Acne is my favourite subject and one of the most satisfying conditions to treat as a Dermatologist. Because of my specialist interest in this subject, I am often asked for my thoughts on why the condition occurs and how it can be managed. Here is an extract from an interview I did with The Sunday Times Style team earlier this year.
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What is the difference between teenage acne and adult acne?
The underlying process is the same in teenage and adult acne, but the pattern of involvement may be different. The proportion of people affected is also different.
The sebaceous glands in the skin produce excess oil, known as sebum. At the same time, the lining of our pores becomes thickened and dead skin cells aren’t shed effectively. The oil and dead skin cells mix together and plug the pores leading to a blockage and this provides the ideal environment for a bacteria called cutibacterium acnes to grow and inflammatory pustules and papules ensue. Our sebaceous glands are influenced by our hormones, which is why acne often flares during puberty or around the time of menstruation in women.
Adult acne (acne in over 25’s) often affects the sides of the cheeks, jawline, chin, neck and upper torso. Teenage acne may be more prominent across the forehead, nose and chin, in the so-called T-zone distribution. Often there is some degree of overlap between these patterns.
More than 80% of teens are affected by acne at some stage. Most cases resolve by the early twenties. Many people are surprised to find out that 10-20% of women over 25 are affected by acne. In some circumstances, the breakouts have persisted since the teenage years, but late onset acne can also occur.
Should you treat acne differently depending on your age? For example, is 13 too young to use a retinoid?
Broadly speaking, prescription treatment is similar for acne in teenagers and adults.
Topical agents, such as retinoids, oral antibiotics and isotretinoin are licensed for use in children aged 12 and over. These treatments may occasionally be given to even younger children, but this would usually be under the close supervision of a Consultant Dermatologist.
The combined contraceptive pill can be helpful in females with acne. It also helps to prevent pregnancy, although it may not be taken primarily for this reason in younger individuals. Because of its effects on ovulation, the pill may be less suitable in young teenage girls where ovulation is not well established.
What are the most common reasons teenagers get acne?
The change in hormone levels during puberty contributes to breakouts during this stage of life as oil production is stepped up under the influence of hormones, such as testosterone. Other factors that predispose to acne include genes, for example a parent or sibling who has also had acne, diet, stress, certain medications, comedogenic (pore-blocking) skincare products or makeup. It is likely that more than one of these factors are acting in combination.
Is there a difference between spots and acne?
Acne is a catch all term that encompasses blackheads, whiteheads, papules (red spots), pustules (pus-filled spots), nodules (large, deep bumps) and cysts (boil-like swellings).
What ingredients are best for dealing with teenage acne?
However your acne affects you, taking action to control it as soon as it appears can help to reduce effects on self-esteem and scarring, which can be permanent in some cases. If the acne is mild, it is worth trying over-the-counter preparations in the first instance. Ingredients like salicylic acid, azelaic acid, niacinamide or benzoyl peroxide can be helpful for teenagers.
Young children may be at higher risk of unwanted effects because of increased absorption of salicylic acid through the skin so it should not be applied to large areas of the body, to irritated skin, used for long periods of time or used under occlusive dressings (air-tight coverings, such as kitchen plastic wrap). It should also be avoided in anyone know to be allergic to salicylic acid or related medications.
I’ve been told parents are panicking and using products that are way too harsh. What are your thoughts on this?
I’ve not seen evidence of this in my practice. In fact, I see many teens with acne who have been under-treated (with a resulting impact on self-esteem and a higher chance of permanent physical scarring), rather than the other way round. I do, however, have many new adult patients who have been looking online for acne solutions and ended up with very irritated skin from trying to combine too many different ingredients!
Traditionally, all teenager acne brands were very drying and stripping. What are your thoughts on this? Why and how can we re-educate on this?
1. Excess sebum production leading to oily skin and blemishes is a common teenage concern. Many products targeted at teens with acne aim to reduce greasiness. Foaming agents/ surfactants used in these cleansers are extremely effective at binding to oils and washing them away, however as the water evaporates from the skin after rinsing, the skin can feel very tight and uncomfortable.
2. People who have acne and oily skin often prefer lighter weight creams. Alcohol is often added to these products to increase fluidity and reduce heaviness. It can also be drying.
3. Finally, many ingredients that help to reduce blemishes, for example benzoyl peroxide and vitamin A, can be irritating to the skin.
There is, therefore, a risk that if you use a cleanser, moisturiser and blemish remedy all designed for oily or blemish prone skin, that you will take a triple hit from all three of these factors and your skin may become dry, red and flaky as a result. This can usually be mitigated by using a mild non-foaming cream or gel cleanser, a simple non-comedogenic moisturiser and starting with 1 active ingredient for treating acne initially rather than going in for all the available options from the get-go.
The biggest mistakes teenagers can make and any extra helpful tips!
1. Not seeking professional help early enough. If your spots are getting you down, speak to your parents about how it is affecting you and see your GP for advice if over the counter solutions don’t seem to be helping.
2. Develop a skincare routine and stick to it every day. It is never too late to start, but it helps to get in the habit from your teenage years onwards.
3. Consistency is key. Stick to the items in your skincare routine and give them a chance to work. Unless you have a bad reaction to a particular product, I would usually suggest using it regularly for 2 – 3 months before switching if you haven’t noticed an improvement at that point. Don’t fall into the trap of using too many products or chopping and changing every couple of weeks. Similarly, don’t stop using the products when the spots are controlled as you could end up back at square one.
4. Whatever you do, don’t scratch, pick or squeeze. This can introduce bacteria, increased inflammation and may ultimately lead to scarring. Always clean your hands before applying your skincare products and avoid touching your face at other times.
5. Keep sugary, refined or processed foods to a minimum. This doesn’t mean that you can’t have an occasional chocolate or treat, however. Beyond this, there isn’t a great deal of evidence that cutting particular food groups out of your diet reduces spots. There have, however, been a few small studies suggesting that dairy, especially skimmed milk, may play a role in certain individuals. Always consult with a doctor before cutting anything out of your diet to ensure you are still getting all the nutrients you need.
6. Look after your general health and wellbeing. Lack of sleep and stress can lower your threshold for breaking out. Try to go to sleep at the same time most nights, don’t scrimp on sleep and find ways to let off steam. This may be through doing a hobby, taking a yoga class or relaxing with friends.
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