Dr. Jimade Ola-Solomon

Acne is the most common skin disease and affects more than 80% of people, and it is usually worst between 11 and 18 years, although some people have some acne into their 20s or later.

Most people are concerned about how they look, and teenagers especially worry about how others see them. They want to feel attractive, appeal to their friends and generally feel good about themselves. But they may also often feel gawky, ugly and lacking in confidence. They often seem to exaggerate the bad points about themselves and ignore the good ones.

Acne is the most common skin disease and affects more than 80% of people, and it is usually worst between 11 and 18 years, although some people have some acne into their 20s or later. It starts most often during puberty and is often worse for boys. Pimples can become a nightmare for an adolescent.

What causes acne?

The skin contains a huge number of pores (tiny holes) connected to glands that produce the oils (sebum) which keep the skin healthy. The cells lining the ducts (the tubes running from the gland to the skin surface) are continually replaced, with the old ones mixing with the oils, and getting pushed out of the ducts.

At puberty the amount of androgen hormones in the body increases, making these glands become more active and make more oil.
There are many bacteria (germs) growing on the skin normally. When there is more oil, bacteria (Propionibacterium acnes) get into the pores and make the mixture of oil and old cells thicker and harder, so the pore can become blocked.

The blocked pore may become:

A blackhead. The black colour at the top is melanin which is made by the skin cells (it is not dirt). Blackheads are not infected, and can remain in the skin for a long time without changing.

A whitehead (a small abscess – red with white pus) when the bacteria get through the lining of the gland, and the immune system tries to kill the bacteria and remove the oils.

A cyst (infected lumps under the skin). This happens more often for boys.

Blackheads do not cause scarring. Blackheads often form in large pores, and if the oil etc is squeezed out the pore may stay open, which can be distressing.

Most whiteheads heal without scarring, but there can be a lot of scarring left when cysts heal.

The areas of the skin most affected are the face, upper chest and back. Teenagers grow out of acne. After puberty most people have little trouble with acne, as their hormone levels settle. Some young women still get some acne around the time of their period, or during pregnancy.

Why do some teenagers get worse acne than others?

The appearance of your child’s skin is largely influenced by two things:

heredity (the genes inherited from parents), and puberty (the hormone changes that happen as your child moves from childhood to adolescence, then adulthood). If the parents of a young person had a lot of acne, then the young person may also have a lot of acne.

But acne is not fair!

Some people can have very little acne even when they take very little care of their skin. Others can have very severe acne even when they take very good care of their skin. One child in a family may have severe acne, while the brothers and sisters have very few spots. Boys often have more acne than girls – this is because boys have more androgens. (Androgens are called ‘male’ hormones, but women have some too.) Boys often have worse acne with more cysts and more scarring.

What triggers pimples?

The ‘worst’ pimple always seems to appear when it is very important for the teenager to look his or her best.
Much has been written about acne, and one of the commonest claims is that stress is a trigger for a new outbreak. It is hard to be certain about the role of stress, and the stresses that are talked about (like tests and parties) are not really avoidable. Acne is also a cause of stress.
Girls seem to get more pimples around the time of their period, which is a time of a lot of hormone changes, so this seems logical.
Many people think some foods trigger acne (chocolate is often mentioned). Some people think this is important for them, but many don’t find any link. Medical research has not found a link.

Living with acne

Teenagers take acne very seriously. They know that companies are making billions of dollars through producing, advertising and selling acne treatments (teenagers all do media studies at school), but they also really want to get rid of their acne, so they will try many products, and they will try hard to look after their skin, until perhaps they give up because their acne is so bad. Young people with bad acne and ugly scars are less likely to be successful with friendships, with study and with getting good jobs as adults. Many teenagers and adults are bullied because of their appearance. Others might find even their friends try to avoid touching them (even though pimples are not contagious), and expressions of friendship like kissing might be avoided too. Young people with bad acne are at an increased risk of anxiety, depression and suicide attempts.

If your teenager has acne that is bad enough to cause distress, go to your doctor earlier rather than later. Medical treatments can make a lot of difference. It is easier to prevent bad scarring than it is to try to get rid of the scars later.  Even if the acne does not seem serious to you, it can still be very helpful for your teenager to talk to a doctor about the treatments that are available.

What young people can do

It is very important that teenagers and their parents know that the care that they give to their skin cannot stop pimples from coming completely, and that if the acne is very bad, skin care is not likely to make any difference. There is also a lot of mis-information about skin care.

Washing the face should only be done once or twice a day, with a mild soap. The skin should not be scrubbed.

Washing hair: the forehead can be oilier than other parts of the face, and have more pimples. The hair just above the forehead is also often oily. Oily hair probably does not cause acne on the forehead to be worse. Washing the hair often (such as daily) can make the hair look better, but may have no effect on the acne. If their forehead has a lot of acne, teenagers will want to cover it with
their hair. This probably will not make the acne worse, and might be helpful in improving the way they feel about their face.

Pimples should not be squeezed, as this can damage the lining of the pore and the sebum and bacteria can get into the skin around the pimple, causing more inflammation (redness, swelling and pus). However most teenagers cannot resist trying to squeeze out pus or a blackhead. If they have to, make sure they know that they should have clean hands, and only squeeze very gently. If the pus or blackhead does not come out easily, it is not ready to come out.

Exposing the face to a little sunlight, not enough to cause any skin damage, may help a little.

Avoiding cosmetics and sunscreens which are oil based might be worth trying.

There are many products for sale ‘over the counter’ at pharmacies, or in supermarkets, which are claimed to reduce or get rid of acne. Some of these may help. Many of them work by increasing the speed of production of cells lining the ducts and cells of the skin of the face. This can unblock the pores, or make them less likely to block. Talk to a pharmacist before buying a product. Cheap products may be as helpful as more expensive ones. Some make the skin more sensitive to sunlight, so sun screen should also be used. If the product causes the skin to become very red or sore, stop using the product.

Medical treatments

There are several treatments that doctors can prescribe that can make a lot of difference to acne. They will need to be used for many months, and sometimes longer, because they do not cure acne. Encourage your teenager to see a doctor early rather than wait for really bad acne. Your doctor may say that the acne is not bad enough for any more treatment yet, but most doctors take acne seriously, and will talk about treatment options.

Antibiotics:
Antibiotics that are taken orally (by mouth) or spread onto the affected skin can help control the bacteria which are part of the cause of the acne. If these make a difference, they are usually prescribed in low doses for many months.

Creams or gel:
There are products with tretinoin (a vitamin A acid) which are applied to the skin. They can make the skin very sensitive to the sun (so sunscreens should be used if the person needs to be exposed to the sun). They also should not be used by a girl if she is pregnant.

Hormone treatments:
Girls with bad acne may get benefit from some types of contraceptive pill (some pills can make acne better, some can make it worse).

Oral Isotretinoin:(which may be called Roaccutane** or Accure**)

Isotretinoin is related to Vitamin A, and can make a lot of difference to the cystic type of acne (the lumps that are beneath the surface of the skin) and acne on the surface.As well as the effects that are wanted, it also makes the face, lips and eyes dry and red, and the skin very sensitive to the sun. It is also known that it can harm an unborn baby. If young women want to try it, they will need to convince the doctor that they are not pregnant and will not become pregnant while they are taking the capsules. Taking it does not mean that babies that a girl or boy might have in later years will be harmed.

Some young people become depressed while on isotretinoin. It is not clear if this is because of the acne, the treatment or unrelated to either.
It seems to be safe otherwise.

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