teenager may not initiate a conversation about control of acne with his or her physician, but often is eager to hear advice on how to control what can be a frustrating and embarrassing 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 staff at Children’s Medical Center of Dallas. 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 harsh 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.

Determining which type of acne a teen has is the first step in directing treatment. Here are two common types:

• Blackheads (or comedones) are caused by pores clogged by debris on the skin surface. Lesions typically show up on the face, nose and forehead 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. Proper cleansing and the use of non-comedogenic face products are also 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. This type is best treated with a drug called Retin-A, a derivative of retinoic acid. Retin-A can be used in conjunction with benzoyl peroxide.

Occasionally, nodules or deep bumps of acne persist. Then, topical antibiotics may be added. Oral antibiotics are sometimes required, but their use is limited to the short term and the physician and family should discuss the relative risks and benefits. Additional treatments also are 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.