A teen-ager may not initiate a conversation about control of acne to his or her physician, but often is eager to hear good advice on how to control what can be a frustrating and embarrassing skin condition.

“At puberty, the sebaceous gland enlarges and sebum (oil) production accelerates in response to increased hormone activity. Comedones or “zits” typically form on the central face area, and can be the first sign of puberty,” says Dr. Patty Hicks, a pediatrician on the medical staff at Children’s Medical Center of Dallas. “It is important to recognize that this very embarrassing skin condition can be controlled.”

A starting point for good skin care includes thorough, but gentle cleansing at least twice daily. It is best to use products that do not include alcohol or other astringents or hard detergents as these only irritate the skin and constrict the pores. For girls who wear makeup, oil-free, non-comedogenic products are best. An oil-free sunscreen also is recommended.

Different types of acne exist. Determining which type of acne a teen has is the first step in directing treatment, Dr. Hicks says. Two common types of acne are:

Blackheads (comedones) are caused by pores clogged by debris on the skin surface. Lesions typically show up on the face, nose and forehead (referred to as the “T zone”) and on the neck, chest and back. Opening the pores can be accomplished with the use of a benzoyl peroxide gel applied sparingly four to seven times a week. Over-the-counter benzoyl peroxide lotions are less effective than prescription gels. Proper cleansing and use of non-comedogenic face products also are important in treating this type of acne.

Papules and pustules are deeper, painful lesions that occur when the infection within the sebaceous gland causes the gland and the area around it to become distorted as the infection spreads below the skin surface. The condition often is created or made worse by attempting to pinch or pop the pimple. These deeper lesions can leave their mark as they heal, resulting in pits or scars. This type
of acne often is helped by a drug called Retin-A, a derivative of retinoic acid. In some cases, Retin-A is used in conjunction with benzoyl peroxide.

Occasionally, neither benzoyl peroxide nor Retin-A is adequate, and nodules or deep bumps of acne persist. Then, topical antibiotics may be added. It is important to emphasize the consistent use of any regimen to avoid resistant organisms. But even with its conscientious use, resistance can develop. Antibiotics taken orally are sometimes required, but their use is limited to the short term, and the physician and family should discuss the relative risks and benefits.

If your pediatrician or family practice doctor cannot control the acne adequately with any of these therapies, he or she may refer your child to a dermatologist for additional treatments available for severe or difficult acne.

“Some view acne as a natural process of puberty, but it must be appreciated for the short-term impact it has on the overall health of the adolescent as well as the potential long-term consequence of permanent scars,” Dr. Hicks says.