The Medical Minute: Back to School often means back to acne

Being a teenager can be tough. Teens must manage high school and the pressures of adolescence while at the same time battling stubborn acne. During summer vacation, teenage acne often lessens because of greater sun exposure and decreased stress, but with school back in session, it’s necessary to remind teens of good skin care practices and ways to treat acne before it becomes a major concern.

Acne affects about 85 percent of people between the ages of 12 and 24, and is the most common skin condition in the United States, according to the American Academy of Dermatology.

“A teen often feels alone in suffering from embarrassing pimples,” said Dr. David Shupp, a dermatologist at Penn State Health Medical Group – Colonnade in State College. “Because acne is caused primarily by hormone levels, the condition often begins at puberty and clears up by the late 20s. Girls are more susceptible than boys to hormone-related acne.”

Shupp said that when a teen begins to experience mild acne, the first step is to treat with an over-the-counter cream, gel or lotion applied directly to affected areas, most commonly the face, chest, upper back and shoulders.

Nonprescription acne medications typically include one of the following active ingredients:

  • Benzoyl peroxide kills bacteria, helps remove excess oil from the skin and reduces inflammation. Check the label for benzoyl peroxide strength, which can range from 2.5 to 10 percent in over-the-counter products.
  • Salicylic acid dries excess oils and works best for blackheads and whiteheads. The strength typically ranges from 0.5 to 5 percent.
  • Adapalene prevents plugging of hair follicles and is available in 0.1 percent strength over the counter. The acne medication, a retinoid derived from vitamin A and commonly sold as the brand name Differin, was previously only available by prescription.

Teens with other skin conditions, such as eczema or psoriasis, should consult their doctor before experimenting with over-the-counter acne medications, according to Shupp.

“If over-the-counter medications don’t provide enough relief from acne, it’s time to discuss prescription medications with a dermatologist or family physician,” Shupp said.

Acne medications available only by prescription include:

  • Stronger retinoids, such as Retin-A. These are among the most effective topical medications but can be more drying than over-the-counter options.
  • Antibiotics, which can be administered orally or via a topical gel or cream to kill excess bacteria. Topical antibiotics are often combined with benzoyl peroxide to maximize effectiveness while lowering the risk of antibiotic resistance.
  • Hormonal treatments, which impact the balance of hormones that cause acne and are usually prescribed to supplement topical medications or antibiotics in young women. Birth control pills are the most common hormonal treatment for acne. Another option is spironolactone, which blocks androgen hormones. An excess of these hormones is a common cause of acne in women.
  • Isotretinoin (common brand name Accutane) is a powerful vitamin A derivative used to treat severe acne that does not respond to other medications. Potential side effects include birth defects, so teenage and adult women taking this oral medication must undergo monthly pregnancy tests.

Shupp noted that a family physician or dermatologist can work with a teen on an ongoing basis to adjust both over-the-counter and prescription medications to achieve the greatest success against acne, while guarding against side effects.

Regardless of the acne treatment chosen, teens can follow these basic steps to improve the likelihood of success:

  • Gently clean affected skin twice a day. Scrubbing can damage the skin and aggravate an acne problem. Avoid abrasive products.
  • Keep hands and hair away from the face to reduce the transfer of oil.
  • Use oil-free cosmetics, sunscreen, moisturizer and hair products. Look for the label “noncomedogenic.”
  • Don’t squeeze pimples. This can lead to permanent scarring.
  • Don’t use acne medication prescribed to someone else.
  • Follow the label or doctor’s instructions for all products. Overuse won’t clear up an outbreak any faster and instead could cause redness or peeling that appears worse than the original pimples.
  • Be patient. Any new product usually takes several weeks or even months to show noticeable improvement. Switching quickly from one product to another lessens effectiveness.
  • Be consistent. After an outbreak clears up, follow physician instructions for maintenance to help prevent future outbreaks.

“Although science has not discovered a cure for acne, careful treatment can minimize this skin condition until adulthood, when most acne clears up on its own,” Shupp said.

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

September 5, 2018 Penn State Health News

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