How to tame your teenager’s acne

Few things can sap a kid's confidence faster than having to show up to school — or anywhere really — with a big breakout. So how can they can get — and keep — their skin clear? To find out, we spoke to Amanda Mogul, PharmD. She’s a pharmacist and clinical assistant professor at Binghamton University’s School of Pharmacy and Pharmaceutical Sciences.

Q: What causes acne?

Mogul: There’s a lot of debate about why one person gets acne and another doesn’t. Mostly it starts within our pores — our hair follicles. Those follicles have an oil-secreting gland. Some people produce more oil. That becomes a breeding ground for bacteria. And when certain types of bacteria grow, it can lead to breakouts. Other factors at play may include:

• Hormones. This is why puberty is such a huge time for acne to develop, and stress seems to make it worse.
• Skin turnover. Our skin cells are constantly renewing. But for some people that happens more slowly, which means the skin can get clogged.
• Diet. Eating a lot of sugar and highly processed foods may make acne worse by increasing inflammation.
• Clothing. Anything that’s constantly touching the face can contribute. So think helmets, hats and headbands. Even hair.
• Genetics. There’s no specific acne gene, but it does seem to run in families.

Q: What are some good over-the-counter treatment options for acne?

Mogul: Some of the most effective acne treatments are retinoids. Most are available by prescription. There’s only one over-the-counter (OTC) retinoid option, called Differin®. It’s a gel. You apply it to your whole face every night. You can also get Differin® as a prescription.

Another OTC option is benzoyl peroxide. It’s available in creams, gels and cleansers. It comes in strengths from 2.5% up to 10%. The lower strength is used more often in daily creams and cleansers. And the 10% can be used as a spot treatment. A lot of people use the retinoid and benzoyl peroxide together. They put on the benzoyl peroxide in the morning and the retinoid at night.

Beyond that, use a mild cleanser twice a day. Avoid bar soap, which can be harsh. Two brands I like are Cetaphil® and CeraVe®. They’re both very gentle. And pore-cleansing strips can be helpful for some people.

The Optum Store carries a variety of skin-care products, including acne-fighting cleansers.

Q: How do you know it’s time to see a dermatologist for teen acne?

Mogul: It can take weeks, up to a couple of months, to see the full effect of OTC products. But if a teen is being consistent and their skin still isn’t clearing up, that’s when they should probably advance to a prescription medication.

Q: And what are the acne treatments available by prescription?

Mogul: There are topical retinoids, available at a higher strength than Differin. We also have topical antibiotic creams with benzoyl peroxide such as clindamycin or erythromycin. And oral antibiotics such as tetracycline or doxycycline.

Our big gun, reserved only for very severe acne, is a short-term medication called Accutane® (isotretinoin). That’s for nodular, painful, pustule-type acne. It totally inhibits that oil production we talked about earlier. It’s very safe, and typically people will be on it for 20 weeks. But it dries out the skin a lot, so it can be uncomfortable. And there are risks involved. It can cause severe birth defects. So women must use 2 forms of birth control while they’re on it. The good news: For most people, the acne doesn’t come back. And if it does a few years later, they can use it again.

Q: Does treatment depend on what kind of acne you have?

Mogul: Definitely. Blackheads and mild breakouts with a whitehead here and there can be treated with OTC products. Once we get to more inflammatory acne that’s red and filled with pus, we would move to prescription medications, gels or possibly oral antibiotics. Severe acne that’s big and painful would probably need oral therapy.

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Q: What are some ways to prevent acne in the first place?

Mogul: There are several healthy habits teens can do:

• Wash their face twice a day with a mild cleanser.
• Clean items that touch their face regularly. That would include things such as helmets, headbands and hats — and during the pandemic, masks. When experiencing a breakout on the forehead, wear hats as little as possible.
• Wash pillowcases often.
• Keep their hair off their face.
• For young men, shaving can irritate the hair follicles. Use warm water, shaving gel and a sharp blade or electric razor.
• Wear oil-free makeup, sunscreen and moisturizer on their face.
• Avoid using tough scrubs on breakouts. And don’t pick at them either.
• Teens who have chest or back acne should wear loose, breathable clothing.

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Additional sources
Acne basics: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Acne and hormonal therapy: American Academy of Dermatology
Acne and genes: BMC Medical Genomics (2021). “Gene variants associated with acne vulgaris presentation and severity: a systematic review and meta-analysis"