Acne

For some it may not be a problem that’s “just skin deep”

Teen aged girl and boyHave you noticed the recent increase in advertising for over-the-counter or mail-in acne remedies? Acne has in fact become one of the most universal medical problems in school-aged children, teens and young adults. Despite how prevalent acne may be, many patients still feel hesitant or embarrassed about seeking medical care or discussing their acne with their physician or provider and instead seek to treat it themselves with one of the many over-the-counter products.

While this may initially be a reasonable approach to try an over-the-counter acne wash or spot treatment, some unfortunately end up spending hundreds of unnecessary dollars on multi-step skin care regimens with inadequate results. Others attempt to modify lifestyle factors such as diet, which have never been proven in large studies to improve acne.

Several recent eye-opening medical studies have shown that children, teens and young adults with acne perceive themselves and are often incorrectly perceived by others to be less clean, less attractive, less successful or even less intelligent. While some parents may regard acne as a “right of passage” these studies have made us realize that acne is not always just a problem that is “skin deep”. It can have serious social and emotional repercussions that may affect a developing child’s self-esteem and self- confidence and can persist into adult years, especially in cases where scarring results. The great news is that there are many prescription options which can treat and then prevent future acne outbreaks.

What causes acne?

Acne is caused by the pores, or hair follicle openings, of the skin becoming occluded, at first on a microscopic level and next on a visible level, with a natural skin secretion known as sebum. Sebum creates a sticky plug in the previously open pores; it naturally increases around the time of puberty but can less commonly occur in infancy or well into adulthood and cannot be controlled by diet. While washing one or two times per day with a gentle cleanser may help to rinse some of these secretions from the skin, more frequent washing usually does not completely prevent the start or progression of acne. The ideal time to begin medical treatment for acne is at this stage. Topical medicines which chemically open the clogged pores can be prescribed and typically take 4-6 weeks to become effective. Once the pore becomes clogged it can then develop secondary bacterial overgrowth and inflammation, which appears as redness of the bumps or “pus” bumps. This represents a more serious level of acne which necessitates immediate medical attention so that permanent scarring does not result.

Who should I call if my child, teenager or I have acne?

Since each patient has a unique skin type it can take years of medical training and clinical experience to learn which product combinations are best tolerated and most effective for each patient. For a child or young adult, the medical professionals most highly trained to diagnose and treat acne are pediatric dermatologists, who have formal training and board certification first in adult dermatology and then specialized fellowship training and board certification in pediatric dermatology. Some pediatric dermatologists even have a background and board certification in general pediatrics so that they can better understand a child’s skin problems in the context of any other medical problems that he or she may be experiencing. A trained, board-certified pediatric dermatologist will consider your child’s skin type, activities and schedule as well as the safety of the medications. This pediatric dermatologist will also provide you with reasonable treatment options that are affordable, or covered by your child’s insurance so that you don’t spend a fortune treating their acne.

If you are concerned about your child’s acne and desire treatment, waiting to make an appointment is a mistake, since many of the treatment options begin working maximally after 4-6 weeks and then show continued improvement thereafter. Starting a new treatment program a few days before an important social event like homecoming, the prom or an interview may not allow enough time for that program to be successful. The best results require a minimum of several weeks to become effective and give you the results you envision. Luckily, there are many safe and effective treatment options available to children with acne so that they can present their “best face” to the world and develop that strong self-esteem we all desire.

Robin P. Gehris, MD (Children's Dermatology Services and Acne Treatment Center)