For many teenagers, acne has become an all-too-familiar rite of passage. Many teens and their parents brace themselves for this common skin condition, but a growing number of pre-adolescents also are experiencing acne. The reason? Dermatologists believe an earlier onset of puberty may be to blame, causing hormones to trigger the start of acne sooner.
Now, a leading group of dermatologists developed new recommendations for treating acne in children of all age groups, which recently have been endorsed by the American Academy of Pediatrics.
Andrea L. Zaenglein, MD, FAAD, a board-certified pediatric dermatologist and professor of dermatology and pediatrics at Penn State/Hershey Medical Center in Hershey, Pa., recently presented the recommendations at the American Academy of Dermatology’s Summer Academy Meeting.
Acne occurring in pre-adolescents (defined as 7- to 12-year-olds) is not typically severe and usually includes comedones (whiteheads and blackheads) on the “T-zone” area of the forehead, nose and chin. Dr. Zaenglein noted that larger, inflammatory lesions are uncommon in this age group.
When determining the most appropriate acne treatments for preadolescents, dermatologists consider the child’s age and type of acne. For mild acne, dermatologists recommend an over-the-counter benzoyl peroxide product. If the acne does not respond to this treatment, dermatologists may offer topical therapy consisting of a combination of benzoyl peroxide, an antibiotic and/or a retinoid.
- Pre-adolescents with larger areas of comedonal acne with or without inflammatory lesions, which may include pimples or nodules, may require combination topical therapy and the addition of an age-appropriate oral antibiotic. Dr. Zaenglein notes that more frequent monitoring by the dermatologist is needed in these cases to determine improvement or progression of acne.
- Although rare in younger age groups, inflammatory acne with pimples and nodules has the potential for scarring. Dermatologists may order a blood work-up to rule out a hormonal imbalance. Combination topical therapy along with an oral antibiotic will be prescribed initially. If acne does not respond to initial treatment, isotretinoin can be used safely in this age group with close and continual monitoring by a dermatologist for any adverse side effects.
Therapy can control acne for several years, but Dr. Zaenglein advised that the condition needs to be monitored by a dermatologist throughout puberty for signs that acne may be worsening, as early onset of comedonal acne can be a predictor of more severe acne in teens or adults.
We asked Kesha Buster, MD, FAAD, a dermatologist with Via Christi Clinic to give us some tips on treating acne in teens:
Avoid using comedogenic (pore-clogging) products on the face. Look for “non-comedogenic” on the label of cleansers, moisturizers, and sunscreens to ensure the are not contributing to acne.
Try to keep hair products off of the face as they can often contribute to acne.
I often recommend that patients keep their acne medication(s) next to their toothbrush to help them remember to use them.
With benzoyl peroxide products, start low (2-5 percent strength). The stronger the product, the greater the risk of irritation (dryness, itch, burning, etc.). Benzoyl peroxide washes, such as Panoxyl four percent creamy wash, are a great start as they can be used in the shower or at the sink. Care must be taken to completely rinse skin after using any benzoyl peroxide wash as it can bleach towels/fabrics. Similarly, hands should be washed after applying a benzoyl peroxide cream to avoid bleaching of clothing/bedding. Lastly, when applying benzoyl peroxide creams at night, use old pillowcases to avoid ruining nice ones.
With kids, prioritization is key. If they are only going to wash their face once daily (which is often fine), then it’s best to do so in the evening so the daily grime can be washed away.