Tiffany Link, MD, PhD, reviews with us her strategies for addressing the specific needs and constraints of teenage patients with acne.
In any discipline, treating the teenage population can present unique challenges. In dermatology, acne is a common disorder that brings adolescent patients into the clinic. Although acne occurs in patients of all ages and not just during the teenage years, addressing the disorder in a younger person encompasses an understanding of the hormonal factors at play as well as the motivation and ability of the patient to be treatment compliant.
Tiffany Link, MD, PhD, a dermatologist in practice in Colorado, reviews her strategies for addressing the specific needs and constraints of teenage patients with acne.
How does addressing acne in teenagers differ from acne in different populations? Are the concerns the same?
Teenagers tend to have a stronger hormonal component to their acne that affects their whole face and sometimes multiple areas of their body (most commonly face, chest, and back), whereas hormonal acne in adult patients tends to be deeper and mostly limited to the lower face/jawline area.
With all patients, the first thing to decide is: does this patient have primarily comedonal acne (whiteheads and blackheads), inflammatory acne (red pustules, deep cysts), or an even mix of both? The treatments for the various types of acne differ slightly.
In adolescents, are there issues of compliance that are unique? What are they, and how do you manage them?
Compliance is an issue with all patients, but particularly in teenagers, and even more so in teenage boys. Teenagers are very busy people and have a lot on their plates. School, sports, after school activities, jobs, homework, friends, family — it can be overwhelming for them. It’s not reasonable to ask a teenager to wash their face multiple times a day and layer 3 to 4 different topicals at different times. I find that compliance is nearly always directly related to how bothered by their acne the patient is. If it really bothers them, they will follow nearly any regimen, although I always try to simplify my treatment regimens in order to increase compliance. For instance, there are combination medications (2 medications mixed into 1) that you can apply once a day, instead of 2 to 3 creams twice a day. The important thing is to meet the patient where they are at.
What role do over-the-counter (OTC) treatments play with teenagers?
There are some great OTC medications that patients can start with before seeing a dermatologist. Washing the face daily (twice daily if they play sports and get very sweaty) is a good start.
For comedonal acne (blackheads/whiteheads), salicylic acid washes can be very helpful. It helps to unroof these clogged pores. It also helps to stop bacteria from growing, although it doesn’t kill the bacteria. [Adapalene] gel or cream can be found for about $13 and is a mild retin-A. This increases the turnover rate of the skin causing the black and white heads to be kicked out of the skin quicker. Only a pea sized amount of the cream should cover your whole face, so use sparingly. Also be sure to only use at night, as this medication is inactivated by sunlight. This can make you quite dry, so a good tip is to use a gentle moisturizer on your face at night before applying the cream. It also makes you a bit more sun sensitive so make sure to use your sunscreen. A zinc-based SPF of 30 is good, fragrance free, and doesn’t tend to make acne.
For inflammatory acne (red pustules and cysts), benzoyl peroxide washes (between 3% to 5% for face, and 10% for chest/back) are the best. These increase turn-over of skin but actually kills the bacteria that causes the inflammatory acne.
Alone, these washes may not be able to completely cure your acne, but it can certainly give you a head start.
At what point do you transition a teenage patient from OTC to prescription medication?
Any acne medication, whether it is OTC or prescription, takes a minimum of 8 weeks of continuous use before you can start to see its effects, so the keys are patience and consistency. If, after 8 weeks, you are not headed towards your goal of clear skin, it’s time to make your appointment with your dermatologist. However, if the teenager is starting to show early signs of scarring (dips in the skin or prolonged red spots which don’t go away), you can start with the OTC treatments, but I would seek immediate help via a dermatologist to avoid any permanent scarring.
Have you been seeing any herbal or homemade treatments becoming popular?
Herbal/homemade treatments have always been something patients seek out and have been popular. However, I have not seen consistent results with any herbal treatments. The OTC products outlined above and the prescription medications definitely provide the most consistent relief of acne.
Are there any newer treatments that you recommend, such as lasers?
Red light and blue light treatments have been used, mostly in mild inflammatory acne, with some level of success. Intense pulsed light (IPL) can certainly help with postinflammatory inflammation but none of these truly help with the root cause of the acne.