Acne Treatments for Children and Teens

Acne is a very common problem in children, especially adolescents. Since acne isn't usually considered to be a serious medical problem, it is often ignored and undertreated. However, acne is quite a serious problem and is very bothersome and stressful for most teens.

Part of the problem that leads to acne not being treated effectively is that parents often incorrectly assume that they need to see a dermatologist for treatment. In fact, most pediatricians can treat children with mild or moderate acne. As a pediatrician, I use any visit with a teen that has acne as an opportunity to discuss treatment options, but it is best to schedule a specific visit with your pediatrician to discuss your child's acne.

Teenage girl washing her face with water
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What Does and Doesn't Cause Adolescent Acne?

Acne usually starts as your child begins to go through puberty when hormones cause his skin to become oily. This may lead to oil and bacteria clogging the pores of his skin, giving rise to the characteristic whiteheads and blackheads of acne.

Some common myths about acne are that it is caused by eating too much chocolate or oily foods or not washing enough. This is usually not true. Washing your face too much can irritate your skin, clog your pores, and worsen acne.

Acne Home Prevention and Treatment

To prevent acne, it is best to avoid things that seem to trigger your child's acne or make it worse. Encourage him to wash his face twice a day with a mild soap and avoid scrubbing or harsh soaps/cleansers, use cosmetics, moisturizers, etc. that are noncomedogenic (don't cause pimples), and avoid popping pimples.

The basic treatments for acne include using an over-the-counter medication with benzoyl peroxide, which can kill bacteria, unclog pores and heal pimples. There are many different brands and forms of benzoyl peroxide, including creams and gels. In general, you should use the highest strength of benzoyl peroxide that your child's face can tolerate.

If your child's skin is not improving in 4-6 weeks, or he has moderate or severe acne, then you should see your Pediatrician to discuss treatment with prescription medications.

Prescription Medications to Treat Acne

Prescription medications for acne usually include a topical antibiotic, such as Cleocin T (clindamycin) or erythromycin. Benzamycin, a combination of erythromycin and benzoyl peroxide is probably the most commonly used. Remember to keep this medication refrigerated and keep if off clothes, as it can cause bleaching. The new version of this medication, Benzaclin, is more convenient, as it doesn't have to be refrigerated. Duac is a similar medication that also doesn't need to be refrigerated.

Retin A is another medication available by prescription, and it is often used in combination with a topical antibiotic. It is also available in different forms and strengths. To prevent irritation, it is usually best to start treatment with a low-strength form of Retin A, such as the 0.025% or 0.05% cream. If well tolerated, it can then be gradually increased to the 0.1% cream or a gel form.

To further prevent irritation, it is best to apply a very small pea size amount of Retin-A to the affected area about 20-30 minutes after your child washes his face. Applying it to wet skin can increase irritation. A newer version, Retin A Microsphere Gel, is usually better tolerated by teens with sensitive skin. Other new medications which are very effective and cause little irritation include Differin, Azelex, and Tazorac.

Teens who don't improve with the above medications, or who have moderate or severe cystic acne, may also need treatment with a daily oral antibiotic. Tetracycline and Minocycline (Minocin) are the antibiotics most commonly used. They are often taken for 3-6 months and then gradually decreased. Birth control pills can also sometimes be used in girls who do not respond to more traditional treatments.

It is not uncommon for children's skin to become irritated after beginning a new acne medication. To prevent irritation, it is sometimes a good idea to start a new medication gradually. I often recommend that children begin to use a new medication every other day, or even every third day. After a few weeks, this can then be increased and moved to daily use as tolerated.

Remember that it can take 3-6 weeks to see any improvement after beginning treatment for acne. Also, keep in mind that acne usually worsens before it gets better.

Do You Need to See a Dermatologist?

In general no. Most Pediatricians are able to treat children with mild and moderate acne. If your child fails this treatment, has significant side effects and can't tolerate traditional treatments, or if he has severe cystic acne that may lead to scarring, then you may want to see a dermatologist. In addition to the treatments discussed above, a dermatologist can prescribe Accutane, a very effective medication for severe and persistent acne. Accutane has been associated with many serious side effects, though, including birth defects, depression and suicide, so your child will need to be closely followed when using Accutane.

Important Reminders

  • Be patient. It can take 3-6 weeks to see improvement and your child's skin may get worse before it starts getting better.
  • Use your medicines every day. If your skin is getting too irritated, red or dry, then start using them every other day. It takes time for your skin to adapt to your new medicines.
  • Accutane can cause severe birth defects, and should never be taken by someone who may become pregnant. There is also a possible association with depression and suicide in teens using Accutane.
  • Don't overdo it! Scrubbing your skin or using too much of these medicines can irritate and dry out your skin and won't make your pimples go away any quicker.
  • Protect your skin from the sun. These medicines will make your skin more sensitive to the effects of the sun, leading to serious sunburns.
  • Call your physician if you haven't improved in 4-6 weeks with your current regimen

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.