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Popping Some Teen Acne Myths

 Author: Mary Keating

For:  Family Living Magazine

Date:  May 2009

1650 words       

Acne appears to be somewhat of a social butterfly. It shows up at parties, proms, first dates, and big events. In fact it is notorious for sticking its head into photographs and almost pulsates when confronted with a mirror. And, most of us have had numerous encounters with acne. Approximately 85 percent of people between the ages of 10 and 24 develop acne. That is almost 17 million people in the US alone.

Fortunately, controlling and preventing breakouts has come a long way in the past couple of decades. With proper care, physician supervision, and common sense, mild to severe acne can be treated.

What causes Acne?

The exact causes of acne are unknown, but it is believed that it can result from several factors, primarily, an increase in hormones called androgens.

“As individuals enter puberty, sometime between the ages of 10 and 14, the body begins producing lots of hormones,” said Earl Stoddard, M.D., Intermountain Dermatology. “Some of these hormones, called androgens, directly affect the sebaceous (oil) glands on the face, neck, back, shoulders and chest. An increase in androgens causes the oil glands to enlarge and produce more sebum (oil). This oil, along with skin cells and bacteria can cause the skin’s pores to become blocked resulting in blackheads, whiteheads, pimples and cysts.”

There is general agreement that emotional stress and fatigue can trigger and even exacerbate acne. This helps to explain why outbreaks often appear on or around important events.

“Stress and sleep disturbances can induce higher levels of internal steroids, which can make acne worsen,” Stoddard said.

Not All Acne is Created Equal

The good news is that acne is commonly a transitory problem. Essentially, once the teen years have passed and hormones level off, most people experience only an occasional bout of acne. Of course, acne has many degrees of severity and some individuals may require treatment into their adult years.

Unfortunately, treatment for acne is not a one size fits all. Acne runs the gamut from mild to severe and treatment options vary depending on the severity of the case.

Mild Acne

Mild cases of acne are commonly treated with an over-the-counter (OTC) medication. These medications are typically applied directly to the affect area(s).

“Common OTC medications for acne can contain benzoyl peroxide, resorcinol, salicylic acid, and sulfur,” Stoddard said.

Of course, the ingredients in many of the OTC medications work differently and come in many forms, including gels, lotions, creams, soaps and pads. The creams and lotions are usually good for people with sensitive skin. The gels and solutions are alcohol based and good for individuals with oily complexions.

OTC Medications

Benzoyl peroxide is useful in killing bacteria and prohibiting oil production. Resorcinol, salicylic acid, and sulfur help to break down blackheads and whiteheads. Salicylic acid also helps to cut down the shedding of cells lining the follicles of the oil glands and is effective in combating inflammation and swelling.

All of these products are available in different strengths. For example, the label may say that the product as 2.5 percent salicylic acid, 5 percent or 10 percent. It is recommended to start with the lowest concentration possible.

Some people experience side effects such as skin irritation, burning, or redness. If severe or prolonged side effects occur, contact a dermatologist.

Severe Acne

People with moderate to severe acne should contact a dermatologist for advice and treatment options. Often, a dermatologist can prescribe topical medications, oral medications or both.

“There are several types of topical prescription medications that are used to treat acne, including antibiotics, benzoyl peroxide, adapalene, retinoic acid, and azelaic acid,” Stoddard said.

Azelaic acid reduces the growth of bacteria and it strengthens the cells lining the follicles, to prohibit oil eruptions. Retin-A is useful because it helps to unplug pores by loosening the cells in the surface of the skin. As a result, pimples are sometimes pushed to the surface of the skin.

Some side effects associated with these medications are stinging, burning, redness, peeling, scaling or discoloration of the skin. In fact, the skin may look worse during the initial phase of treatment before improving as some level of irritation will be involved and it takes time for the skin to adjust.

A dermatologist could also recommend oral or topical antibiotics. Oral antibiotics are thought to control acne by curbing the growth of the bacteria and reducing inflammation. Common types of oral antibiotics include erythromycin and tetracycline.

Importance of Treatment

Acne can cause many problems other than skin eruptions. Severe cases can often result in physical and emotional issues affecting social interaction and self-esteem.

When acne is severe, it can be extremely traumatic to a teenager, leaving life-long physical and emotional scars. Acne can significantly impact the way a person views themselves. Effects can include social withdrawal, low self-esteem and self-confidence, embarrassment, depression, poor body image, anger and discouragement.

If severe acne is disrupting normal teenage emotional development, a good place to begin working through the process is by making an appointment to see a dermatologist.

 A Little Q & A?

To squeeze or not to squeeze?

“It’s tough to let that large pimple just sit there,” Stoddard said. “Picking and squeezing can lead to infection, and worst of all, often leads to permanent scarring.”

A dermatologist can offer some tools to safely remove large blackheads or pimples without the risk of infection or scarring.  For “Acne Emergencies,” like the mega pimple before prom, a dermatologist can perform an in-office extraction or administer an injection to make it much better within hours.

When to see a dermatologist?

“For very mild acne, anti-acne products from the store or through the mail can be helpful,” Stoddard said. “But if these are not working or if you are developing scarring, consult a dermatologist.  It is difficult to reverse scarring, but with proper treatment, we can minimize future scarring.”

If you do not see an improvement after 6 to 8 weeks of using non-prescription medications, consult a dermatologist.

Is there anything I can do to make it disappear today?

“This is a great question.  An individual pimple starts under the surface, almost like a volcano, then erupts, then fades,” Stoddard said. “This entire process can take up to 8 weeks.  This is why we always tell individuals to be patient with treatment.  If a flare of acne was already in the works, meaning under the surface, before you start treatment, the treatment is not going to stop that flare.  Treatments take 6-8 weeks before patients will begin to notice improvements.  So don’t expect results tomorrow, and don’t give up or immediately switch treatment.  Constantly changing your treatment is very hard on the skin and often makes acne worse.  I know this is hard, but be patient.” 

Can you wash it away?

“No – acne is not caused by dirty skin,” Stoddard said. “Certainly you should not let your face become excessively dirty or use heavy amounts of make-up as this could aggravate acne.  But washing more than twice daily, is too much.  Too much washing can lead to excessive drying which will stimulate sebum (oil production) and can actually make your acne worse.”

When washing your skin, you should use a mild cleanser once in the morning and once at night. Some people tend to scrub their skin to stop outbreaks, but scrubbing can make your skin worse. Remember that it is important that you thoroughly rinse your skin after washing it. Using an astringent is only recommended when you have oily skin, and even then the astringent should only be applied to oily spots. Dermatologists also recommend that you wash your hair regularly if it is oily, because the oil can get on your forehead and face, and lead to breakouts.

Avoid excessive touching of your face. If you squeeze or pop your blemishes, you run the risk of developing scars because dirt on your hands can infect your acne, and in some cases, squeezing the spot may only spread the bacteria even further.

Use cosmetics without oil, including hair care products. Men who shave should do so carefully, as to avoid nicking their blemishes.

Do Acne Treatments Really Work?

“YES.  Some work better than others,” Stoddard said. “But what works for your friend, may not be right for you.  Far too often, I see patients using their sister’s medicated cream or their friend’s medicated wash.  When it doesn’t work, they think they can’t be helped.  See a dermatologist to get the right treatment for you and your skin.”

What about make-up?

“Yes, you can wear make-up,” Stoddard said. “Look for water based oil free products.  Mineral based make-ups are best.  Make-up that will not worsen acne is advertised as non-comedogenic.  But in this case, even too much of a good thing is bad.  Be sure to use it sparingly.”

If you wear make-up, be sure to take it off at night. And, be sure to wash cosmetic brushes once a week in soapy water to remove oil and bacteria.

Do different foods affect acne breakouts?

“Excessive dairy (milk, cheese, yogurt, and ice-cream) intake, due to hormones used in the dairy process, has been linked to worsening acne,” Stoddard said. “But, teenagers need dairy for growth of healthy bones.  So, I never tell kids to give up dairy.  You can switch to organic dairy, but I think that the effect of dairy on acne is minimal.  People are still looking at the effects of greasy and high sugar content foods on acne, but for now, we just don’t know. Just eat healthy.  That will never hurt you.”  

Does toothpaste applied to pimples work?

“NO.  If you want to try and make it go away faster, spot treatments containing salacylic acid or benzoyl peroxide can be helpful,” Stoddard said.