Odds have it that our children’s faces – so precious and so beautiful to us – will at some point be assailed with pimples. Generally breakouts occur during puberty, that angst-filled time in kids’ lives when there’s already a heightened degree of self-consciousness and insecurity to contend with. At the mild end of the spectrum, acne can be annoying. On the more moderate to severe end, it can be scarring, both physically and emotionally, contributing to a young person’s low self-esteem and depression.
“It’s rare to find a person who went through high school with zero pimples,” says Tom Cooper, M.D., a dermatologist with Dedham Medical Associates in Dedham, a multispecialty practice. “Close to 100 percent of people experience some degree of acne during their lifetime.” He stresses that acne cannot be cured, but the good news is that it can be treated.
With that in mind, we asked Cooper, along with Cheryl Levin, M.D., a dermatologist at Harvard Vanguard’s Chestnut Hill/West Roxbury and Kenmore practices, for advice on acne treatments and how to help kids through the troublesome – yet inevitable – pimple years.
What Is Acne?
The most common type of acne and the type most of us experience is acne vulgaris, says Cooper, describing it as “an inflammatory condition of the skin usually characterized by pimples or pustules or larger cysts, which are deeper more destructive kinds of lesions.” There is also a non-inflammatory kind of acne, which are blackheads, notes Cooper. “A blackhead is a plug of dead cells mixed with oil that fills the follicle. The black color is a chemical reaction of the dead cells with the air. It is not dirt, although it resembles dirt.”
Acne typically shows up in boys and girls at about ages 10 or 11, although Cooper says he has seen it in girls as young as about 7 and sometimes in infants. Most people “outgrow” acne, says Cooper, generally by their late teens to early 20s, although some have it beyond that, well into adulthood.
What Causes Acne?
Blemished skin is not due to poor hygiene. Young people are not responsible if their skin isn’t clear.
According to Cooper, acne has a genetic component, running in families, and it is hormonally triggered. Male hormones (the normal hormones present in both males and females) are required to produce acne. Sometimes it is caused by excess oil production, which is also genetically based and driven by hormones. Other times it is an inflammatory response to certain triggers. Bacteria plays a role, as well.
As for whether a poor diet can cause acne, Cooper says, “In the old days, like in the 50s, we would tell people certain foods could trigger acne. In the 80s and 90s, that went by the wayside. Now in the last five to eight years, there is a growing sense that diet might play a role.” Recent studies, he says, suggest that a diet that is high in sugar or dairy may trigger acne. Cooper encourages following “what our society would accept as a healthy diet.”
As with all medical conditions, Cooper says the key is to strive for the least amount of medication needed to effectively treat the condition. For many parents of adolescents, that means a trip to your local pharmacy for over-the-counter remedies. But, Levin notes, “If non-prescription, over-the-counter acne treatments are not working, it’s best to speak with your child’s pediatrician or a dermatologist who can identify a good option for your child from the wide range of prescription medications available.”
Levin recommends four over-the-counter acne products to try:
1. Benzoyl peroxide, which she says, is toxic to the bacteria associated with acne, so it unclogs pores and removes dead skin. “It is sold either as a wash, cream or gel, in strengths ranging from 2.5 percent to 10 percent,” says Levin. “I recommend starting with the lowest strength to see how your acne reacts. You should also moisturize after application, as it can be irritating to the skin.” Be careful when applying it, as it can bleach clothing and hair, although it doesn’t bleach skin.
2. Alpha hydroxy acids, including glycolic and lactic acids, help to remove dead skin cells and decrease inflammation. “They also have the added benefit of increasing collagen and elastin, helping to improve [skin with] acne scarring,” notes Levin. “These acids can be mildly irritating to skin.”
3. Salicylic acid slows shedding of cells inside hair follicles and clogging of pores, thereby improving acne. According to Levin, “It works especially well for people with oily skin, although it can be mildly irritating to skin. It is sold in 0.5 percent to 2 percent formulations, so you should start at a lower dose and work your way up until you find the strength that works best for you.”
4. Sulfur, which Levin says is often combined with resorcinol or sodium sulfacetamide, removes dead skin cells and decreases inflammation. “It can cause peeling and occasional burning of skin. I recommend [patients] begin by using it a few times per week, slowly building up to daily use,” says Levin. “Sulfur can have a slight odor, depending upon the brand, and can occasionally cause [skin] discoloration.”
If the above methods aren’t effective in clearing the pimples, parents will want to seek medical help and stronger measures, particularly if the acne is severe and looks like it might cause scarring or when the child is particularly bothered by it.
A Word About Prescriptions
Cooper says he commonly prescribes over-the-counter benzoyl peroxide in conjunction with the prescription Retin A (generic name: tretinoin). Side effects are rare, he says, but there’s concern of developing resistance to bacteria, which is why benzoyl peroxide is prescribed. “Benzoyl peroxide prevents resistance to bacteria from developing in the skin,” he says.
Accutane (isotretinoin), the oral version of Retin A, is extremely effective but is used generally as a last resort in treatment.
The prescription medicines are “pretty safe,” says Cooper. “The main issue is dryness and sometimes the medicine can aggravate the acne. … There’s always hope to get off an oral antibiotic, but some patients need to be on it for months, years or, as adults, even decades.”
One thing to keep in mind is that to maintain the benefits of the medication, you have to continue using it and not discontinue it after the acne is under control. Cooper equates it to a person taking high blood pressure medicine. “You wouldn’t just stop the medicine after the blood pressure is controlled,” he says. “You have to keep taking it.”
Therefore, parents should keep an eye out to make sure their teens are compliant and consistent with the medication, and with younger adolescents, may need to take a hands-on approach.
Additionally, Cooper says, “You don’t just spot-treat the individual pimples. You put the medicine on the whole area where you could have breakouts. You aren’t just treating today’s pimple, you are treating tomorrow’s pimple and next Sunday’s pimple.”
For the Best Acne Skincare Tips, click HERE.