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The Informed Parent

The Basics Of Acne

by Shanna R. Cox, M.D., F.A.A.P.
Published on Apr. 20, 2009

Teenage acne…it’s something almost all of us have been through and understand. Parents are anxious for their kids to have a better outcome than they may have had, and not suffer from longtime effects or scars. The good news is that acne is well discussed and there are many good treatment options readily available.

Let’s review a few key points to remember about acne. There are many things thought to be associated with acne, but many of these beliefs are myths. Most dermatologists agree that acne is a result of the following factors:

  • Aberrant keratinization of the hair follicle that leads to comedon formation
  • Hormonal stimulation of the sebaceous gland
  • Growth of the bacteria P.acne in response to increased sebaceous lipid
  • Inflammatory and immune response to P.acne infection

Notice that the above list did not include candy, pizza or inadequate scrubbing. Although these things are frequently blamed for teenage acne, evidence suggests they play little to no role in its pathogenesis.

There are many good medications that may be used to combat this inflammatory disease. The physician must decide the level of acne present and evaluate any previous treatments given. Many teens require two medications to help combat their acne. This brings up one of the biggest difficulties in getting rid of it in teens: lack of compliance. Many teens have trouble committing to a daily regimen either because of limited time or a belief that the treatment is only for “bad breakout.” On the contrary, the mainstay of acne therapy has to do with daily and diligent use of the prescribed medications.

It is important for the physician to know if a teen doesn’t like or isn’t using a prescribed medication. This will help the physician to determine the best regimen for the teen, and to avoid unnecessarily increasing the strength of treatment if a previous treatment failed from improper use rather than inadequate efficacy.

Acne is typically graded based on the distribution of lesions, the severity of the disease, and the effects psychosocially that it may have on the patient. Acne medications are generally either topical or oral. There are many different classes within each category. Topical medications range from retinoids and salicylic acid based treatments to antibiotic creams, gels or foams. Topical therapies may be used with oral therapies or in isolation for mild to moderate inflammatory or comedonal acne. More severe acne may require oral antibiotics, or an antihormonal or retinoid oral medication. Because these medications are taken by mouth, they have systemic effects that must be discussed with the teens prior to their initiation in order that side effects may be minimized.

Lately, some patients have been asking about laser and light therapy in addition to dermabrasion. Although these therapies are practiced in spas and in some dermatology offices, their efficacy has not been borne out in literature to date.

Parents should make sure their teens understand that acne is both normal and treatable, and something that can and should be discussed with their doctor. With a little discussion, and cooperation, a few simple medications could make a teen’s life a little brighter!

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