1. What are the main causes of acne ?
Acne is caused by multiple factors including hormonal imbalances (that’s why it’s often worse in teenagers, during this hormonal adjustment period), overproduction of oil, clogging of pores by keratin (now the excess oil is trapped!), genetic predisposition and a tendency for inflammation in the hair follicle.
The first step is always a comedone (ie a blackhead or whitehead), which develops because a pore is blocked with dead skin material (keratin etc.), and the oil (sebum) can’t flow freely to the skin’s surface. A secondary step is then invasion with certain types of bacteria, at which point the non-inflamed comedone turns into an inflamed lesion, ie a papule or pustule (that’s spots, pimples and/or cysts).
Acne’ by the way is simply the medical term for spots and pimples, it does not say anything about the degree or severity. So, any degree of spots and pimples is called ‘acne’ (and warrants treatment!), even if mild.
Acne is known to significantly impact confidence and quality of life and has even been linked to suicidal thoughts. Acne can be particularly traumatising for teenagers in this formative time life. Teenage acne is NOT a rite of passage, but a potentially scaring skin disease that needs treatment, ideally by a dermatologist.
2. What age group does acne affect most?
Acne is most common in teenagers with up to 80 – 90% being affected at some point. However, adult acne is also becoming more and more common these days and we see women with acne in their 30s or 40s every single day in clinic.
An imbalance with (relatively speaking) too many male hormones (androgens) such as testosterone will aggravate acne. Androgens increase in both boys and girls during puberty. Androgens make the skin’s oil glands larger and produce more sebum (oil).
If there is a general tendency for acne, then stress such as school exams can make it worse. However, if there is no genetic acne predisposition at all, then stress won’t cause you to breakout, so stress (and other lifestyle factors such as a high sugar diet and heavy skincare) can aggravate preexisting acne, but does not cause it as such.
3. How can teenage acne be treated?
First of all, acne should be acknowledged as a skin disease, not something you will want to treat with over the counter product (you would not try and do that with any other potentially scaring facial skin disease, would you…). So, any acne patient should see a doctor, ideally a dermatologist, to get the very best treatment possible.
Acne should ideally be treated with a combination approach of:
a) pore-un-clogging creams (for example vitamin A derivative prescription creams) and
b) anti-bacterial creams (for example topical antibiotic prescription creams).
In more severe cases, oral acne antibiotics or oral vitamin A derivative tablets (also known under one of the brand names, ‘Roaccutane’) might be prescribed. The latter is a highly effective type of oral treatment, which has the ability to switch the acne of for good (rather than just controlling it while you take the medication). You may have read worrying things about Roaccutane on the internet. However, in my opinion, Roaccutane’s bad rep is largely undeserved, as with the much lower daily doses we tend to prescribe today, the side effect profile is hugely improved these days. It’s a very popular treatment in our clinic, both both adults and teenagers.
4. What skincare routine is best for teenage acne?
In addition to the above mentioned prescription creams (or in some cases tablets), using the right type of skincare on a daily basis is extremely important, as using unsuitable skincare will significantly aggravate acne and can even undo the success of the prescription treatment.
The following are suitable skincare items for teenage acne:
1.) A foaming cleanser (could contain added active ingredients such as salicylic acid or glycolic acid) should be used twice per day, morning and evening.
If the skin is sensitive, a gentler gel cleanser can be used instead of a foaming cleanser.
In any case, strictly avoid most creamy and all oil cleanser!
Also, no hot cloths, sponges or other cleansing aids please (just clean hands, a suitable cleanser and luke-warm water). While there are pimples or spots, please do not use any electronic cleansing brushes either.
Lastly, no waterless cleansing with wet wipes.
2.) Acne sufferers should only use light-weight, oil-free moisturizers and sun creams (if needed) . Nothing greasy, oily or heavy. And if the skin feels oily, no moisturiser may be needed at all.
Moisturizers containing glycolic acid, salicylic acid or vitamin A derivatives such as retinol or retinaldehyde can be useful as a stand-alone treatment trial, but if prescription strength vitamin A (eg Adapalene or Tretinoin) is prescripted, then the skincare should be mild and not containing any retinoid or acids.
With regards to foundations, there are specialist acne foundations such as Oxygenetix Acne Control, which are much better than high-street make-up.
Ideally, no powders should be used (and certainly no re-usable make-up brushes, as these collect bacteria no matter what you do!).
If serums are used, only water- or alcohol-based serums are allowed, no oil-based serums.
No facial oils whatsoever – I mean it!
3.) Also no hydrating masks please (even if the skin feels dry), as they will all contribute to clogged pores. If you want to use a mask, a clarifying clay mask for example would be suitable to use once or twice per week.
You can find suitable skincare products on www.EudeloBoutique.com.
5. At what point should a teenagers with acne visit a doctor?
I generally don’t recommend treating acne on your own at home. However, if you really want, you may try a vitamin A, glycolic or salicylic acid cream for 3 months (acne responds slowly…) at home, but if it doesn’t clear with this, then please see a doctor, ideally a dermatologist, asap. Don’t delay treatment, as this is a potentially scaring facial skin condition (… and also one of the main causes for depression and even suicidal thoughts in teenagers).
We see the impact of teenage acne on youngsters here at Eudelo every single week. When I see them for the first time, they often don’t even make eye contact and don’t talk much. However, when we review their (improved!) skin after two or three months, we often see that not only their skin has changed, but their personality, too. They often speak more, make eye contact and seem overall happier and more confident, which is such a pleasure and privilege to witness.
6. Are there any lifestyle changes that can prevent teenage acne from getting worse?
Lifestyle changes are important, but usually need to be accompanied by other forms of treatment, as on their own they usually don’t lead to satisfactory improvement.
Using the correct skincare is one of the important lifestyle measures to think about and that includes the correct make-up/foundation/concealer (and never ever go to bed without removing your make-up!). There are specialist make-ups that can safely be worn every day, but please avoid high street make-up, as it can contribute to clogged pores.
Also, we know that eating a diet rich in sugar and/or processed carbohydrates can aggravate a preexisting acne, so sugar and starch intake should be reduced. Most people don’t realize that starch is essentially one long string of sugar molecules. As soon as it enters your body, it is cut down into individual sugar molecules. So, a diet with excess intake of starch/ carbohydrate based foods (bread, pasta, rice, potatoes etc.), especially the highly processed type, should also be avoided.
Other lifestyle factors that can aggravate acne are friction caused by leaning on or rubbing the skin; picking or squeezing pimples (leave that to the therapist as part of a dermatology grade facial!) and pressure from for example caps, beanie’s, bike helmets, backpacks and tight collars.
7. Can facials help teenage acne?
Dermatology grade facials including a mild peel and comedone extractions (remember, every pimple starts with a comedone!) can be very helpful in deed. However, strictly avoid high street and spa facials, as they will likely make the breakouts worse (I would rather that patients don’t have facials than the wrong ones).
In general, please note that acne breakouts should not be treated in a beauty salon or cosmetic clinic, but by an experienced doctor, ideally a dermatologist.
Most important take-home message: don’t soldier on yourself – there is effective help!