products promise clear skin. Benzoyl peroxide, salicylic acid, and a topical retinoid, adapalene (Differin), can be helpful for mild acne. However, many OTC products can actually exacerbate the condition. If acne is not improving with OTC treatment or is severe, a dermatology professional can decide what the best skin care/treatment regimen is appropriate for you.

Treatment of acne is primarily aimed at addressing the formation of clogged follicles and inflammation of the skin. This may include prescription face washes, topical creams/gels/lotions, oral antibiotics, an oral anti-hormonal agent, birth control pills, or an oral retinoid, isotretinoin (commonly known as Accutane).

Topical treatments are first line therapy but can take 2-3 months to become effective. While patience is needed when treating acne, an oral antibiotic may be added on for several months for additional improvement and to allow time for topical treatments to kick in. Guidelines from the American Academy of Dermatology recommend limiting antibiotic use to the shortest possible duration (ideally 3 months) to prevent bacterial resistance. If acne is not responding to conventional treatment or is more severe, isotretinoin is a very effective option. When taking isotretinoin, regular office visits, lab monitoring, and birth control (for females) is required during the course of treatment.

Management of Acne

Last but not least, a good skin care regimen is a necessary part in the management of acne. Use of a gentle cleanser, such as Cetaphil/CeraVe, and non-pore clogging (non-comedogenic) products is the foundation for any prescription treatment. Likewise, being consistent with topical medications and adhering to the regimen can be one of the biggest hurdles to treatment, especially for teens. A good skin care regimen should be built into one’s morning and evening routine, just like brushing your teeth!

Source: New York Times: Managing the Scourge of Teenage Acne, January 8, 2019.