Dr. Gellner: It's almost school time and your teenager might be a little self conscious about some changes that have gone on over the summer, so how do we address the acne issue? I'm Dr. Cindy Gellner. Today we're going to talk about acne on The Scope.
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Dr. Gellner: We see it a lot; teenagers come in for something else and we notice that they have a lot of acne on their face, and they're kind of embarrassed to talk about it. They're like, "Uh," and we ask, "Do you want me to give you something to help the acne?" And they're like, "Yes. Somebody finally can help me." So what is acne exactly and why do teenagers get them?
Well, acne is a skin condition that occurs when the oil glands in your skin are clogged and they become inflamed or infected, and more than 90% of teenagers have acne. There are a couple different types of acne. You'll have whiteheads, which are the closed, plugged oil heads. You'll have blackheads, which are open, plugged oil glands. The oil turns black when it's exposed to air. Then, some kids will get those red, painful bumps. Those are the pimples that everyone wants to really squeeze hard. Those are the inflamed oil glands. The larger ones can actually become quite painful. Acne usually appears on your face but it can also appear on your neck, shoulders, back, chest, so it can be anywhere on the upper part of the body.
But what causes acne is actually due to the over activity and plugging of the oil glands and that is caused by an increased level of hormones during the teenage years. Hence, that's why you don't see a whole lot of acne until kids become 12, 13, then all of a sudden the hormones turn on and everything starts going haywire, and boom, there's the acne.
Heredity also plays an important role. If you or your spouse had a lot of acne issues, you're going to want to help your teenager out, because they might also have a lot of acne issues.
A couple misconceptions. Acne is not caused by diet. You cannot get acne from eating too many fried foods or chocolate or any other foods, although that does not mean you can just go ahead and indulge on those types of foods. Acne is also not caused by dirt or by not washing your face often enough. I have a lot of parents that come in and they say, "He just scrubs his face all day and they still get acne." It's because it has nothing to do with dirt. Your child's face is probably super clean.
Everyone always wants to know, "How long is this pimple that just showed up going to stay around?" New whiteheads usually stop appearing after about four to six weeks of treatment, and you probably need to continue treatment for several years. Acne usually lasts until about 20 or 25. That's because those hormones are still going until that long. But a lot of people worry about scars. Well, only the deep acne, the cystic acne and the ones that are irritated enough usually cause scars. Most acne does not cause scarring.
Unfortunately there is no cure for acne. There is medicine, though, that will help treat it. The basic treatment is to be sure to wash your face twice a day and after exercise and the most important time to wash your face is actually at bedtime, because you'll be washing off any dirt or makeup or anything, and be sure to use a mild soap. There are a lot of mild soaps out there. Some of them also are targeted for teenagers. You want to make sure it's mild so that you don't over irritate your skin, because the medications to treat acne can be irritating themselves.
Make sure not to pick or squeeze at your acne. I know it's easier said than done, but picking at acne actually stops it from healing as well. If you squeeze some of the deep cystic acne too much, you can actually cause bleeding in the skin and blotches that continue to last. It actually causes more damage to your face than if you would just leave it alone.
Make sure that if your girls wear makeup that they use makeup that says hypoallergenic or noncomedogenic on the label. Noncomedogenic is just a big fancy word that says "does not cause or worsen acne."
So what about those whiteheads? Those are the classic pimples. The best medicine is actually benzoyl peroxide. That's over the counter. That's in several different preparations there. Depending on your insurance, it might be covered. Benzoyl peroxide is actually a chemical that helps open up the pimples and unblocks the blackheads. It also will kill the bacteria. It actually helps stop the reproduction of the bacteria.
What I usually tell my patients is wash your face at night and then put on the benzoyl peroxide over your face at night, and let it stay on there. Let it dry. Then, in the morning, wash it off. Make sure that you just put a little bit on and only put it on once a day. It's because it can be really irritating to the skin. If your skin becomes red or starts peeling, you're using too much of it or putting it on too often. I usually say do it every other day if you're having that.
Now, just be careful, benzoyl peroxide is something that will actually bleach your clothing, your carpet, everything, so make sure that if you're putting it on, it doesn't drip on anything that has color that could be bleached.
In addition to the benzoyl peroxide for the whiteheads, those pimples, another medication that most of us will prescribe is something called clindamycin gel. That's actually an antibiotic that works on the acne bacteria which is Proprionibacterium acnes, and what that does is it actually kills the bacteria. So the benzoyl peroxide will stop the bacteria from making new bacteria, and the clindamycin will actually kill the bacteria that's already there. There are actually a couple of preparations that actually combine the two together already, so you're attacking your acne in two different ways.
For the blackheads, you're going to use the exact same thing. You're going to use the benzoyl peroxide. It also helps to open up the oil glands. Some people will use a blackhead extractor, although we usually recommend only somebody who's trained, like an esthetician, do that so you don't cause too much damage to your skin.
The one everyone always worries about are those big red bumps, the cystic acne. Those are where the infection from the acne bacteria has actually gone beyond the oil gland. It's actually underneath. Some people who have those frequently, they'll actually get an oral prescription for antibiotics. They're very painful and they can really be a detriment to your child's self esteem if they have a lot of them. Some dermatologists also recommend at this time that you can use Retin-A for the skin. That is something that if you have a female who is of reproductive age and they're on Retin-A, you do want to have a discussion about birth control at that time because Retin-A, even absorbed through the skin, can cause birth defects. It's usually a medication that's not given quite so readily, but it is something that is very effective for cystic acne.
For acne that is really severe, to the point where none of these other medications are working, we get a dermatologist involved. A lot of people have heard of Accutane. Accutane is very similar to Retin-A, and that one only a dermatologist can prescribe. In fact, they actually have to have a special license to prescribe it because of the birth defects that that can cause and the side effects that it can cause. So if your acne is not under control and you're thinking that your child may need this, this is actually a last resort medication and again, your child would have to see a dermatologist for that.
A lot of girls also will come in and say that they want birth control because the birth control will actually help the acne. That's actually a true statement, although most of us will not even discuss birth control until a girl is at least 14, mainly because we need her to start having some of the puberty changes happen already. But because of the hormonal influence on acne, the birth control pills often are quite effective at helping severe acne. We don't use it for mild acne, just severe.
So acne is sort of a rite of passage for teenagehood. Remember, benzoyl peroxide is your first step, and if it's not helping, go see your doctor and they can discuss some of those other options, and the most important thing, don't pick your pimples.
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