By Dr. Sheila Fallon Friedlander
Most of us cringe when we hear that term hurled at some poor suffering teenager. As if adolescence weren’t challenging enough, nature has chosen that time of life to raise the hormonal thermostat and push pores and oil glands into overdrive, often with unfortunate results.
Acne remains a major concern for teens and they are often frantic to find a quick and permanent remedy. Medical facts and folklore provide a confusing array of information and fact is often hard to separate from fiction. Fortunately, research advances in this field have provided “myth-busting” information to deal with misconceptions such as those listed below.
Myth #1: “Dirt” is the root of the problem in acne and blackheads prove this point. Blackheads do not represent dirt in pores; they instead consist of oil and skin cells plugging pores. Oxygen turns these substances black. Acne has very little to do with dirt and much more to do with hormonal changes.
Scrubbing the skin too vigorously will irritate the skin and make it difficult to tolerate effective acne treatments. Abrasives, extractors and exfoliators may do more harm than good. The goal of cleansing is to remove excess oil and debris from the skin. Some acne washes also contain medications such as salicylic acid and benzoyl peroxide, which may help control acne better than excessive scrubbing.
Myth #2: Acne is a teenage disease which disappears after high school. Acne can occur at any age, but is most common in adolescence. Babies may have a touch of pimples in the first month of life, and less commonly, infants can develop acne any time in the first year of life. These two forms of acne are generally just a variation on the normal process but occasionally the development of acne in childhood is associated with a true hormonal abnormality related to a glandular disturbance, or, rarely, a tumor. For that reason, any child who develops acne before 7 years of age should be evaluated for that possibility.
Adolescent girls with significant acne and problems with excess hair or irregular periods may have an underlying hormonal irregularity; there are tests to rule this out.
The average age of acne onset was previously thought to be around 12 or 13 years old. We now see perfectly normal children presenting with whiteheads and a few red bumps on the forehead and chin who are as young as 7 or 8. Nonetheless, these younger children should be evaluated for any other evidence of hormonal irregularity.
Myth #3: The more expensive the medication, the more likely it is to work. Acne comes in different forms and severities. What works for one type of acne may not work for another, but the difference is in the way the medication works, not in the price tag. Benzoyl peroxide is a useful medication for all mild forms of acne, and over-the-counter forms can be obtained very inexpensively in either wash, cream or gel forms. Unfortunately this product may not be well tolerated by dry, delicate skin, and can bleach clothing. Other topical and oral agents may sometimes be required to treat more significant acne, but generic products are often available which decrease cost dramatically.
Myth #4: Acne is a nuisance, not a real problem. Acne usually affects individuals at a very vulnerable time in their emotional development. It is hard for a teenager to feel good about himself if his peers are referring to him as “pizza face.” Long-lasting feelings of poor self-image may follow him into work interviews as well as social interactions. In addition, untreated acne may lead to permanent scarring. Therefore, appropriate therapy is crucial to provide an optimal outcome in both the short and long-term.
Dr. Sheila Fallon Friedlander is a pediatric dermatologist at Rady Children’s Hospital-San Diego and professor of clinical pediatrics and medicine at UC San Diego.