What Zit All About? Acne 101

image: Kjerstin Michaela Haraldsen, Pixabay

Blackheads, whiteheads, pimples, and oily skin are the hallmarks of acne. Most of us had our fair share of acne over the years and we heard a lot of advice about how to manage it. From basic advice of washing twice a day with soap to using expensive skin care products you can get delivered to your door every month to prescription medicines, acne remedies abound.

The reason there are so many strategies out there is that acne is embarrassing for teenagers and adults alike. Often the thought of going to the doctor to talk about skin issues (or even bringing up the topic with parents) is too difficult for most teenagers. Parents need to take the lead and ask teenagers if they are interested in doing something about their acne. Some teens are interested in working on their skin while others aren’t.

Before discussing the skin care regimes that work, it makes sense to understand the different components of acne.

  • Blackheads and whiteheads: These are pores that are blocked with debris (i.e., dead skin, oils, bacteria) but don’t have much inflammation (swelling or redness). What makes them black or white is whether the pore is still open (blackhead) or closed at the top (whitehead).
  • Pimples: These are blackheads or whiteheads that have gotten inflamed. Usually they are still close to the skin’s surface so the inflammation (i.e., swelling, redness and pus accumulation) come to a head quickly and resolves. Sometimes pimples will scar but if they are left alone and there are few of them scarring is less common.
  • Cystic acne: These are pimples deep under the skin as well as large inflamed pimples near the surface. What differentiates cystic acne from regular pimples is size of the swelling and depth of the inflammation. Because some of these acne lesions are so deep, they don’t come to a head and those that do are so large that they may leave scars.

Once parents have broached the subject with their tween or teen, what strategies work?

For mild acne that is made up of mostly blackheads and whiteheads and only a few pimples here and there, washing twice a day with a mild soap and using benzoyl peroxide 10% (available in a variety of over-the-counter preparations) once a day makes sense.

Once pimples are the main attraction, benzoyl peroxide probably won’t cut it. Talking to your pediatrician is the best first step. When pimples are the main issue, retinoids in the form of a cream used once-a-day (along with skin hygiene) is the best approach. Retinoids take about eight weeks to work and your teenager’s skin will actually look a little worse before it starts to look better. Once the improvement starts though, it’s a big improvement!

Because retinoids can be harsh on the skin, some doctors start with topical benzoyl peroxide and antibiotic combo creams or gels. These are not as effective but may be enough for mild acne.

Cystic acne is different. Because of its scarring nature and because many of the pimples are so deep, topical management doesn’t work well. Heading the dermatologist makes sense. Accutane is the best management strategy for cystic acne. Even with all of its challenges (including monthly lab tests, appointments, and side effects), this pill is by far the most effective approach. It is taken for nine months or so and then many people need a second course a year or two later for another three to six months. All in all it’s easier than years-long skin regimes and far more effective.

The biggest challenge though in any acne treatment plan is compliance. Many teenagers get frustrated or bored with the skin regime of washing twice a day and applying product. Because so few solutions are foolproof and all require continuous participation to gain continued results, teenagers are at risk for falling off the skin regime bandwagon when results aren’t as good as they had hoped, or when their skin is looking better for a week or so. Either way their lack of commitment is the Achilles’ heel of any approach parents and doctors put forth. That’s why opening the conversation with your teens and getting a real sense of how interested they are in addressing their skin health is key to moving forward.

Many families ask about commercially available skin regimes that they see engaging advertising for. Many of these products do work and if they teen is coming to you engaged by the sales pitch, he or she may be more committed to the regime which is really the “magic” that ensures the success of the product.

As a final comment, let’s cover some common myths and truths about what makes acne worse.

  • Myth: Never use moisturizer on your face.
    • Moisturizing acne-prone skin can get tricky. You want to be sure to choose an oil-free moisturizer. Many products now will even say “non-comedogenic” on the label, which is good sign it’s acne friendly.
  • Myth: Chocolate (or milk, or fatty foods) makes acne worse.
    • Eating a healthy diet and drinking plenty of water is great for your body and your skin. Eating certain foods though won’t make your acne worse. All kinds of old wives’ tales surround food and acne, but research shows that what you eat makes no real difference in how your acne progresses.
  • Truth: Hair products, like gels and hair oils, increase acne.
    • Any oils, gels or even your hair’s own natural oils (if on your forehead all the time) can worsen your acne. If your forehead is your main problem area, keep your hair off your face and keep hair care products far away!

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

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