Making adolescence easier: Doctors have answers for acne

Sophia Yen

For teenagers struggling with acne, Sophia Yen, MD, has a simple message: Your doctor can help.

"People don't realize how easy it is to treat," said Yen, an adolescent medicine specialist at Lucile Packard Children's Hospital and clinical assistant professor of pediatrics. There are good reasons to visit a doctor for acne treatment, she added: Prescription acne medications work better than over-the-counter products; the treatment can be tailored to the severity of the acne; and for teens with insurance coverage, prescription treatments often cost less than those purchased over the counter.

Physicians can also help navigate the tricky terrain between parents and kids around seeking acne treatment. "I think it should totally be up to the teen to decide whether to treat his or her acne," Yen said, adding that teens may feel self-conscious but not say so.

"Some patients, when I ask if they want to do something about their acne, say, 'No, I'm fine,'" Yen said. "But after I tell them about the easy, effective and simple treatments we can offer, they say, 'Um, I think I do want that acne cream or pill you talked about.'"

Pediatricians, adolescent medicine specialists and dermatologists can all treat teen acne, and are excellent resources for hesitant teens or parents who don't want to create a conflict about their child's skin, she added.

Parents may be especially anxious if they struggled with acne themselves. There is a genetic component to acne, Yen said, noting that genes influence the skin's response to inflammation and its propensity to scar. But acne medication can help prevent scarring, reduce skin pain and build patients' social confidence.

The first-line acne drug Yen recommends is topically-applied tretinoin, a vitamin A derivative that increases skin-cell turnover, decreases the skin's oil production and prevents pimples from forming. Because of its mechanism, it takes six to eight weeks for patients' skin to improve.

"It clears out all the zits that are on their way," Yen said. "So I tell patients, 'You gotta get through the ugly to get to the pretty.'" The drug also increases sun sensitivity, so patients must use a non-pore-clogging sunscreen, which is identified on some labels as "non-comedogenic."

If tretinoin doesn't help, doctors add on topical antibiotics or benzoyl peroxide to kill acne-causing bacteria, or oral antibiotics for chest or back acne that is hard to treat topically. Young women who have perimenstrual acne flares — skin outbreaks tied to their menstrual cycles — may also find birth control pills effective, Yen said.

Finally, for patients who need stronger treatment, there is the acne medication isoretinion. Although very effective, it has notable side effects, including causing severe birth defects if used during pregnancy. Female patients must use two forms of birth control and have monthly pregnancy tests while using the drug. For many patients, a three-month course of isoretinion is sufficient, Yen said.

In addition to prescribing acne treatments, Yen also dispels common acne-related myths. Among the common misconceptions are:

• Myth: People with acne should wash their faces more often. Fact: Excessive face-washing strips the skin of natural oils, causing oil over-production that can worsen acne, Yen says. Two or three daily face-washes are plenty.
• Myth: Junk food causes acne. Fact: Food choices such as french fries and chocolate have never been scientifically linked to acne. However, working in a greasy environment (such as flipping burgers at a fast food restaurant) can trigger acne outbreaks, as can stress, wearing a lot of pore-clogging makeup, or wearing a football helmet or other sports equipment that puts pressure on the skin.
• Myth: You can get rid of pimples by squeezing them. Fact: No, Yen says: Squeezing increases skin damage and makes pimples heal more slowly.
• Myth: Only teenagers get acne. Fact: Although acne is common in high school, some people develop acne in their college years or later. The same treatments that work for teens can also help adults.

Yen likes seeing how her patients' self-confidence grows after she helps treat their acne. She recalls one patient who came to her office with a spiffy new hairstyle after his acne cleared.

"I didn't realize that had been an issue, that he was using his hair to hide acne on his forehead," she said. "I want teens to know that if their acne bothers them, we can help."