Expert Advice | Teenage Acne – what to do

Teenage Acne – what to do,

by Dermatologist Doctor Benedetta Brazzini from The Skin Investment Clinic

Teenage acne, a rite of passage for many adolescents, can be both physically and emotionally challenging. The journey from childhood to adulthood is marked not only by hormonal changes but also in many instances, by the emergence of acne. It can be very distressing for teenagers who are likely to be more self-conscious, impacting both their physical and mental health.

This blog explores the causes of teenage acne, lifestyle measures which can help, and effective treatment options, aiming to provide valuable insights for both teenagers and their parents.

Causes of Teenage Acne:

Hormonal Fluctuations: During puberty, the body experiences surges in hormones, including androgens. These hormones stimulate oil glands, leading to excess sebum production and clogged pores.
Clogged Pores: Dead skin cells can accumulate on the skin's surface and mix with sebum, resulting in the formation of comedones (blackheads and whiteheads). Bacteria thrive in these environments, leading to inflammation and pimples.
Genetics: A family history of acne can increase the likelihood of a teenager experiencing the condition. Genetics influence factors like sebum production and skin sensitivity.

Lifestyle Measures to help with acne:

Healthy Skincare Routine: Encourage teenagers to adopt a gentle skincare routine. Cleansing twice a day with a mild cleanser helps remove excess oil and dirt without over-drying the skin.
Hands Off: Picking or squeezing pimples can worsen inflammation and potentially lead to scarring. It will also prolong redness and cause excoriated lesions that will give the sensation that the acne is not improving. Most likely the acne is controlled but what you can see are the effects of picking. If you start picking and can’t stop, ask for help. There are ways to control this impulse. Teens need to be educated about the importance of avoiding this habit.
Balanced Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins supports overall skin health. Limiting sugary and high-glycaemic foods might help manage acne.
Hydration: Drinking enough water helps maintain skin hydration and overall wellness, contributing to healthier skin.
Physical exercise, preferably outdoors, is very important but do ensure you immediately cleanse your face with a gentle cleanser to wash away the sweat which may further clog pores
A good night's sleep: Aim to sleep at least 8 hours per night (going to bed by 11 pm). You get the best rest in the evenings - going to bed late and waking up late doesn’t give your body the same chance to properly recover.

Treatment Options:

As acne is a chronic disease, you need to look for a way to control the acne rather than a treatment that will heal it for good. By understanding the triggers for breakouts and what works for your skin means acne can be managed long term. Left alone it is likely to continue into adulthood, leave red marks and scarring, and impact a person’s mental health. So, the sooner you treat it, the better.

First-line treatment is always topical i.e applied to the skin. Teenagers’ skin is usually delicate and sensitive and therefore needs to get gradually used to acne treatments that can be quite strong and irritating initially.

As soon as a few spots appear or the skin starts becoming oily, I would recommend using appropriate over-the-counter products or ask to be seen by a specialist. Mild cases of teenage acne can often be managed with OTC products containing ingredients like salicylic acid or benzoyl peroxide. These products help unclog pores and reduce bacteria. An exfoliating cleanser (that contains alfa and/or beta hydroxy acids) used in combination with an astringent mist and a keratolytic cream is helpful. A non-comedogenic moisturiser can be combined with these products as well.

Left alone, it is highly unlikely the spots will heal themselves and often on-line remedies are not always appropriate for certain skin types so do be careful. Many teenagers look to Tik Tok for solutions but what suits one person may not suit another so it is best to seek professional medical advice.

If this is not enough, then specialist advice is necessary. At this stage, various treatment options can be considered, such as chemical peels with salicylic acid or pyruvic acid and perhaps starting topical retinoids and topical antibiotics.

Topical treatments are usually quite strong so you need to help your skin get used to them. If you use them the wrong way and without the correct precautions, you may think your skin cannot tolerate them and so you won’t persevere. Always ask for help on how to use them and your dermatologist will be able to reassure you on the best way to get your skin used to these products.

If these topical treatments are not sufficient, then oral antibiotics can be considered in conjunction with topical treatments.

If these treatments do not control the acne, then second-line antibiotics can be considered, and for girls in their late teens, Spironolactone.

Roaccutane is a controversial medication. Some patients will inevitably need it, but these are for very severe acne cases which are the minority. My strong advice is to try all other treatments and leave it as the absolute last resort.

There is a form of acne called comedogenic acne, where the main lesions are macro-comedones (commonly called whiteheads and blackheads) rather than inflammatory spots. In these cases, cauterisation of the macro-comedones is a very effective treatment which we do in our clinics.

The after effects of Acne

Very often, young people have treatment that controls the breakouts, but they are left with severe redness. This redness is as stressful as acne itself. Often, young people think that the treatment hasn’t worked because they don’t realise that the acne is under control, but the redness (which is the consequence of the spot) can take up to 9 months to disappear.

In these cases, treatments like micro-needling, TCA cross or laser treatment with a vascular laser are helpful. These treatments can make the redness fade, and, at the same time, stimulate collagen production, decreasing the formation of atrophic scars (depressed scars).

Once you reach the stage where acne is under control, it is very important to start a maintenance regime. Acne is a chronic disease, and if all treatments are stopped suddenly, acne will recur relatively quickly.

Most patients with acne see a natural improvement during the summer months. But unfortunately, there are cases where sun and heat make acne worse so you must be careful in the sun.

The sun has a positive effect on both our skin and our mood. It is an important source of vitamin D production, and it stimulates the production of serotonin (the happiness hormone). In patients with acne, moderate sun exposure helps decrease inflammation, and a tan helps to hide signs of acne. But please wear a high non comedogenic SPF to protect skin from harmful rays. Unfortunately, sun exposure also has negative effects such as dehydration and thickening of the stratum corneum. This leads to increased production of sebum and increased formation of macro-comedones.

My final top tips for my teenage patients:

Start treatment promptly
It’s really important to follow your treatment plan exactly to give you the best chance of resolving your acne.
Do not pick or squeeze your spots and ask for help to find coping mechanisms before you cause scarring.
Try to lead a healthy life-style.
Watch what you eat. Make sure you have a low sugar diet (avoid refined sugars and alcohol) but a balanced diet in terms of fibres, protein, carbohydrates, and fats.
If you are self-conscious, you can use make-up to hide the acne lesions, redness, and scars. Use make-up made for acne prone skin, non-comedogenic, without perfumes. Do not let your skin make you hide from other people, acne does not define you so try not to let it rule your life.
If you have greasy skin do not wash your face more than twice a day. The more you wash the more your skin tries to catch up producing more oils. But obviously do wash your face after exercise with a gentle cleanser to wash away the sweat and dirt.
Minimal sun exposure during the early and late hours of the day can be beneficial but too much sun exposure can worsen signs and symptoms of acne. Ensure you always wear a high non comedogenic oil free SPF in the sun.

The Skin Investment Clinic specialises in acne and acne treatment. If you would like professional help with acne, please contact your nearest clinic located in Surrey, Hampshire, Wiltshire and London or book a FREE virtual skin consultation to discuss your skin and our recommendations.

Dr. Benedetta Brazzini

The Skin Investment Clinic

www.theskininvestmentclinic.com

[email protected]