Acne Tips from Pediatric Partners

Acne is a common skin condition that affects many teenagers. While it can be frustrating, there are ways to manage and treat it effectively.

There are many myths about what causes acne, but there are 3 main causes:

• Hormones. You get more of them during puberty. Certain hormones, called androgens, trigger the oil glands on the face, back, shoulders, and upper chest to begin producing more oil. This can cause acne in some people. Some girls get more pimples before and during their periods. This is caused by changes in the levels of hormones.
• Bacteria. Bacteria called Propionibacterium acnes can be part of the cause of acne.
• Plugged oil ducts. Small whiteheads or blackheads can form when the oil ducts in your skin get plugged with oil and skin cells. They can turn into the hard and bumpy pimples of acne.

Acne is not caused by

• Dirt. That black stuff in a blackhead is not dirt. A chemical reaction in the oil duct turns it black. No matter how much you wash your face, you can still get acne.
• Contact with people. You can't catch acne from or give acne to another person.
• Food. Even though soft drinks, chocolate, and greasy foods aren't really good for you, they don't cause acne directly. There is some information suggesting a diet high in sugar and starch may worsen acne, however. Some supplements (such as whey protein) may worsen acne.

​Tips for Managing Acne:

1. Keep Your Skin Clean:
   • ​Wash your face twice daily with a gentle cleanser to remove excess oil, dirt, and bacteria.
   • Avoid harsh scrubbing, as this can irritate the skin and worsen acne.
   • In the shower, first wash and condition your hair, then if it touches your shoulders or back, put it in a towel wrap before washing face, back, and chest. (If you aren't washing your hair and it is long, put it up prior to your shower.) This prevents hair products from irritating skin and worsening the acne.
2. Avoid Touching Your Face: Refrain from touching or picking at your acne lesions, as this can lead to infection and scarring. Keep your hands away from your face as much as possible.
3. Choose Non-Comedogenic Products: Look for skincare and makeup products labeled as "non-comedogenic," which means they won't clog pores. Avoid heavy, oil-based products that can exacerbate acne.
4. Moisturize: Even if you have oily skin, it's important to moisturize daily to keep your skin hydrated. Opt for oil-free, non-comedogenic moisturizers to prevent clogged pores.
5. Use Over-the-Counter Treatments: There are many over-the-counter acne treatments available, including creams, gels, and spot treatments containing ingredients like benzoyl peroxide, salicylic acid, and sulfur. Follow the instructions carefully and be patient, as it may take several weeks to see results. If these are not sufficient after 2-3 months, a visit with us to discuss prescription medication is recommended.
6. Practice Sun Protection: Protect your skin from the sun by wearing sunscreen with an SPF of 30 or higher every day, even if it's cloudy. Sun exposure can worsen acne and increase the risk of scarring.
7. Eat a Healthy Diet: While diet alone isn't a major cause of acne, eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall skin health. Limit sugary and greasy foods, as these can contribute to acne breakouts in some individuals.
8. Manage Stress: Stress can trigger acne flare-ups, so find healthy ways to manage stress such as exercise, meditation, or spending time with friends and family.
9. Sheets: ​ Wash or change your pillowcase 1 to 2 times per week. Residue from hair products and oils can worsen acne.
10. Don't pop or pinch your zits. This can open the lining of the oil ducts and make them redder and more swollen. It can also cause scars.

Medical treatments for acne

There's no cure for acne, but there are over-the-counter and prescription medicines to help keep your acne under control. Sometimes dermatologists or other skin care specialists use chemical peels or lasers to treat acne.

Acne usually clears up as you get older without any treatment.

Use the acne washes, creams, and other products in the area you get acne, not just on each individual pimple. The pimples develop over weeks and if you only treat the ones you see, you miss the ones that are going to show up soon.

Expect treatment to take 2-3 months. Try any new acne regimen for 3 months before giving up because it will take that long to see the maximal benefits.

Over the counter medicines

Medicine bought in stores off the shelf is called over-the-counter or OTC medicine. There are 3 main types of OTC medicines for acne: benzoyl peroxide and adapalene.

For all topical medicines: Apply a thin layer to the entire area where pimples may occur. Don't just dab it on top of your pimples. A pea-sized amount should be used to cover the entire face. You can use a "5-dot" method where a small dot-sized amount is applied to the forehead, each cheek, nose, and chin. Avoid the skin around your eyes.

Benzoyl peroxide.

• Benzoyl peroxide wash, lotion, or gel is an effective acne treatment you can get without a prescription. It helps kill bacteria in the skin, unplug oil ducts, and heal pimples.
• There are a lot of different brands and different strengths (2.25% up to 10%).
• The gel may dry out your skin and make it redder than the wash or lotion. If that happens to you, you can try the wash or lotion.
• Benzoyl peroxide can be used as a wash in the morning or applied to the face after washing with a gentle cleanser.
• If using benzoyl peroxide as a wash, make sure you completely rinse it off before using a hand towel or getting dressed, as it may bleach cloth such as towels, clothing, and pillowcases.

Adapalene.

• Adapalene is a topical medicine that is available without a prescription. It is a very effective medicine for acne, especially when used in combination with benzoyl peroxide.
• Adaptalene should be used nightly.
• This medicine may dry your skin out and make it red at first.
• Adapalene should be applied once a day at night after washing with a gentle cleanser.

Salicylic acid.

• Salicylic acid is a beta hydroxy acid (BHA) that is commonly used in skincare products for treating acne. It works by exfoliating the skin, unclogging pores, and reducing inflammation.
• Salicylic acid comes in creams, lotions, gels, and washes in different concentrations ranging from 0.5% to 2%.
• Creams and lotions are suitable for mild to moderate acne.
• Gels are suitable for oily or acne-prone skin types.
• Salicylic acid also comes in pads and wipes. Pre-soaked pads or wipes are convenient for on-the-go acne treatment. They are typically formulated with a lower concentration of salicylic acid and are suitable for daily use.
• Salicylic acid facial cleansers are formulated to cleanse the skin while treating acne. They are gentle enough for daily use and help prevent breakouts.

Peels, lasers, and other treatments

• Chemical Peels are performed by dermatologists or skincare professionals. They involve applying a chemical to the skin to exfoliate the top layer and improve acne, acne scars, and skin texture.
• Laser Treatments are performed by dermatologists and other skincare professionals who are licensed to use these. Laser treatments can effectively reduce the number and severity of acne lesions, including pimples, blackheads, and cysts. Lasers can stimulate collagen production and promote skin renewal, leading to smoother, more even skin texture. It allows for precise targeting of acne-prone areas, minimizing damage to surrounding healthy skin.

Prescription Medications

The type of prescription medicines to treat acne include retinoid, antibiotics, and isotretinoin. In females, hormonal treatments can also help.

• Retinoid. If OTC medicines do not get your zits under control, we may prescribe a stronger retinoid to be used on the skin (like Retin-A and other brand names). This comes in a cream or gel and helps unplug oil ducts. It must be used exactly as directed. Make sure to use sunscreen and try to stay out of the sun (including tanning salons) when taking this medicine. Retinoids can cause your skin to peel and turn red.
• Antibiotics. Antibiotics, in cream, lotion, solution, or gel form, may be used for "inflammatory" acne. Antibiotics in pill form may be used if the treatments used on the skin don't help but are not recommended for long term use.
• Isotretinoin. This is a pill that is used for more severe forms of acne and acne that has not improved with other conventional acne treatments. It must never be taken just before or during pregnancy. There is a danger of severe or even fatal deformities to unborn babies. Patients who take this medicine must be carefully supervised by a doctor knowledgeable about its usage, such as a pediatric dermatologist or other expert in treating acne. Isotretinoin should be used cautiously (and only with careful monitoring by a dermatologist and psychiatrist) in patients with a history of depression. Don't be surprised if your doctor requires a negative pregnancy test result, some blood tests, and a signed consent form before prescribing isotretinoin.
• ​Hormone regulation. Many females benefit from contraceptive medications or spironolactone for acne.
  • If spironolactone is prescribed, be sure to stay hydrated. Sit before standing after laying for a long period of time if you get dizzy. You may not see results from spironolactone right away. Most people start to see less breakouts and oily skin within a few weeks, but your response to the medication may be different. Studies have also found that people tend to get more of a benefit from the medication the longer they take it. Using spironolactone with oral contraceptives seems to increase benefits in many females. Spironolactone is a tablet that you take by mouth, once daily. Doses for acne range from 50 mg to 200 mg. Your provider will determine what is the best dose for you depending on your situation. We typically start with a low dose and increase if needed for best symptom control. You can take spironolactone with or without food, but make sure you pick one way and stick to it. Also avoid taking it before bedtime since it can make you go to the bathroom.
  • More information on oral contraceptives is found on https://pediatricpartnerskc.com/Oral-contraceptives-AKA-birth-control-or-hormone-t

If you are prescribed oral contraceptives:

• Begin a pill pack on Sunday. You do not have to wait until after your period if pregnancy is not a risk. If it is, be sure you are not pregnant before starting. Talk to your prescriber about this if there is a possibility of pregnancy.
• Take a pill about the same time every day. We recommend evening time so that you don't need to wake early on non-school days to take it.
• If a pill is missed, take it as soon as you remember.
• You can take 2 pills at the same time if you find you forgot a day, but that might lead to less pregnancy protection, spotting, and nausea.
• Oral contraceptives never protect against sexually transmitted diseases. Use a condom every time if you have sex.
• You will be asked to provide a urine sample yearly to test for chlamydia while you are on oral contraceptives (routine for all females over 15 years), whether or not you are sexually active.
• Many insurance companies require 90 day prescriptions for these medicines. Once a few months have been used, please let us know how it's working or not. The prescription will be adjusted as needed.

REMEMBER

Here are things to keep in mind no matter what treatment you use.

• Be patient. Give each treatment enough time to work. It may take 3 to 6 weeks or longer before you see a change and 12 weeks for maximum improvement.
• Be faithful. Follow your treatment program every day. Don't stop and start each time your skin changes. Not using it regularly is the most common reason why treatments fail.
• Follow directions. Not using it correctly can result in treatment failure or troublesome side effects.
• Only use your medicine. Doctors prescribe medicine specifically for particular patients. What's good for a friend may not be good for you.
• Don't overdo it. Too much scrubbing makes skin worse. Too much benzoyl peroxide or topical retinoid cream can make your face red and scaly. Too much oral antibiotic may cause side effects.
• Don't worry about what other people think. It's no fun having acne, and some people may say hurtful things about it.
• Try not to let it bother you. Most teens get some acne at some point. Acne usually clears up as you get older. Remember that acne is temporary and there are a lot of ways to keep it under control.

When to See a Dermatologist or other Skin Specialist: If your acne is severe, persistent, or causing distress despite the treatments we can prescribe, it may be time to see a dermatologist or other skin specialist. A dermatologist can prescribe stronger medications, such as topical retinoids, oral antibiotics, or isotretinoin, to help manage your acne more effectively. Other skin specialists may use chemical peels or laser therapy.