Ask a Pediatrician: How to battle the acne curse

What causes it, why it flares up — and how to banish it


This time of year, a lot of my teenage patients start to be a little more concerned about their appearance due to upcoming proms, dances and graduations. Acne on the face, back, chest and arms may suddenly become a source of great distress.

Acne does not respond well to emergency treatment, so now is the time to start a change in skin care regimen so that by the time the big night rolls around the dreaded pimples and zits have surrendered.

Ninety percent of all teenagers will have acne at some point in time during adolescence. Acne is triggered by increased androgen production, which occurs during puberty. There is a natural increase in the size of our skin sebaceous glands which produce an oily substance called sebum. Sebum, combined with dead skin cells and dirt, blocks skin pores.

This creates a paradise for Propionibacterium acnes, a bacterium which naturally occurs on our skin. Sebum serves as food and fuel for these germs and allows them to multiply. This large population of bacteria triggers an inflammatory response producing swelling, redness and, sometimes, pain.

In my experience, teens struggling with acne could care not less about the above information, they just want the blemishes gone. Yesterday. So here are some quick things to think about when your face isn’t as clear as you would like.

— Physicians take acne seriously, as it can lead to self-esteem problems that can cause depression and anxiety.

— Excessive milk intake (3 times the recommended serving) correlates with worsening acne, however research indicates that chocolate consumption does not affect acne. High-carbohydrate diets have been shown to contribute to acne as well as an elevated Body Mass Index, so healthy diet and healthy weight do make a difference in skin appearance.

— Sebaceous glands in the skin have receptors for the hormones released by the body in response to stress. This means that stressful times lead to more oil production in the skin and, thus, increased acne.

— Scrubbing the skin creates micro traumas to the pores and increases the inflammatory response — making acne worse. Wash skin with a sensitive-skin liquid face cleaner twice a day, but avoid scrubs, sponges or any type of abrasive chemicals. Products that remove oil from the skin do so only temporarily and have not been shown to be an effective way to wash the skin.

— Over-the-counter benzoyl peroxide products work by decreasing the number of bacterial colonies on the skin. The OTC concentrations can cause some mild skin irritation but overall are well tolerated and have been shown to be quite effective if applied twice a day.

— Prescription antibiotic creams also help to control bacterial skin colonization. They do not work well alone and should be used in conjunction with benzoyl peroxide or a retinoid.

Retinoids work by decreasing skin follicle blockage. They also appear to have an anti-inflammatory effect and decrease redness. These creams can be quite expensive and require a doctor’s visit, so try the over-the-counter ones first.

— Be mindful of the way that the medications you are using are presented. Gels are best for oily skin; creams and lotions are better for dry skin. Solutions and washes are best for large areas such as the back or chest.

— Picking at acne increases redness and swelling and makes acne more noticeable. It also increases the risk for scarring. Nobody wants to walk around with pus coming out of their face, so it is fine to use a warm washcloth to soften the skin and bring the pus to the surface to allow it to drain out. But DO NOT squeeze!

— Consistency of treatment is critical to make progress. Keep your skin regimen simple, and think about what things might prevent you from taking care of your skin. Address these obstacles so that you can follow the plan.

For example, if you are too tired in the evening to wash your face, consider doing it right after you get home from school and in the morning. If a certain medication makes your skin red or dry, then try a different kind. If you know that you touch your face often during stressful times, consider a stress ball or some other tactile comfort mechanism to help keep your hands off your face.

These tips should help you to look your best for those special events and beyond. If a blemish still shows up on a critical day, remember the smile on your face is the thing people notice over all else including dress, tux, corsage, limo and, of course, pimples. Have fun!

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