This skin disease has a prevalence of almost 95 percent in adolescents. Acne is very common, especially in teens, and is a disease of the pilosebaceous unit. This disease typically begins at the start of puberty because of an increase of androgens. Some medications have also been known to cause acne vulgaris or an acneiform (acne-like) eruption. Topical or systemic corticosteroids, testosterone, lithium, low-estrogen oral contraceptives, progesterone-only birth control, vitamins B2, B6 and B12 are just a few of the medications that have been known to cause acne. Acne is a benign condition; however, it can lead to permanent scarring and psychosocial distress. Acne can range from being a mild disturbance to being the center of an adolescent’s life due to the range of its severity.

 

 

There are three stages of acne - mild, moderate, and severe. 

These stages help to decipher the stepwise approach to the treatment of acne and which combination of products might best be used to treat it. 

 

Mild – also termed comedonal – whiteheads and blackheads, no inflammation. 

 

Moderate – greater number of blackheads and whiteheads, papules and pustules, slight inflammation, acne may include face and other areas. 

 

Severe – significant inflammation, severe papules and pustules, cystic nodules, high risk for scarring and post-inflammatory hyperpigmentation. 

Preventable causes of acne include touching, rubbing, and/or over cleansing the face, and applying oil-based cosmetics to the face that are not labeled non-comedogenic. In males, acne is more prevalent on the trunk. External agents may precipitate this type of acne such as a high grease atmosphere when working in restaurants, occlusive sports gear, hats, or playing some instruments. 

Psychological Influences of Acne 

Prompt treatment is key to avoiding the long-term effects that acne can inflict regarding psychological distress 

 

Acne is a benign condition, however it can lead to permanent scarring and psychosocial distress for teens. If acne isn’t treated early, it can leave pitting scars and hyperpigmentation that can be irreversible. Low self-esteem, social avoidance, and lack of motivation to achieve goals are some of the long-term psychological effects. Therapeutic Options for Acne Acne will often resolve after the teenage years. However, to treat acne in teenage years most effectively, consistent care is necessary. This will require seeing a dermatologist for prescription topical and/or systemic medications targeted to skin. The dermatologist will most likely discuss the avoidance of oil-based products and application of only non-comedogenic products and non-abrasive products on the skin. Topical treatment options that a dermatologist may select include antibiotics, benzoyl peroxide, and retinoids. Oral medications that might be recommended include spironolactone, antibiotics, and oral contraceptives. If acne is severe, results in scarring, and continues to be severe despite other treatments, then oral isotretinoin, commonly known as Accutane, might be advised.

 

New Technology - Blue Light Treatment for Acne Blue light treatment is most effective on patients with pink or red pimples (inflammatory acne). Blue light kills acne-causing bacteria, Propionibacterium acnes, that is responsible for inflammation in the skin. The presence of infrared light (heat) causes the pores or oil glands to shrink in size. Smaller pores promote less oil and dirt to accumulate, as well as bacteria, resulting in the resolution of acne. Blue light treatment is a great option for patients who are looking for improvement in inflammation, frequency of breakouts, and skin texture.

 

 

 

Acne scars are formed when cystic breakouts penetrate the skin causing damage to the tissue. For the best results from scar treatment, the type of scar must be known. Atrophic scars (depressed) and hypertrophic scars (raised) are the two major types of acne scars. Atrophic scars are commonly known as ‘boxcar,’ ‘ice pick,’ and ‘rolling’ scars. These scars are formed when insufficient collagen is made beneath the skin surface while the breakout is healing. Hypertrophic scars are formed when there is too much collagen being made while the breakout is healing. Dark spots are temporary and will usually fade over a few months spontaneously. Treatment options for acne scarring are versatile and constantly improving. Alpha hydroxyacids (AHAs) are a great option for rough acne spots and discoloration as they result in increased exfoliation. They are often found in products that treat acne. Skin peels and retinoids are a great option for discoloration as well as for hypertrophic and hypotrophic scars because they improve the texture, appearance, and pigmentation of the skin. Salicylic acid is a common ingredient in acne products and is beneficial for clearing pores, reducing swelling and redness, and exfoliating the skin. Salicylic acid is useful for discoloration, hypertrophic and hypotrophic scarring. Dermabrasion is an effective treatment that is commonly used to treat acne scars that are shallower and closer to the surface. Microneedling is excellent for hypotrophic scars as it stimulates collagen synthesis via producing small punctures in the skin. These options are selected according to the type of scar present. It is important to realize that reversing a scar is impossible, although improving the appearance of a scar or causing it to be less noticeable is achievable with these options.

 

Take Home Points - Prevention and Prompt Treatment The main points to remember about teenage acne are that prevention and prompt treatment are critical. Prevention includes being proactive about the products being used and consulting with a dermatologist if these products are not working effectively. Seeing a dermatologist allows the patient access to professional-grade products for the skincare regimen. Prompt treatment is also beneficial because it prevents the long-term consequences of acne, including scarring, hyperpigmentation, and adverse psychological effects.

 

By Dr. Alpesh Desai