Why Me?
I have asked myself this question over and over
again because I was a teenager with terrible acne, and
I still struggle with breakouts even now. Statistics are
against teens because 85% of them are destined to get
some amount of acne. Knowing they’re not in this alone
may be comforting to some, but for me it didn’t help.
Even with all of today’s modern conveniences and
technologies, being a teen really isn’t any easier now
than it was when I was a kid. Expectations are high during
these turbulent yet exciting years, which serve as the
bridge between childhood and adulthood. Without question,
teens must do their best to balance between preparing
for the future while simultaneously trying to figure out
who they are, how they want to behave, and who they want
to become when they grow up. And if all of that isn’t
challenging and demanding enough, their hormones are raging,
plus there are all the pressures of popularity and sexuality
that feel confusing, melodramatic, and tragic.
It’s ironic and usually depressing that, just as
teens are getting to a point in their lives where appearance
becomes a major part of their identity, acne rears its
unattractive, red, oily, white-spotted, swollen head.
Teens lucky enough to have acne-free skin (frequently
the popular ones, right?) will likely still endure the
occasional blemish and most likely will find it traumatic.
Between school, work, family obligations, and maintaining
a social life, is it any wonder that acne can be such
a devastating intrusion on a young person’s life? I know
it was on mine.
To make matters worse, searching for treatments
amidst the countless options out there is enough to make
anyone break out. And companies know this, launching an
endless array of anti-acne products marketed directly
to teens. Happy, blemish-free teens smiling at the success
of whatever product is being advertised with trendy music
playing in the back-ground are meant to seduce a teen
into believing that these products must be the answer.
It never quite turns out that way, and often these products
just make the problem worse.
What these ads never contain are good, solid, research-based
details about what works and what doesn’t for problem
skin. They assume teens don’t want information, they just
want products. And while they may be right, it is absolutely
true that everyone—regardless of age—needs information
so they know how to make good decisions about the products
they buy. Advertisements and infomercials may be intriguing,
but they aren’t based on facts, they never tell the whole
story, and they often mislead.
But there is good news. While acne is difficult,
if not impossible to cure, there are solutions to control
it, and depending on the type of acne, it doesn’t have
to be expensive. Once you learn some basic facts about
what causes acne and what should (and should not) be done
to manage it, you and your teen will be far ahead of the
game. Becoming aware of the many myths surrounding this
stubborn skin problem, as well as informing yourself and
your teen about which products claim to “cure” the condition
but may end up only making matters worse (and there are
a lot of those out there) are great ways to start. The
information provided in this report will help you play
an active role in finding solutions that work. But be
forewarned, there is rarely a quick fix, and it will take
educated experimentation to find out what will work best
for the teen in your life.
What Causes a Pimple?
There is very little mystery about how
a pimple is created. Hormones (which are wildly out of
control for both boys and girls during the teenage years
due to changes caused by puberty) stimulate the oil glands
to become more active. The hormonal interaction comes
primarily from androgens (male hormones present in both
men and women), which have cor-responding receptor sites
at the bottom of the pore lining. (Receptor sites are
contact areas for substances such as hor-mones that tell
a specific part of the body what to do.) When androgens
hook up to the receptor sites on the pore, they communicate
excess production of sebum (oil) which starts the formation
of a clogged pore that, with the presence of a specific
bacteria, can cause a blemish. (Source: Clinical Dermatology,
September-October 2004, pages 360-366.)
Excess hormones communicate an increase in the production
of sebum (oil) in the sebaceous gland (oil gland), which
causes a backup in the pore. This oil being created (which
is more solid than typical fluid inside the pore) is unable
to move freely and evenly through the pore’s opening,
resulting in a blockage that leads to a clogged pore.
This may be due to an abnormally shaped pore lining (the
pore lining is made of skin cells that can build up and
close off access to the sur-face), or a defect in the
kind of sebum being produced.
Complicating matters is a specific type of bacteria
that’s naturally present in our pores called Propionibacterium
acnes (P. acnes). This bacterium subsists and flourishes
on our dead skin cells and oil. When oil and dead skin
cells back up in the pore lining, it’s as though this
bacterium is first in line at an all-you-can-eat buffet.
The “gorging” the bacterium does results in an inflammatory
response which, cou-pled with the bacterium’s gluttonous
nature, causes it to proliferate. Guess what the result
is? A red, raised, often swollen pimple (Sources: Drugs,
2003 volume 63, issue 15, pages 1,579-1,596 and Advances
in Dermatology, January 2003, pages 1-10). There are other
factors that may contribute to acne. It is suspected that
other growth hormones and insulin-like growth factor may
play a role in the prevalence of teen acne (Source: http://www.emedicine.com/).
There is also research looking at the presence of certain
fatty acids in sebum that may trigger breakouts. What
remains a complete mystery is why one pore gets a blemish
and not another, and why some people have acne erupt from
what seems to be every pore on their face.
There are several types of pimples that comprise
acne, as well as blackheads (technically referred to as
open come-dones) and whiteheads (closed comedones), bumps
that are filled with sebum but are not inflamed or filled
with fluid. They are as follows:
Papules are the mildest type of
acne lesion, though “mild” is a relative term because
these red bumps may be quite painful. They result from
the pore lining becoming swollen as a result of bacterial
inflammation and too much oil being pre-sent in the pore.
This is the easiest form of acne to manage and over-the-counter
products can prove extremely helpful.
Pustules form from papules, and
occur when the pore lining ruptures, thus spilling its
contents into the swollen, red bump at the base of the
pore. Pustules tend to be larger and more painful than
papules. Most teens dealing with acne will have an assortment
of papules and pustules. It often takes a mixture of over-the-counter
and prescription-only products to manage this condition.
Cysts are the largest, most painful,
and difficult to treat type of acne lesion. They reach
deep into the sebaceous gland and, if left untreated (and
even sometimes with proper treatment) often result in
scarring because they stretch and dam-age surrounding
skin and its support structure. If this type of acne is
prevalent, dermatologist treatment is mandatory as no
over-the-counter products can address the cause.
Blackheads form when oil and dead
skin cells trapped in the pore lining make their way to
the pore opening. The oil oxidizes at the surface, forming
the recognizable black dots that are most commonly seen
on the nose. Contrary to com-mon perception, blackheads
are not related to dirt! It is also important to note
that blackheads are not caused by bacteria. As such, they
do not respond to topical disinfectants (benzoyl peroxide,
sulfur, alcohol, topical antibiotics).
Whiteheads (not the pimple kind,
but hard, white bumps some skin types get) also result
from the mixture of excess oil and dead skin cells, but
do not oxidize because they are covered by a thin layer
of skin. They resemble white to slightly translucent bumps,
and are often seen on the forehead and cheeks. Whiteheads
may lead to inflammatory acne if P. acnes bacteria get
involved.
Don’t Make Matters Worse!
At any age the question about removing or squeezing
blemishes is a contentious one. Some say doing so will
only make matters worse so they are best left alone. Others
say removing the contents of a blemish helps healing and
im-proves appearances in the long run. It turns out both
points of view are accurate. You definitely can make acne
worse by attacking the lesions—making sores and scabs,
damaging skin, rupturing the pore, which spreads oil and
bacteria in ar-eas it doesn’t belong, and making skin
more inflamed—thus impairing the healing process. Such
obsessive, over-zealous behavior actually has a name,
acne excoriee, and the result is almost
always red or dark discolorations, which can lead to permanent
scarring. None of that is desirable. On the other hand,
white, pus-filled bumps on the face don’t look or feel
great either. The issue is one of degree. If the contents
of a blemish can be gently (the operative word being gently)
removed without injuring skin or creating a sore, then
it can help heal the blemish faster and reduce swelling
(after all, it’s usually the matter trapped inside the
pore that’s causing the inflammation). If not, then the
blemish should be left alone.
Another type of acne you and your teen should be
aware of is acne cosmetica. Some individuals
have sensitivity to makeup—particularly foundation or
emollient moisturizers—as these products sometimes are
formulated with ingredients that can trigger breakouts.
Hair-styling products also can trigger acne-like eruptions,
especially when used in great amounts around the hair
line or if the hair hangs on the face. Fluoride toothpaste
or the mint/peppermint/wintergreen fla-vorings are other
culprits. Those who tend to break out around their mouth
and chin may want to talk to their dentist about avoiding
fluoride toothpaste or products containing these flavorings
for a period of time to see if that clears up the prob-lem.
While acne cosmetica rarely causes large breakouts,
it isn’t fun to deal with and can be persistent. To avoid
this prob-lem it is critical to make sure your teen removes
all makeup every night, and never sleeps in makeup. Also,
make sure your teen avoids moisturizers or other skin-care
products that are thick or emollient as these almost always
contain ingre-dients that can clog pores and cause eruptions.
Pressure or friction against certain areas of the
face or body may cause blemishes to emerge. This skin
condition is called acne mechanica. With
this form of acne, simple everyday behavior—resting the
chin on hands, rubbing cheeks frequently, vigorously wiping
the face with hands or a towel while sweating (as opposed
to dabbing at the face with a towel), tight jeans (causing
breakouts on thighs and buttocks), sports gear etc.—can
result in breakouts. Helping your teen eliminate these
behaviors or changing clothing fabrics (softer rather
than tougher materials and less restricting fabrics) can
go a long way to improving conditions.
Treating the Problem
Now that you’re aware of the basic types of acne
lesions and blemishes and what can cause them to occur,
let’s go over the necessary steps to take in order to
get things under control from a skin-care perspective.
For optimal results when fighting blemishes and acne,
the three necessary steps are:
1. Reduce oil to eliminate the environment that
acne-causing bacteria thrive in
2. Exfoliate the skin’s surface and within the pore
to improve the shape and function of the pore
3. Disinfect the skin to eliminate acne-causing
bacteria living inside the pore
Ways to accomplish each of these goals are presented
below. It is critical to stress to your teen that compliance
and consistency are key to any successful anti-acne routine.
Keeping acne under control demands sticking to a reliable
rou-tine and not getting complacent once things begin
to improve. Bottom line: Managing acne takes patience,
persistence, and educated experimentation.
Reducing Oil Production
Reducing oil is perhaps the hardest part of dealing
with acne because oil production is hormonally generated,
and there are no topical agents that can inhibit the male
hormones that cause excess sebum production. It can become
an endless battle that is commonly approached in an overzealous
manner by the overuse of excessively drying and irritating
skin-care products. Battering the skin in such a way results
in damage to the skin’s protective outer barrier, which
impairs the skin’s healing process and increases bacteria
growth. It may seem logical to try and scrub away acne,
or to dry it up with products that burn and tingle, but
any perceived benefit is short term, and in the long run
these products will only make the problem worse.
It is also important to remember that, save for
the prescription drug Accutane or oral hormone blockers
(discussed later in this report), any means of reducing
oil is temporary. Skin-care products and cosmetics cannot
permanently change the amount of oil the oil gland produces.
Workable options to temporarily reduce oil include charcoal
or clay masks (but be sure they do not contain irritants
such as menthol, camphor, peppermint, or SD-alcohols which
can negatively affect skin) and, oddly enough, plain Milk
of Magnesia. The main ingredient in this liquid antacid
is magnesium hydroxide, which hap-pens to be an excellent
absorbent for excess oil.
Cleansing
The gentlest, most effective way to reduce surface
oil daily, keep redness at a minimum, and help skin heal
is the daily use of a mild, non-drying, non-irritating,
water-soluble cleanser in the morning and evening. Make
sure your teen avoids any cleansers that contain menthol,
peppermint, camphor, eucalyptus, citrus, or other ingredients
that prompt a cooling or tingling sensation. They are
incredibly common in anti-acne products, yet do nothing
but irritate skin. Don’t mistake that tingle as a sign
the product is working. It’s working to cause irritation—not
to make acne any better—and these ingredi-ents can’t change
oil production.
Tip: At night, especially if your
teen wears foundation or face powders, rather than using
a scrub-type cleanser, it can be far more effective to
use a clean washcloth with the cleanser to help mechanically
exfoliate the skin’s surface, and it saves having to use
two cleansers instead of just one. And many scrubs contain
ingredients that just aren’t helpful for any skin type.
It is also imperative to avoid emollient cleansers
and bar soaps or bar cleansers of any kind. These types
of cleansers often have pore-clogging ingredients, rinse
poorly, and, in the case of bar soap, can raise skin’s
pH level, encouraging the growth of acne-causing bacteria
(Sources: Skin Pharmacology and Physiology, July 2006,
pages 296-302 and Derma-tologic Therapy, February 2004,
Supplement, pages 16-25 and 26-34).
You’ll come across a lot of anti-acne cleansers
that claim to be medicated. Although they typically contain
active ingre-dients such as triclosan (a topical disinfectant),
benzoyl peroxide, or salicylic acid, they are essentially
wasted in a cleanser because their contact with skin is
so brief that almost all of the benefit is rinsed down
the drain. In addition, medi-cated cleansers should not
be used around the eyes or mucous membranes, which make
them trickier to work with.
The goal is to find a water-soluble cleanser that
is gentle yet dissolves excess oil and removes makeup
without leaving a greasy residue or film. The following
cleansers are recommended for this purpose:
Alpha Hydrox Foaming Face Wash ($6.99 for 6 ounces)
Cetaphil Daily Facial Cleanser for Normal to Oily Skin
($6.99 for 8 ounces)
Clinique Liquid Facial Soap Mild Formula ($14.50 for 6.7
ounces)
Neutrogena Liquid Neutrogena Facial Cleansing Formula
Fragrance Free ($9.09 for 8 ounces)
Paula’s Choice One Step Face Cleanser Normal to Oily/Combination
Skin ($12.95 for 8 ounces)
Paula’s Choice Skin Balancing Cleanser Normal to Oily/Combination
Skin ($12.95 for 8 ounces)
Note: If your teen is removing stubborn or waterproof
makeup or mascara, she may need to also use a makeup re-mover.
Exfoliating
All skin types can benefit from exfoliating, but
this is especially true for those with oily, blemish-prone
skin. The best time to apply an exfoliant is after cleansing.
Although topical scrubs abound, they are merely average
options when com-pared to the clinically significant impact
a well-formulated alpha hydroxy acid (AHA) or beta hydroxy
acid (BHA) product has on acne-prone skin. Also, just
as with anti-acne cleansers, many topical scrubs labeled
for acne-prone skin are loaded with irritants that won’t
improve matters, or the scrub particle is too harsh and
scratches skin. As I mentioned be-fore, even a gentle
washcloth is preferred to a topical scrub.
Glycolic acid and lactic acid are the most common
and well-researched AHAs. There are others, but these
two provide the best penetration and proven results. Both
work to dissolve the bonds that hold dead skin cells to
the surface, allowing them to shed normally. As dead skin
cells mix with excess oil in the pore and find their way
to the surface, they tend to stick around longer than
they should and prevent other surface skin cells from
shedding properly, creating a dull complexion while at
the same time worsening already-clogged pores.
Salicylic acid is the only BHA ingredient. It is a long-established,
anti-acne ingredient that has several distinct advantages
over AHAs. BHA is oil-soluble so it penetrates into the
pore lining to help dissolve clogs an AHA product can’t
reach; it has antibacterial properties so it can kill
off acne-causing bacteria in the pore; and it is anti-inflammatory
due to its close relation to aspirin (aspirin is acetyl
salicylic acid), which helps to reduce the redness and
swelling that acne causes. If your teen is allergic to
aspirin, you will most likely need to avoid purchasing
a salicylic acid product for them. In this instance, an
AHA exfoliant is your next best option.
AHA products work best in 8% to 10% concentrations
and BHA products work best in 1% to 2% concentrations.
A key element for both AHAs and BHA to assure effectiveness
is the pH level of the product. In order for the AHAs
or BHA to function optimally as exfoliants, the products
containing them must have a final pH value of 3-4. A lower
pH will also work, but dipping below a pH of 3 tends to
be too irritating for skin. As the pH value rises above
4, the exfoliant becomes inef-fective (Source: Journal
of Chromatography, August 2004, pages 255-262). Most companies
selling AHA or BHA products do not indicate a pH, so I
encourage you to consider the options suggested below,
all of which I’ve tested and are formu-lated in the correct
pH range to work as indicated:
Alpha Hydrox Enhanced Lotion ($10.89 for 6 ounces);
contains 8% glycolic acid
Alpha Hydrox Oil-Free Formula ($10.89 for 1.7 ounces);
contains 8% glycolic acid
Neutrogena Healthy Skin Face Lotion ($12.59 for 2.5 ounces);
contains 8% glycolic acid
Neutrogena Rapid Clear Acne Defense Face Lotion ($7.39
for 1.7 ounces); contains 2% salicylic acid
Olay Total Effects Anti-Aging Anti-Blemish Daily Moisturizer
($18.99 for 1.7 ounces); contains 1.5% salicylic acid
Paula’s Choice 1% Beta Hydroxy Acid Lotion or Gel ($15.95
for 4 ounces); contains 1% salicylic acid
Paula’s Choice 2% Beta Hydroxy Acid Liquid, Lotion, or
Gel ($15.95 for 4 ounces); contains 2% salicylic acid
Paula’s Choice 8% Alpha Hydroxy Acid Gel ($15.95 for 4
ounces); contains 8% glycolic acid
Peter Thomas Roth AHA 12% Ceramide Hydrating Repair Gel
($48 for 2 ounces); contains a 12% combination of lactic
and glycolic acids
ProActiv Clarifying Night Cream ($28.75 for 1 ounce);
contains 1% salicylic acid
Eliminate Acne-Causing Bacteria
A topical antibacterial agent is essential for fighting
blemishes. It is practically the only way—from a skin-care
product point of view—to eliminate acne-causing bacteria.
Alcohol (as in SD-alcohol or isopropyl alcohol) shows
up in many anti-acne products in amounts high enough to
disinfect skin, yet it is exceedingly irritating and therefore,
can cause more prob-lems than it solves because irritation
can trigger more blemishes. Sulfur is another potential
disinfectant but it is rarely used in over-the-counter
products because of its irritating, drying tendencies.
Plus the high pH of sulfur can encourage bacteria growth.
Tea tree oil is a potential option, but its results are
not as impressive as those for benzoyl peroxide, and the
necessary strength of 5% is rarely, if ever, seen in anti-acne
or other commercially available skin-care products (Sources:
Medical Journal of Australia, October 1990, pages 455-458
and Die Pharmazie, March 2005, pages 208-211).
Without question, the gold standard in topical antibacterial
products for acne is benzoyl peroxide (Source: Skin Phar-macology
and Applied Skin Physiology, September-October 2000, pages
292-296). The amount of research demonstrat-ing benzoyl
peroxide’s effectiveness is exhaustive and conclusive
(Sources: American Journal of Clinical Dermatology, April
2004, pages 261-265 and Journal of the American Academy
of Dermatology, November 1999, pages 710-716). Among benzoyl
peroxide’s attributes is its ability to penetrate into
the hair follicle to reach the problem-causing bacteria
and kill it with a low risk of irritation. Furthermore,
it doesn’t pose the problem of bacterial resistance that
some prescrip-tion topical antibacterial agents (antibiotics)
do (Source: Dermatology, January 1998, pages 119-125).
As with all anti-acne products, many of those that contain
benzoyl peroxide couple this active ingredient with irritants
such as alcohol or menthol. Below is a list of recommended
benzoyl peroxide products, ranging from 2.5%-10% concentrations.
It is best to start with the lower percentage and see
how your teen’s skin responds before considering stronger
versions, which may prove more irritating:
Clean & Clear Persa-Gel 10, Maximum Strength
($4.99 for 1 ounce); contains 10% benzoyl peroxide
Clearasil Ultra Vanishing Acne Treatment Cream ($9.99
for 1 ounce); contains 10% benzoyl peroxide
DDF Benzoyl Peroxide Gel 5% with Tea Tree Oil ($21 for
2 ounces)
Neutrogena On-the-Spot Acne Treatment ($6.59 for 0.75
ounce); contains 2.5% benzoyl peroxide
N.V. Perricone Outpatient Therapy Acne Treatment Gel Cream
($55 for 2 ounces); contains 5% benzoyl peroxide
Oxy Lotion, Vanishing Acne Medication ($5.69 for 1 ounce);
contains 5% benzoyl peroxide
Oxy Lotion, Vanishing Acne Medication, Maximum ($6.49
for 1 ounce); contains 10% benzoyl peroxide
PanOxyl Aqua Gel, Maximum Strength Acne Treatment ($4.99
for 1.5 ounces); contains 10% benzoyl peroxide
Paula’s Choice Blemish Fighting Solution ($14.95 for 2.25
ounces); contains 2.5% benzoyl peroxide
Paula’s Choice Extra Strength Blemish Fighting
Solution ($14.95 for 2.25 ounces); contains 5% benzoyl
peroxide
Peter Thomas Roth BPO Gel 5% ($24 for 3 ounces)
Peter Thomas Roth BPO Gel 10% ($26 for 3 ounces)
ProActiv Repairing Lotion ($21.75 for 2 ounces); contains
2.5% benzoyl peroxide
Stridex Power Pads ($6.99 for 28 pads); contains 2.5%
benzoyl peroxide
*Note: Benzoyl peroxide negates the effectiveness
of retinoids (discussed later in this report), such as
Retin-A or Ta-zorac, and therefore should not be used
at the same time. Your teen can enjoy the benefits of
both treatments by using the benzoyl peroxide product
in the morning and the retinoid product at night. The
exception to this is prescription Differin (adapalene).
It has been shown to remain stable and effective when
used at the same time as benzoyl peroxide (Source: British
Journal of Dermatology, October 1998, page 139).
The routine described in this report (cleansing,
exfoliating, disinfecting, and absorbing excess oil) should
keep most cases of teen acne under control. However, if
your teen’s acne proves resistant to these over-the-counter
options, pre-scription or medically-supervised anti-acne
treatments are the next step. These are almost always
used in conjunction with the steps previously described.
Prescription Options—When to See a Dermatologist
After about six months or so of trying a variety
of over-the-counter treatments (following the guidelines
discussed in this report), consider taking your teen to
see a dermatologist, or talk to your family physician
about prescription acne treat-ments. A doctor can offer
a grab bag of options—often a combination of treatments—that,
combined with a gentle skin-care routine, can finally
achieve the results you and your teen want.
Retinoids are perhaps the best
tricks dermatologists have up their sleeves. Retinoids
are compounds derived from vi-tamin A. Their importance
to skin care, especially for those with acne, is due to
their fundamental role in the way the body makes skin
cells and regulates their healthy, normal growth. Not
only are retinoids known for improving skin cell function
for all skin types but there is ongoing research looking
at how retinoids can reduce or prevent skin cancers.
Because of their ability to regulate skin cells
(a completely different physiological mechanism than BHA
or AHAs),
prescription-strength retinoids can improve the shape
of the pore lining, allowing oil and dead skin cells to
flow unimpeded to the surface. Several prescription-strength
retinoids are available, including tretinoin (found in
Retin-A, Retin-A Micro, Avita and also in generic brands),
Differin (adapalene, available as a cream or gel), and
Tazorac (tazarotene). The amount of research showing these
active ingredients to be formidable weapons against acne
is immense (Sources: Journal of Drugs in Dermatology,
September 2006, pages 785-794; Pediatrics, September 2006,
pages 1188-1199; Cutis, July 2006, pages 12-8, supplemental;
and Journal of the American Medical Association, August
11, 2004, pages 726-735).
Depending on your teen’s skin type, retinoids may
be used once or twice daily. Most people do well with
a once-per-day application in the evening but some sensitive
skin types may do better building up to daily use by starting
with every-other-day application. Retinoids may be used
with an AHA or BHA product to enhance effectiveness, with
the exfoliant being applied before the retinoid.
Note: Retinoids (and BHA and AHAs) can make skin
more sun-sensitive so making sure your teen is sun-smart
is very important. That means religiously using an SPF
15 or higher rated sunscreen with the UVA-protecting ingredients
of either titanium dioxide, zinc oxide, or avobenzone.
For teens with oily skin who don’t like using sunscreen
lotions, there are foundations that contain sunscreen
(Revlon is at the top of the game in this arena) or pressed
powders.
Topical Antibiotics are also viable
contenders and should be considered if benzoyl peroxide
doesn’t prove effective. Topical antibiotics include such
drugs as clindamycin, erythromycin, and tetracycline.
These have limitations because they have difficulty penetrating
into the pore lining and the fact that long-term use can
lead to bacterial resistance, meaning they stop being
as effective as they once were. Some topical prescription
antibiotics containing benzoyl peroxide are available.
Studies have shown that when used together, benzoyl peroxide
and topical antibiotics demonstrate greater benefit than
when either is used alone (Source: Journal of Cutaneous
Medical Surgery, January 2001, pages 37-42). Ex-amples
of such combined therapy drugs include Benzaclin and Clindagel.
Azelaic Acid, the ingredient found
in prescription-only medications such as Azelex and Finacea,
occurs naturally in wheat, barely, and rye. It has an
antibacterial and exfoliating action on skin, which definitely
gives it purpose in the battle against blemishes. In addition,
azelaic acid tends to be better tolerated than retinoids
for persons with sensitive skin. Re-search has shown that
pairing azelaic acid with benzoyl peroxide (either over-the-counter
or mixed with a prescription topical antibiotic) is preferred
to using either active ingredient alone (Source: Journal
of the American Academy of Derma-tology, August 2000,
Supplemental, pages 47-50). Prescription Azelex contains
20% azelaic acid, while Finacea contains 15%. Both are
effective against acne so which one to choose depends
on individual preference for the cream texture of Azelex
or the gel texture of Finacea.
Oral Antibiotics are a typical
recommendation in the treatment of acne to kill acne-causing
bacterium, but I have strong reservations about this.
While there are several studies showing that using antibiotics
in combination with topical retinoids and exfoliation
can control and greatly reduce breakouts (Sources: Cutis,
June 2004, pages 6-10 and Interna-tional Journal of Dermatology,
January 2000, pages 45-50), this doesn’t address the issue
of building up bacteria resis-tance, which means that
in 6 months or so the antibiotic would lose efficacy and
the acne would return and require a dif-ferent antibiotic
to treat it (Sources: British Journal of Dermatology,
August 2005, pages 395-403 and Journal of the American
Medical Association (JAMA), August 11, 2004, pages 726-735).
While short-term oral antibiotic use may be an option,
according to the JAMA study “Long-term topical or oral
antibiotic therapy should be avoided when feasible to
minimize occurrence of bacterial resistance.”
The most common oral antibiotics prescribed for
acne are tetracycline, minocycline, doxycycline, and,
if the –cycline family of drugs is not tolerated or advisable,
erythromycin. Tetracycline is generally not prescribed
for patients younger than age 13 because it can cause
permanent discoloration of dental enamel. Drugs in the
–cycline family may cause in-creased sensitivity to sunlight.
One more point, a study involving more than 600
participants described in the Lancet, December 2004, pages
2188-2195, found benzoyl peroxide the most effective treatment
for treating blemishes when compared to oral antibiotics
(such as tetracycline), topical antibiotics (such as erythromycin),
or combination treatments. (Oral tetracycline suffered
in the comparison because of the common problem of eventual
bacteria resistance to antibiotics.)
Photodynamic Therapy is a relatively
new procedure, also known as Light Therapy. It has been
shown to be some-what successful for treating acne (Source:
Journal of Cosmetic Laser Therapy, June 2004, pages 91-95).
This medical treatment uses a topical medication known
as aminolevulinic acid in conjunction with non-skin-damaging
lasers or a spe-cial blue light source (Source: http://www.aad.org/). After the
topical medication is applied, the patient sits in front
of the light source for 15-30 minutes. Anywhere from 3-5
sessions over a period of time are necessary before results
are seen, mak-ing this a treatment that requires time,
patience, and cost. However, if no response is observed
in these initial sessions, ongoing treatments are unlikely
to improve matters. Light Therapy’s effect on acne has
to do with its impact on porphyrins, which are by-products
of acne-causing bacteria. Porphyrins are highly sensitive
to certain wavelengths of light (specifi-cally, blue light).
Exposure to this light causes a chemical reaction that
is toxic to acne-causing bacteria, thus destroying it
without damaging skin (Source: European Journal of Dermatology,
September 2006, pages 340-348).
Devices such as the ClearLight system have been
FDA-approved for the treatment of mild to moderate inflammatory
acne (Source: www.fda.gov/fdac/departs/2002/602_upd.html#acne).
It is important to note that Light Therapy does not improve
blackheads, whiteheads, or cystic acne, nor does it reduce
oil or pore size, so any claims of this nature are false
and not demonstrated in the literature.
Lasers are also an option for acne
treatment. There is increasing research showing that treatments
with the SmoothBeam Laser (a 1,450-nanometer diode laser)
can significantly improve acne, possibly by affecting
the sebaceous gland and killing acne-causing bacteria,
thus reducing the number of acne lesions. A series of
treatments (usually 4-6) is needed, but one study showed
that patients maintained clear skin 12 months after the
last treatment (Sources: Journal of the American Academy
of Dermatology, July 2006, pages 80-87 and Lasers in Surgery
and Medicine, September 18, 2006).
Non-ablative lasers are options as well, though
their effect has primarily been linked to reducing inflammation
rather than acne lesion counts (Source: British Journal
of Dermatology, October 2006, pages 748-755). There may
be potential as more research is done, but for the time
being what has been published involves studies exploring
treatments on small groups of people. Even when laser
therapy has shown positive results, it is noted that patients
were continuing topical treatments (prescription or not)
and therefore the laser alone was likely not wholly responsible
for the benefit (Source: Seminars in Cutaneous Medicine
and Surgery, June 2005, pages 105-112).
Keep in mind that if you decide to try laser treatments
to control your teen’s acne it is a costly endeavor, with
a standard series of treatments, ranging from $2,500-$5,000
depending on where you live.
Accutane (active substance isotretinoin)
is the only medication or skin-care treatment of any kind
that has the potential to cure acne. If your teen’s acne
persists after trying most of the suggested treatments
discussed in this report, it may be necessary to consider
this powerful oral medication derived from vitamin A.
Success with Accutane can be nothing less than astounding—eliminating
any signs of acne or oily skin for a long period of time
and sometimes permanently. It would be a primary consideration,
but unfortunately, it has serious side effects that need
to be reviewed by you and your teen’s physician. Most
of the side effects are limited to the duration of treatment,
but they can still be daunting while your teen is experiencing
them. In short, this is not a drug to be considered lightly.
Accutane works by halting the production of oil
in the oil glands, and in the process, it shrinks those
glands to the size of a child’s. This prevents oil from
mixing with dead skin cells in the pore lining, eliminating
the environment that promotes acne-causing bacteria growth.
Accutane is particularly helpful for those dealing with
cystic acne because shrinking the oil gland eliminates
the deep plugs that can rupture the pore lining, leading
to severe inflammation and scarring. Normal oil production
usually resumes when Accutane therapy is completed. However,
the oil glands rarely grow to the size they were before
treatment began and usually continue to function normally.
A course of Accutane generally lasts 4-6 months, and in
some cases a second course may be needed. As successful
as Accutane can be, its use does not mean your teen will
never break out again. However, any breakouts that do
occur after taking Accutane are likely to be very responsive
to conventional treatments.
Accutane is controversial for many reasons, but
principally because of its most insidious side effect:
It has been proven to cause severe birth defects in nearly
90% of babies born to women who were pregnant while taking
it. Female patients (including teenagers, be they sexually
active or not) must consent to at least two forms of birth
control while taking Accu-tane. In terms of other side
effects, the most commonly experienced are dry skin and
lips, mild nosebleeds, mild hair loss, aches and pains,
sensitivity to sunlight, itching, fragile skin, and increased
cholesterol levels.
One more point to be aware of is the correlation
between Accutane and feelings of depression and/or suicide
attempts. Although the FDA’s determination is that there
is inconclusive evidence implicating Accutane as a causative
factor for ei-ther of these issues, Hoffman-La Roche,
the manufacturer of Accutane, agreed to put a warning
statement in the product information insert.
Debunking Acne Myths
Most of us are familiar with the most common
myths surrounding acne, whether we know they’re myths
or not (and many people genuinely believe them, often
as a result of coincidental personal experience). ALL
of the statements below are false; see how many of them
you thought were true, either presently or in the past:
Acne is caused by poor hygiene. (There is no evidence
showing this to be true, but proper skin care can reduce
the problem once you have it.)
Acne is something you will eventually outgrow. (Generally,
this is true for men, but not for women. While men’s hor-mones
calm down after the age of 20, women’s continue to fluctuate,
and that can perpetuate or even trigger acne where no
problem existed before.)
Acne is caused by a reaction to certain foods, such
as chocolate or fried foods. (There are no specific foods
that cause acne for everyone. The only time diet plays
a role is if you are allergic to certain foods, such as
nuts, iodine, gluten, milk, etc.)
Acne is caused by stress. (A great deal of research
has shown how emotionally upsetting acne can be for people,
but there is no link between stress and acne. Stress levels
for those people without acne have not been shown to be
different than for those with acne.)
Acne is caused by psychological problems. (Please see
comments about stress.)
Acne is caused by masturbation or impure thoughts.
(I know people used to believe that one, but to say the
least it doesn’t have a modicum of fact behind it, and
is a complete fallacy.)
Getting or maintaining a suntan clears acne. (Getting
tan may help skin look better for a short time, but it
doesn’t heal acne, prevent bacteria growth, or inhibit
oil production. And keep in mind that down the road, unprotected
sun exposure and getting a tan is a major cause of wrinkles,
discoloration, and skin cancer.)
Drinking sugar-rich carbonated beverages causes
acne. (Please see the comments about diet.)
Acne is contagious. (Not in the least. The kind
of bacterium that causes acne, P. Acnes, is anaerobic—meaning
it doesn’t like air or sunlight, lives far below the skin’s
surface, and doesn’t ever leave or it would die—therefore,
it can’t be transferred. And you certainly can’t catch
someone else’s hormone development.)
Cleansing the face several times per day helps clear
acne. (Too much cleansing can actually cause more acne
by breaking down the skin’s external barrier, increasing
bacteria growth, and inflaming the skin, causing an irritant
response and triggering breakouts.)
You can dry up a blemish to help it go away quickly.
(Blemishes aren’t wet, and drying skin causes irritation
and can make matters worse. Absorbing oil is helpful,
but this is a different process from “drying up” skin.)
Steaming the skin helps clear clogged pores. (Heating
up the skin can cause inflammation, break surface capillaries,
and make skin look redder; none of that is helpful for
any skin type.)
Now that you have a greater understanding of what
is fact and fiction, as well as an outline of various
treatment proto-cols, you will be able to take charge
of determining how to treat your teen’s acne and help
them manage it. Remember, compliance with a routine that
is producing good results is fundamental to its success.
Encourage your teen not to be-come discouraged when something
isn’t working, or may not be working as well as it once
did. It stands to reason that as acne comes under control,
the results will seem less impressive than at the onset.
And remind your teen that there is no single “best” anti-acne
routine. Rather, educated experimentation is necessary,
and in almost every case, a combination of therapies produces
the most gratifying results. With perseverance and knowledge
based on substantiated proof, you can help make acne a
minor blip on the radar of teen life—an accomplishment
that will make life easier for all concerned, most importantly
your teen!