How to Cope With Severe Acne

What to do when your teen has “bad skin.”

As if the teen years weren’t tough enough with social and school pressures, kids are also suffering through their most awkward physical transformations—and one of the most upsetting changes for teenagers is right there on their faces for the whole world to see.
Acne is the age-old cosmetic plague of middle school and high school—about 85 percent of all people will deal with it in some way during their lives—outbreaks can range from moderate to severe, with angry clusters of red bumps covering once soft, smooth skin. What's worse, when breakouts are bad, permanent scarring can be a real danger.

Acne flares up disproportionately during adolescence—typically beginning around ages 10 to 13 and lasting five to 10 years after that—because the body’s dramatic hormonal changes during teen years causes an increase in oil secretions (called sebum) and enlarged facial oil glands. When that oil combines with dead skin cells and bacteria to clog pores—you get pimples.

Possible Causes of Acne

Why do some teenagers escape their teen years practically unscathed, while others get hit with bumps of all kinds? Just like any other skin disease, there are many factors that play a role in determining who gets acne and who doesn't, says Dr. Elma Baron, a dermatologist at University Hospitals Case Medical Center in Cleveland.
“Genetics is definitely one factor; sometimes it runs in families,” explains Baron. While some teens are naturally more affected by their hormones being out of whack than others.     
It could also be how teens deal with stress says Dr. Camila Janniger, a member of the American Academy of Dermatology and clinical professor of dermatology and chief of pediatric dermatology at Rutgers New Jersey Medical School. “When you have more stress, you stimulate the adrenals, and they produce more stress hormones.”
Diet could also play a role: Although no definitive link has been made yet between diet and acne, a 2013 American Academy of Dermatology study may have discovered preliminary evidence of a connection. Researchers found eating high-glycemic index foods (like white bread and white potatoes) may worsen acne as a result of its affect on growth and sex hormones. Possible associations were also found between acne and dairy products (specifically skim milk), which often contains hormones.
Baron tells parents and teens there isn't any indisputable scientific evidence that diet aggravates acne, but if you're regularly eating something that makes your skin worse, avoid it. And that goes for drinking more water, too. “It’s a common belief that more water helps acne, but there is no published scientific evidence,” says Baron. “It’s never a bad idea to increase water intake for good hydration, though.”

How to Manage Breakouts

Ultimately, there isn’t much teens can do to prevent the eruption of acne in the first place. “There are ways to minimize the disease, there are ways to control the disease, there are ways to prevent flare-ups,” says Baron. “But there is no way to prevent the onset of acne.”
“The goal is control—to minimize the impact of the breakouts,” says Baron. “Eventually, acne will improve over time, but you want to prevent long-term effects, like scarring.” Medications can make breakouts less severe and help clear them up significantly, though it is rare to get 100 percent clearance, according to Baron. And the acne drugs require patience and commitment—the drugs and creams usually don’t work right away and have to be taken for months at a time to see results.
“A lot of people give up,” Baron says. “That’s usually the main cause of unsuccessful treatment of acne: a lack of compliance by the patient.” For teens, it can be a particularly long process, because hormonal shifts go on for years. Parents can help their kids to keep at it, “but at the same time, I don’t want the parents to be overly anxious about the acne. Often, I find that the mom is more worried about it than the child. If your own parent is saying you have something horrible on your face, that doesn’t help at all.”
Its also important to reassure your teen that acne won’t be around forever. “I would be very encouraging and emphasize that the zits are most likely a stage and not permanent,” suggests Baron. “Be a cheerleader for them.”
In addition to a course of treatment prescribed by their doctor, it’s crucial that teens follow a proper skin care routine to minimize flare ups, which includes washing the face with a mild soap or cleanser twice a day and moisturizing. “Look for products that have no fragrance, are non-comedogenic and are labeled as mild or gentle,” says Baron.
Talk to a dermatologist to figure out the best course of action for your kid—the sooner he starts, the sooner his acne disappears.

Level 1: Comedonal Acne

What it is: Comedonal is the mildest, most basic type of acne. It’s non-inflammatory (so there’s no redness) and shows up as whiteheads (pores clogged beneath the surface that cause little white bumps on the skin) or blackheads (open pores on the skin clogged with keratin that have turned black because of exposure to the air).
Treatment: For the mildest acne, Baron suggests keratolytic medications, which get rid of the keratin plugs that cause whiteheads and blackheads. These include everything from over-the-counter salicylic washes and benzoyl peroxide creams to prescription-strength Retin-A.

Level 2: Inflammatory Acne

What it is: This moderate, inflammatory acne is characterized by bumps that are visible at a distance. It presents as pustules (red bumps filled with white pus) or papules (inflamed red bumps without pus).

Treatment: For moderate acne, anti-inflammatories are best—anything from anti-inflammatory antibiotics, like tetracycline, to other oral medications. The topical form of the drug Dapsone (an antibiotic that limits bacteria growth) can also help.

Level 3: Nodular Cystic Acne

What it is: Nodular cystic acne is the most severe type of acne, and appears as large, red, inflamed bumps (sometimes in clusters) covering the face, neck and back. “This type of acne is the most prone to scarring,” Baron explains.

Treatment: Severe acne needs to be treated with more heavy-duty prescription drugs, like Accutane (an oral medication), along with topicals like Dapsone. Birth control pills like Ortho Tri Cyclen might also be prescribed to girls to help regulate hormones.

Hiding the Evidence

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