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Acne & Skin Care:

A Guide for Teens

Acne is a common and treatable skin condition that causes pimples or “zits” and other skin problems. About 80-90% of teens (girls and guys) will have some kind of acne breakout during their adolescent years. Acne can begin as early as age 8 but usually improves when a girl reaches her twenties. If you’re a teen, chances are you’d like to know what to do about it. Read on to find out what causes acne, what kind of treatments are available, and how you can care for your skin.

What causes acne?

Clogged pores or follicles - Acne is caused by clogged “pores” or “follicles” (small openings in the skin) that contain a hair and sebaceous (oil) gland. The medical term, “acne vulgaris” is the most common kind of acne. It can show up anywhere on the body but it is usually found on the face, back, shoulders, and chest. Follicles become clogged by dead skin cells and oil (called sebum) made in the pore.

Hormones and extra sebum - When you become a teenager and go through puberty, your body makes more hormones (especially androgen hormones) that can cause too much oil or sebum to be made. Sebum is supposed to carry dead skin cells up to the surface of the skin, but when there is too much of it, it clogs the pores leading to whiteheads, blackheads, pimples, and cysts.

Try to avoid things that can irritate your skin and cause acne such as:

• Tight headbands, helmets or wool hats
• Greasy lotions, hair products, and oily makeup
• Grease-filled air in restaurant kitchens — if you work in this type of environment, be sure to wash your face when you get home.
• Stress. When you are emotionally stressed your body makes extra hormones that can cause breakouts. Try to learn ways you can de-stress and relax!

Some people believe chocolate, soda, greasy foods, and dirt can cause acne, but these are just myths – not true at all.

How does acne develop?

We have hundreds of hair follicles, or pores, on the surface of our skin through which hair grows. Deep inside each follicle is a hair shaft attached to small glands called “sebaceous glands”. These glands make an oily substance called sebum to moisten our hair and skin. Sometimes when too much sebum is made, it can mix with dead skin cells (that we are constantly shedding) to create a sticky plug.

Trapped bacteria grow very fast in these plugged follicles and make chemicals that can cause swelling, redness, and pain. Eventually the plugged follicle can burst and spill everything – oil, dead skin cells, and bacteria – onto the skin surrounding other follicles.

Increased hormones (androgens) lead sebaceous glands to enlarge,

causing an increase in sebum (oil), resulting in clogged pores: acne

There are several different types of acne:

• Whiteheads are swollen pores that are filled with dead skin cells and sebum.
• Blackheads happen when a clogged pore is open and a chemical reaction causes the surface to darken. The blackhead is not dirt so it can’t be washed away. It is actually caused from a build up of melanin-a skin pigment.
• Pimples occur when a clogged pore becomes infected by bacteria causing a red, raised bump to appear on the skin. Pimples can have a pus filled top, which is the body’s way of reacting to a bacterial infection. Pimples, also called “zits,” can be tender to the touch.
• Cysts occur when clogged up pores break under the skin causing bigger and often very painful bumps. If left untreated, these cysts can cause scarring.

Who gets acne?

Eight out of ten teens will get acne sometime during their teen years because puberty is the time when there are many hormonal changes. Hormones are chemicals that are responsible for all of the physical changes that happen when you go from being a child to an adult. Teens who have a family history of acne (their parents had acne when they were teens) are more likely to get it, but keep in mind that most teens who get acne will be free of it by the time they are young adults.

Young women often complain of acne just before their periods. The medical term for this is called “premenstrual acne” and it is usually due to the hormones that are active before your period. Some girls are more sensitive to these hormones than others. So even if you are careful about taking good care of your skin, chances are you may have a mild to moderate breakout before your period. The good news is that once your period is over the acne usually goes away.

Acne is also common in girls who have polycystic ovary syndrome (PCOS). PCOS can cause weight problems, acne, excess hair growth and irregular periods. So check with your health care provider if you have any of the symptoms.

Do over-the-counter medicines work on acne?

Over-the-counter (no prescription is required) acne medicine that contains benzoyl peroxide (such as Clearasil?, ProActiv and Oxy?), resorcinol, salicylic acid or sulfur often help with mild acne. Each product works slightly differently. Products come in soaps, cleansing pads, creams, gels, or lotions. Acne preparations may cause a rash or redness. Your skin may sting or burn if the medicine is too strong.

Remember when using over the counter acne medicine:

• Stop the acne medicine if you have any side effects
• It takes about 6-8 weeks of using a product to see a difference in your skin
• Be careful to keep the medicine away from your eyes, mouth, and inside your nose
• If you have taken good care of your skin for at least 2 months (washed it twice a day, avoided products that can clog pores, and tried nonprescription acne medicine) and the pimples just won’t go away, don’t worry—make an appointment with your health care provider or dermatologist to talk about stronger (prescription) medicine that may be helpful.

Makeup and foundation that claims to clear acne while making your pimples less visible may just cover them up. Sometimes the ingredients in some kinds of make-up can actually cause pimples. Look for oil-free, “non-comedogenic” products.

What about prescription medicine for acne?

Your health care provider may prescribe products with benzoyl peroxide, retiinoid products such as Retin A , Differin , Avita , Tazorac , and antibiotics such as tetracycline, erythromycin, minocycline, and doxycycline.

Benzoyl Peroxide - Health care providers who prescribe this kind of medicine usually tell teens to start out slowly, using it 2-3 times a week and working up to every night. Wash and dry your face completely before applying it. You should use a very small amount-about the size of a pencil eraser. It’s common to have red or dry skin at first. If your skin becomes so dry that it peels, your health care provider will probably tell you to cut down on the number of days/week that you use it. Because benzoyl peroxide has a “bleach-like” quality, make sure you rinse your face completely after using it so you don’t lose the color in towels, pillowcases, and shirts. If you are leaving on the medication overnight, sleep on a white pillowcase.

Retinoid products are very helpful for mild acne (whiteheads and blackheads). Apply a thin layer of this medicine after you have gently washed and dried your face. People who use this medicine sometimes say that their acne got slightly worse before it got better. For moderate to severe acne (pimples, cysts, and scars), you will likely need this medication along with others.

Antibiotics may be applied directly to your face (lotion or gel) or taken by mouth. In some products, benzoyl peroxide and a topical antibiotic are mixed together. They help treat the bacteria that can cause pimples and cysts. If you are taking oral antibiotics, follow the instructions on your prescription bottle. Some antibiotics require that you take them on an empty stomach while other kinds say you can take them any time. If you are taking oral antibiotics you are slightly more likely to get a yeast infection.

Talk with your health care provider about medicines that might be helpful for treating your acne. Even prescription medicine is not an overnight cure. You’ll need to be patient as it can take 8-12 weeks for acne to get better with any treatment. Remember don’t forget to use oil-free sunscreen and stay out of the sun as much as possible. Antibiotics and other acne medicine can make your skin burn faster from sun exposure or tanning beds/booths. If you get bad sunburn, call your health care provider!

How is severe acne treated?

If your acne doesn’t get better with over-the-counter medicine or the usual prescription medicines, your primary care doctor or dermatologist may consider prescribing Accutane (the brand name) or Isotretinoin (the generic name). It is a pill that is swallowed once a day for 15-20 weeks. Accutane is reserved for the severe acne that doesn’t improve with other treatments.

Girls who use Accutane :

• Should NOT HAVE sexual intercourse or use two methods of birth control (if sexually active), including 1 month before starting Accutane , during treatment, and 1 month after treatment has stopped. Taking Accutane during pregnancy causes birth defects.
• Should AVOID THE SUN unless sunscreen with full protection is used, because of the risk of severe sunburn. That includes tanning beds/booths too! Accutane and other acne medicine can make your skin burn faster and also make your acne get worse.
• Should be MONITORED BY THEIR DOCTOR including regular check-ups!

Tips for Taking Care of Your Skin

Do’s:

• Wash your skin twice a day (morning and before bed) with a mild soap such as Purpose , Basis , or Neutrogena to remove oil.
• Wash your face after you exercise as oil builds up and can clog pores.
• Wash your face well after you come in contact with oils or grease such as working in a fast food restaurant.
• Wash your hands before touching or rubbing your face and try not to rest your chin, cheek, or forehead on your hand. Just think of all of the things you may have touched during the day with your hands! Breaking this habit may help to clear up most of your problem areas.
• Wash your hair regularly especially if it’s oily. Oil from your hair can make your face and neck extra oily.

Don’ts:

• Don’t scrub your face or use harsh soaps; you can’t scrub acne away but you can make your acne worse if you are too rough when washing your face.
• Do not use alcohol based cleansing products.. Products with a high percentage of alcohol can make your skin very dry and irritated. It actually can cause your body to make more oil that can result in more acne.
• Don’t pick, pop or squeeze pimples or anything on your face no matter how tempting! All that poking can cause more inflammation and possibly leave you with a scare.
• Do not use moisturizers or sunscreens that have oil in them. Look for a label that says “oil free” and make sure you use a “facial” moisturizer, not a “body” moisturizer.
• Keep hair gels, hairspray and other hair products away from your face as they can clog your pores. Wash your face after you use these products to keep oils away.

If you have acne and you’re a teen, you are not alone. Most teens will have a breakout at some point during their teen years. Taking good care of your skin, and avoiding things that can irritate it, will help. If your skin is a concern to you, talk to your health care provider. There are treatments for acne!

Written by the CYWH Staff at Children’s Hospital Boston

Updated: 11/1/2007

Related Information:

• A Guide to Puberty and Menstrual Cycles
• Tips for Staying Healthy
• Healthy Eating for Teens
• Wellness 101
• Related Links

Looking for other health info? Check our A-to-Z Index.

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