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Studying Acne in Teens

In This part

Addressing teenage acne

Figuring out what causes teenage acne

Acne is the most common skin problem that teenagers face.

Just about nine out of ten have to deal with pimples or acne at some time, or nearly 90 percent of teenagers have to deal with at least an occasional breakout of pimples. In this part get the lowdown on teenage acne. Help you spot teenage acne in all its glory.

Identifying Teenage Acne

We dermatologists generally refer to the acne that you get as a teenager as acne vulgaris. Yeah, it sounds horrible, but vulgaris is the Latin word for “common,” not “obnoxious” or “repugnant.” And as you saw in the stats I just tossed around, common is a good choice of words! (Some adults also suffer from acne vulgaris that sticks around after the teen years turn to the 20s and beyond. But most adults usually have a somewhat different type of acne, which

I discuss in part 7.) In teenagers, acne is one of the signals that your body is going through a tremendous upheaval called puberty (see the Understanding the Causes of Teenage Acne” section, later for details). Teenage acne often begins around the ages of 10 to 13. It may start before puberty in both sexes, but teenage girls tend to start getting acne at a younger age than boys; however, boys tend to have the more severe cases. Studies have shown that puberty is occurring at an earlier age these days, and so is acne. Most teenagers grow out of it when they reach 19 or 20; however, don’t be surprised if your acne persists into your early 20s and even into later adulthood. But just because acne is common and almost every teen suffers through it doesn’t mean you can’t do anything about it. You don’t have to just wait for it to go away. That’s what I’m here for — to help you knock out those pimples, whiteheads, and blackheads. With so many excellent acne treatments available today, treating your acne will prevent (or at least greatly lessen) the scarring that often results from untreated acne.

The curious case of the mail-order miracle

David is 16. He first started getting acne when he was about 14 when he saw a few small whiteheads and blackheads on his forehead and nose. Then his skin became greasy. His mom told him that if he just washed his face more often, his skin would look better and the pimples would clear up. But despite increased washing, his acne got worse and he started developing a few red pimples in addition to the whiteheads and blackheads. His mom started buying an acne cream from the drugstore. David tried it for a few months and it seemed to help a little. But when he turned 16, he became really embarrassed and extremely self-conscious about how bad his acne made him look and he hated going to school. His mom then ordered a product that she saw advertised by doctors and movie stars on television. It was very expensive, but it promised to stop David’s acne in its tracks! So Mom began ordering it by mail on a monthly basis. But just like the other over-the-counter product that she tried, this one helped a little, but not for long. By the time his mother brought him to me, David’s acne was completely out of control, and the mail-order product was starting to really irritate his face. After a few months of prescription cream medication, his face became almost completely free of acne! I reminded David and his mom about a few key points: You can’t wash acne away, and in many cases washing your face too frequently or scrubbing too hard can worsen the appearance of acne. I also mentioned that it’s hard for movie stars and “television doctors” who have never even seen your skin to make the correct diagnosis, let alone know exactly the best way to treat your personal skin problem. Not that many teens have real problems (like scars or serious emotional problems) from acne, but if you do, there are a bunch of things that can be done to help you with those issues as well. In later parts, I cover the physical scars and the emotional ride that some teens with acne have to endure

Studying teen skin

Teenagers’ faces are all different. Your skin may be dark or light complexioned. You may have dry skin, oily skin, combination skin, sensitive skin, or be “thick-skinned” (I’m talking blowtorch-resistant, here). I can’t generalize, but there are a couple of tendencies that make your skin different from that of adults:

More oiliness and less sensitivity: Teen skin tends to be a little oilier, and that’s probably a good thing because many treatments that are effective for teenage acne can be somewhat irritating to the more sensitive skin that commonly affects adults. The extra oil serves as a waterproof barrier between you and the outside world and protects your skin from irritation

Easier to heal: Your skin tends to be more “forgiving” and to heal more completely after experiencing acne. This is especially important when it comes to avoiding permanent scars and those dark spots that tend to appear in people of colour when their acne lesions heal. We go into physical scars of acne later on and the dark spots and other issues related to acne in dark complexioned skin a little after that.

Exploring teen acne

Good ol’ acne vulgaris, teenage acne. If you have it, you have an idea what it looks like but there may be more in store. Plus, if you skipped over parts 4 and 5, getting a handle on some of the terminology here can help you out if your dermatologist starts throwing it around. So, without further delay, here are the main features of teen acne:

Centred on the T-zone: Typically, teenage acne tends to flare up on the forehead, nose, and chin. Sometimes however, acne can have a mind of its own and it can pop up anywhere on your face or trunk.

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Blackheads and whiteheads: We dermatologists call these two unwelcome visitors comedones. Actually we call blackheads open comedones and whiteheads closed comedones. (You have to turn back to find out why) These black and white bumps are largely the upshot of teen acne and aren’t so common in adults.

Inflammatory lesions: These acne lesions are called papules, pustules, nodules, and cysts. These are the red, pus-filled, lumpy, inflamed, and sometimes sore, painful zits.

Tracking acne’s footsteps

In its full glory, teenage acne generally looks like a mixture of blackheads and whiteheads (comedonal acne) with papules and pustules (inflammatory acne) and macules (healing lesions). Awesome! Here’s how teenage acne can look in different kids. Maybe you’ll find your type in one of the following descriptions:

Initially, the main lesions may be whiteheads and blackheads. Often they start out in a nice, embarrassing, central location —

The nose and forehead, this part called the T-zone is where your skin tends to be most oily and, therefore, likely to develop acne. As time goes on, you may discover a zit (also called pimples or papules; the red stuff) here and there, and an additional blackhead or whitehead now and then. There’s a good chance that they will come and go. At this point, we’re still in the “it’s no big thing” stage. This type of acne is a rite of passage that almost all of us go through. If you’re lucky, this will just pass by itself or you can help it clear up with some inexpensive over-the-counter stuff that you can buy at your local drugstore (see later on for the names of these medications).

Sometimes, however, the going can get a little rougher: The whiteheads and blackheads want to hang around a lot longer and sometimes a population spurt of inflammatory papules and pustules really start making their presence felt. They can be seen in the centre of the face but may also be scattered all over the place including your neck, chest, and back. If you have dark skin, you may not see all of this red stuff because your acne may look brown or even darker on your skin (see later where we look at acne in darker skin).As individual acne lesions heal, macules (dark red or purple spots) form and linger until the lesion heals completely. The macules may look brown or almost black in colour if you are very dark-complexioned.

In some teens, especially those who have inherited a tendency to develop scarring acne, acne nodules may appear.

They can get quite large, lumpy, and painful. They’re inflamed lesions that are situated deeper than ordinary papules and pustules and can, if they go untreated, leave deep or thickened scars. This is called nodular acne fortunately, even if acne reaches this point, dermatologists can treat it very effectively in many people with oral antibiotics and, if necessary, with an oral retinoid, known as isotretinoin, or Accutane. (I discuss this drug later) Besides these strong medicines, we have many new tricks, such as lasers and special lights to treat your acne. Later we explain these cutting-edge treatments.

Understanding Causes of Teenage Acne

You may think you have teenage acne as some sort of punishment for a crime you didn’t even know you committed. Actually though, you’re breaking out for two main reasons. The first is that, as you mature, your hormones are telling your oil glands to produce too much oil, and your body isn’t handling the oil very well. Another reason you’re breaking out? Well, you may be able to go ahead and blame your parents or other ancestors for this one. Heredity plays a huge role in whether you end up with acne. In part 7, I go over both topics to give you a better idea of why you’re breaking out. (Later I provide you with many other theories and possible causes of acne.)

Hormones gone wild

By the time you hit puberty, it may seem like all you hear about is hormones and how they’re to blame for every problem you have, from shyness to a low paying job to acne. In the case of acne, what people are telling you is the truth. Hormones are to blame! Hormones are the chemical messengers that provide the signals that regulate many of your body’s functions and that are responsible for the changes you experience during puberty. They’re also responsible for bringing your acne to the forefront. The most important hormones when it comes to acne are your androgens. Androgens are really a group of closely related hormones. The androgen testosterone is the main “male” hormone. Besides bringing on puberty-related changes, it’s also central to our acne story. Androgens are a natural part of development for both boys and girls, but boys tend to produce more of them, especially testosterone, which is why boys have bigger bodies and stubbly beards. The higher level of testosterone in boys is considered to be the reason that they tend to get more severe breakouts of acne than do girls. As in males, androgens also are necessary for the development of acne in females. Estrogen and progesterone are female hormones that play the primary role in puberty. These female hormones play less important roles in the evolution of teenage acne than do androgens, but their influence on acne’s ups and downs, as well as their part in its treatment, is significant. We look into both of them in relation to adult onset acne later, and tell how they’re used in the treatment of acne in later parts.

Dousing occasional flare-ups

When she was in eighth grade, Margot’s parents had taken her to see a dermatologist who prescribed a cream and a gel. This approach worked very well for several years and kept her acne under good control. However, during midterms in her sophomore year of college, she began getting red bumps all over her face. She started to wear a cover up makeup, which she hated to use. “It looked so artificial,” she said. “I stopped going out on dates; I was so embarrassed about the way I looked.” Moreover, her pimples would flare up “like clockwork” right before her periods. An oral antibiotic was recommended (acne medications that are taken by mouth) might help to clear up her skin. She said that she was somewhat reluctant to start taking them because she was concerned about the possible dangers, but nonetheless agreed to start taking them. Later, she was very pleased with how much progress she’d made. Her face was looking better and her red pimples were now flat, so she could more easily cover them with makeup, then suggested that she gradually taper off the oral antibiotic by lowering her dosage and suggested that hopefully she could “wean” herself off of the oral therapy and see if the cream and gel alone would do the job. We agreed that we could try the oral method again, if necessary. The system worked very well. Except for breakouts before her period, Margot’s acne was not much of a problem. On several occasions during her junior and senior years, oral antibiotics were required and they continued to have success in quelling bad flare-ups.

Watch this space for part 7

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