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What is Acne

What is Acne

Acne pimples are one of the biggest causes of teenaged anxiety and heartbreak. Acne is very common. Most teenagers develop at least some acne by the time they reach adulthood. There are many myths and false ideas about acne. Many of these make parents or teens feel guilty or inadequate. Diet does not cause acne. A high-fat or high-sugar diet is a bad idea for other health reasons, but these things do not cause acne. There are not specific foods, like chocolate or French fries, that cause acne. Personal hygiene is important for many reasons, but it does not help or hurt acne. People with acne are not unclean. The black part of a “blackhead” is from skin oil, not dirt. In fact, hard scrubbing to remove blackheads can make things worse. Bad behavior does not cause acne, and acne has nothing to do with having sex or masturbating.

Acne is the natural result of changes in oil glands and skin as people reach adolescence. The first step in formation of an acne pimple is skin oil and dead skin cells building up in a pore. This usually forms the “blackhead” that teens worry about. This is the mildest and most common form of acne. Doctors call it “comedonal” (comb-ee-dough-nall) or “non-inflammatory” acne. When the skin around the blackhead becomes inflamed, doctors refer to it as “inflammatory” acne. The inflammation (redness, pain, and swelling) comes from the normal skin reaction to oil and dead cells, and to the by-products of certain skin bacteria. Mild inflammatory acne looks like the typical “whitehead” pimple with a red base. This acne does not cause scarring unless the teenager breaks the skin by digging or picking. So-called “scarring papular” acne has enough inflammation to cause a scar even without picking. Nodular acne produces large, red, painful bumps that can distort the skin on the face. This kind of acne can cause severe scarring.

What is the biggest concern?

The biggest concern for most teenagers with acne is their appearance. Studies show that teens often over-estimate the severity of their acne, but that doctors often under-estimate it. This can make for very bad communications. If your teen is distraught by his or her acne, please help your doctor to understand how seriously s/he takes it. Although serious infections can occur as a result of acne, or of picking at it, this is unusual. The biggest problem with picking at or squeezing pimples is that it increases the soreness and damage to the face that can cause scarring.

Long-term scarring from acne can be devastating for young people. Depression, anxiety, embarrassment, and excessive shyness can all result from acne and a teenager’s reaction to it. Some teens even seriously contemplate suicide as a result of their acne. Effective treatment of acne can help in all of these areas. It improves self-esteem, body image, assertiveness, and social interactions. Parents and doctors should not underestimate the negative impact of acne on teens, nor the positive impact of good treatment.

Acne treatment

There are many different treatments for acne, depending on the type and severity. The most important thing to remember (and to remind yourself and your teen about) is that all forms of treatment take time. Most treatment does cause improvement for the first several weeks. In fact, many treatments appear to make the skin worse for up to three weeks. It is important to stay with the program that your doctor prescribes. If you or your teen start to feel discouraged, please talk to each other about it and remind each other of the long-term importance of treatment. Of course, please be sure to let your doctor know if you feel the treatment really isn’t working.

Please be sure your teen understands that acne is not a hygiene problem. Scrubbing at the skin or excessive use of drying soaps or alcohol-containing pads will only make the condition worse. They may even interfere with the medication your doctor recommends.

Mild Acne

Mild acne, even with some inflammation, usually gets better with “topical” (skin) treatment only. Your doctor may recommend or prescribe a medicated ointment, cream, or cleanser. These medications keep pores open, reduce blackheads (comedones) and some kill bacteria on the skin. Dozens of products containing benzoyl peroxide are available as over-the-counter creams, lotions, soaps and gels. Many prescription medications contain this drug as well. Other prescription topical medicines include adapalene (Differin®) and retinoic acid or tretinoin (Retin-A®, Renova®, and others). Some products contain these medications in combination with each other or with antibiotics such as erythromycin, tetracycline, or doxycycline.

Almost all of the topical acne medications cause some irritation of the skin as they go to work. They may make the skin sensitive to sunlight, wind, and dry conditions. You can treat most of these with simple moisturizers. Please check with your doctor or pharmacist about which moisturizers will not interfere with the acne medicine. Again, please remember that these medicines often make the acne get a little worse before it gets better. Please encourage your teen to stay with the program.

Moderate Acne

Teens with acne that is inflamed, or acne that did not get better with topical treatment only, may need to take oral medication in addition. Most often doctors prescribe an antibiotic such as tetracycline or doxycycline (many brands) or erythromycin (many brands). These drugs help to kill the skin bacteria that cause inflammation. As with all antibiotics, it’s important to take all the medicine and to try not to miss doses. Some of these antibiotics can cause mild stomach upset. It’s also important to continue to use the topical medication that your doctor prescribed.

Severe Acne

People with severe acne, especially nodular acne, need to take oral medicines that contain isotreninoin (eye-so-trett-in-owen; Accutane®). Some doctors also find this medication useful for people with moderate acne who have not gotten better with other forms of treatment. Accutane® is a powerful drug that works well and has a long history of safety when people use it correctly.

Accutane® causes birth defects. Any woman of child-bearing age (anyone who has had one period or more) should not take this medicine unless there is absolutely no chance they could become pregnant. They should also not become pregnant for at least one month after stopping the medication. Many doctors recommend that sexually active women use two forms of birth control if they take Accutane®. Please discuss this medication and its consequences very carefully with your daughter if she is going to use it.

In some cases doctors may prescribe hormone treatments including oral contraceptives (birth control pills). These can work by helping to counteract the effects of normal sex hormones during adolescence. People who take these medications should not smoke while using them, to avoid dangerous blood clot formation.

Oral medication doesn’t replace the need for continued use of topical medicines, unless your doctor instructs you otherwise. As with all of the medicines we’ve discussed, oral medication takes time to work, and may cause more problems if you stop it too early.

Dangerous Acne Symptoms

Aside from its significant impact on teenagers’ self-esteem and emotional state, acne does not pose much of a physical danger. If a teenager picks at or squeezes a pimple, s/he may develop a bacterial infection. In unusual cases bacteria or infected material can travel from the face into the brain through veins on the face, which is another reason to avoid picking or squeezing. Here are some things to look out for that might suggest that an infection is brewing:

  • Suddenly worsening redness or swelling of a pimple
  • Spreading of redness, swelling, or pain to an area that does not include a pimple
  • Prominent swelling of an eyelid or inability to open an eye
  • Fever
  • Severe headache
  • Blurry vision
  • Stiff neck

If any of these occur, please be sure to call your doctor’s office right away.

Accutane® has some important side effects, though they are not usually major. Dry skin and initial worsening of the acne are the most common. More unusual effects include some thinning of the hair which can be quite concerning to teenagers of both sexes, aching muscles, and blurry vision. Some teens can develop increased pressure inside their skull that can cause headaches and vomiting severe enough to raise concerns about brain tumors. There is no tumor, and the condition goes away when the medication stops (tetracycline and doxycycline can sometimes cause a similar condition). Again, women who could become pregnant should not take Accutane® unless they are reliably using an effective form of birth control. Clindamycin is an antibiotic in some topical creams that can (very rarely) cause serious diarrhea and bowel inflammation. If your teen develops abdominal pain, cramps, and loose stool on a clindamycin-containing medication, please let your doctor know.

Other points of concern

As we mentioned above, many things that people commonly believe about acne are not true. There is no need to change diet, avoid any activities, or become “cleaner” if a person has acne. Patience and faithful use of the proper medications will work.

Dermatologists agree that if a medication seems not to work after 4 to 8 weeks, it is time to change. Some teens end up on up to 5 or 6 medications. This is usually unnecessary, and it can be very hard to stay with this kind of regimen. It is better to change medications completely than to continue adding one medication after another. If you have concerns about this, your doctor will be happy to hear them and will work with you. Your teen needs to be on a treatment program that s/he can understand and manage.

Other Conditions that Might Be Present with Acne

Acne is not usually related to other severe conditions. One fairly common condition, called “polycystic ovary syndrome,” causes acne, obesity, and often excessive hairiness in teenage girls. Your doctor will decide if your daughter needs testing for this condition. Also, please remember the emotional impact of acne on teenagers. If you are worried that your teen is depressed or feels left out of social activities, please discuss it with him or her and offer a visit to the doctor or counselor.