Acne

Almost all teenagers get acne at one time or another. Whether your case is mild or severe, the information here can help you keep your acne under control.

What causes acne?

You haven’t done anything to cause your acne. It’s not your fault if you have it. Pimples are caused when oil ducts in the skin get plugged up and then burst, causing redness and swelling. Although there are many myths about acne, the following are the three main factors that cause it.

1. Hormones: When you begin puberty, certain hormones, called androgens, increase in both males and females. These hormones trigger oil ducts on the face, back, and upper chest to begin producing oil. This can cause acne in some people.
2. Heredity: If other members of your family had acne as teenagers, there may be a chance that you’ve inherited a tendency toward getting acne as well.
3. Plugged oil ducts: If you are prone to acne, the cells that line the oil ducts in your skin tend to get larger and produce more oil, and the ducts get plugged. This traps the oil and leads to the formation of blackheads or whiteheads. The plugged ducts allow germs in the skin to multiply and produce chemicals that cause redness and swelling. This is why simple blackheads and whiteheads may turn red and bumpy and turn into the pimples of acne.

There is not much you can do about heredity, so your best control efforts are those that keep the oil ducts unplugged.

What makes acne worse?

1. Pinching (or“popping”) pimples,which forces oil from the oil ducts into the surrounding normal skin, causing redness and swelling.
2. Harsh scrubbing, which irritates the skin.
3. Things that rub on the skin, such as head bands, hats, hair, and chin straps, which also cause irritation.
4. Certain cosmetics (makeup), such as cream, sand,oily hair products, which can block oil ducts and aggravate acne.
5. Some medications.
6. For young women, changes in hormone levels brought on by menstrual periods.
7. Emotional stress and nervous tension.

What doesn’t cause acne?

• Acne is not caused by foods you eat. Despite what you may have heard, there is no proof that soft drinks, chocolate, and greasy foods cause acne.
• Acne is not caused by dirt. The black plug in a black head is caused by a chemical reaction. It’s not dirt. No matter how carefully you wash your face, you can still have acne.
• Acne is not something you can “catch” or “give” to another person.
• It’s not caused by sexual thoughts or masturbation.

Treating acne

It’s important to know that there is no true cure for acne. If untreated, it can last for many years, though acne usually clears up as you get older. The following treatments, however, generally can keep acne under control.

1. Use topical benzoyl peroxide lotion or gel.

Benzoyl peroxide helps kill skin bacteria, unplug the oil ducts, and heal acne pimples. It is the most effective acne treatment you can get without a doctor’s prescription. Many brands are available in different levels of strength (2.5%, 5%, or 10%). Read the labels or ask your pediatrician or pharmacist about it.

• Start slowly with a 2.5% or 5% lotion or gel once a day. After a week, increase use to twice a day (morning and night) if your skin isn’t too red or isn’t peeling.
• Apply a thin film to the entire area where pimples may occur. Don’t just dab it on current blemishes. Avoid the delicate skin around the eyes, mouth, and corner of the nose.
• If your acne isn’t better after 4 to 6 weeks, you may increase to a 10% strength lotion or gel. Start with one application each day and increase to two daily applications if your skin tolerates it.

2. If you don’t see results, see your pediatrician.

Your doctor can prescribe stronger treatments, if needed, and will teach you how to use them properly. Three kinds of medications may be recommended:

• Tretinoin (Retin-A) cream or gel helps unplug oil ducts but must be used exactly as directed. Be aware that exposure to the sun (or tanning parlors) can cause increased redness in some people who are using the medication.
• Topical antibiotic solutions may be used in addition to other medications for a type of acne called pustular acne.
• Oral antibiotic pills may be used in addition to creams, lotions, or gels if your acne doesn’t respond to topical treatments alone.

3. What about the “miracle drug” Accutane?

Isotretinoin (Accutane) is a very strong chemical taken in pill form. It is used only for severe cystic acne that hasn’t responded to any other treatment. Accutane must never be taken just before or during pregnancy. There is a danger of severe or even fatal deformities to unborn babies whose mothers have taken Accutane while pregnant or who become pregnant soon after taking Accutane. You should never have unprotected sexual intercourse while taking Accutane. Patients who take Accutane must be carefully supervised by a doctor knowledgeable about its usage, such as a pediatric dermatologist or other expert on treating acne. Your pediatrician may require a negative pregnancy test and a signed consent form before prescribing Accutane to females.

Important things to remember

Be patient. It takes 3 to 6 weeks to see any improvement. Give each treatment enough time to work.

Be faithful. Follow your program every day. Don’t stop and start each time your skin changes. Remember, sometimes your skin may appear to worsen early in the program before you begin to see improvement.

Follow directions. Not using the treatment as directed is the most common reason the treatment fails.

Don’t use medication prescribed for someone else. This holds true for all medications, especially Accutane. Doctors prescribe medication specifically for particular patients. What’s good for a friend may be harmful for you. Never take Accutane that’s prescribed for another person.

Don’t overdo it. Too much scrubbing makes skin worse. Too much benzoyl peroxide or Retin-A cream makes your face red and scaly. Too much oral antibiotic may cause side effects.

Finally, many people don’t understand acne and may say hurtful things about it. Although acne may bother you, keep in mind it’s only temporary. With present-day treatment, it usually can be controlled.

A word about… acne and birth control pills

In 1996, the Food and Drug Administration (FDA) approved a low-dose birth controI pill to be used as an effective treatment for acne in women over 15 years of age. Research has shown that certain birth control pills lower the levels of hormones that cause acne.

However, taking birth control pills along with other medications for the prevention of acne may reduce the effectiveness of both medications. If you are taking birth control pills, talk to your pediatrician about their effect on acne.

Adapted directly from AAP patient handout “ Acne Treatment and Control.”