Acne is very common amongst teenagers around the world. However, this is of little comfort to a self-conscious teenager who is afflicted with spots and pimples for years during this difficult time.

Acne is a skin condition with six different types of sebum related spot:

• Blackheads – small black swollen pores, this is not dirt but pigmentation from the hair follicle showing through.
• Whiteheads – also congested pores but they don’t pop when squeezed.
• Papules – usually called pimples or spots, they are red and tender.
• Pustules – papules with a white pus head on them.
• Nodules – hard, red, painful lump under the skin.
• Cyst – large boil like pimples that can scar.

Acne is caused by increases in sex hormone levels during puberty.

Certain hormones, such as testosterone, cause the oil-producing glands that coat hair follicles to over-produce this sebum.

A bacterium called P acnes thrives in these high sebum conditions leading to inflammation and pus as the immune system attempts to defend itself from the bacteria.

In addition, the sex hormones also cause a thickening of the hair follicle structure which leads to the blockage of the skin’s pores. Sadly cleaning doesn’t remove these blockages and can sometimes lead to more sebum production and more skin inflammation.

Acne does run in families, so if you and your partner suffered from acne in puberty, it is likely that your teenager will also have acne.

During the menstrual cycle, there is an additional fluctuation in the production of sex hormones such as oestrogen, progesterone, and testosterone. These cyclical hormonal changes can lead to monthly breakouts of acne in teenage girls who are already menstruating.

There’s no evidence that diet, poor personal hygiene or being sexually active cause acne. People have long associated chocolate consumption with blemishes and breakouts, but it could simply be that some girls eat more chocolate around their period and they also get more spots and pimples around their periods, and so this false causal link is perpetuated.

Encourage your teenager to avoid these common mistakes that teenagers make trying to get rid of their spots:

• Avoid frequent washing as this can stimulate sebum production.
• Avoid very hot of very cold water.
• Do not squeeze blackheads, spots or pimples as this can lead to a worse infection, inflammation, and even permanent scarring.
• Avoid comedogenic makeup which can block pores to cover up.

Try to:

• Use lukewarm water and a mild facial cleanser.
• Choose water-based non-comedogenic makeup if you want to use a concealer.
• Use a sensitive skin, fragrance-free, water-based emollient moisturiser if you have patches of dry skin.
• Wash hair regularly and try and keep hair out of your face.

Although acne can’t be cured, it can be controlled with treatment. Several creams, lotions, and gels for treating spots are available at pharmacies.

If your teenager suffers with acne, it’s a good idea to speak to your pharmacist for advice. Products containing a low concentration of benzoyl peroxide may be recommended – but be careful, as this can bleach clothing.

There are over the counter products containing low levels of benzoyl peroxide that can help to manage (but not cure) acne.

However, go to your doctor if your teenager’s acne is:

• Severe.
• Covering the back and neck.
• Causing your child distress.

Severe acne can be treated with a range of antibiotics and prescription creams and topical treatments. Acne treatments can take several months to show an improvement in the skin condition so try to be patient and follow your doctor’s treatment instructions.

Speak to your teenager’s doctor about the following acne treatments as well as their side-effects.

Gels, creams, and lotions for the skin, including:

• Benzoyl peroxide (anti-bacterial).
• Topical retinoids (exfoliates dead skin cells not suitable for pregnancy).
• Topical antibiotics (antibacterial).
• Azelaic acid (alternative to benzoyl peroxide and topical retinol).

Tablets, including;

• Antibiotic tablets – usually used in combination with a topical cream – to treat more severe acne.
• Hormonal therapies for acne associated with menstrual flare ups.
• Oral contraceptive can improve acne in girls experiencing menstrual flare-ups or suffering from polycystic ovary syndrome.
• Co-cyprindiol – reduces the production of sebum but slightly increased risk of breast cancer and other side effects.
• Isotretinoin – controls sebum production and skin bacteria – has many side effects and isn’t recommended for females of childbearing age – so only considered in severe cases of acne and can only be prescribed by a dermatologist.

Tan & Bhate (2015) ‘A global perspective on the epidemiology of acne.’ British Journal of Dermatology Special Issue: The Changing Faces of Acne: Expert Insights. Volume 172, Issue Supplement S1, pages 3–12, July 2015