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The Skin They’re In

When Clearasil Doesn’t Cut It

Oh, the indignities teenagers have to suffer. Think mood swings and the obsessive need to shower for an hour at a time. But it’s all just part of the gig right? So is acne.

When the dreaded teenage scourge visited my now 14-year-old daughter last year I responded with the usual platitudes. You’ll grow out of it. Everybody gets it. It’s not that bad. But over the next few months, as I noticed it spreading across her face and shoulders, I became uncertain. I wondered, should I take her to the dermatologist?

It wasn’t until I discovered my daughter standing in front of her mirror crying one morning that I had my answer. The over-the-counter products I had been buying weren’t working and she confided in me that she was embarrassed to wear her summer tank tops and swim suits. Yep, it was time to get some help.

“Sometimes parents think acne is a minor issue and they’ll blow it off,” says Georgia K. Seely, M.D., of Dermatology Associates of Virginia, P.C. in Richmond, “or they think they have to live with it, that’s it’s just part of growing up.”

The American Academy of Dermatology estimates that by their mid-teens as many as 40 percent of adolescents have acne or acne scarring that should be treated by a dermatologist. The most common skin disorder in the U. S., acne affects as many as 85 percent of all people at some point in their lives. But just because it’s common doesn’t mean it’s easy to deal with, and it causes many teens like my daughter to suffer from lowered self-esteem and even depression. The good news? Most acne can be controlled. Teens don’t have to suffer.

When it’s time to see a dermatologist

If acne is mild or intermittent, Seely says over-the-counter products and gentle washing twice a day with mild soap will usually do the trick. Most products contain the same basic ingredients; a combination of benzoyl peroxide, which fights bacteria and unplugs pores, and salicylic acid, which unplugs pores by removing dead skin cells. Often, finding the right one is just a matter of trial and error. Kristen Wood, a Richmond mom of two, ages 15 and 13, says she had to try a number of different over-the-counter medications before she found one that Kept her teens’ break-outs at bay.

But what Leslie Dolliver of Glen Allen discovered when she tried over-thecounter medications for her teens was that the products that controlled her daughter’s blemishes didn’t have any effect on her older son’s more stubborn acne. “Every case is individual,” explains Shelley Hoover, M.D., of Affiliated Dermatologists of Virginia in Richmond, “so it’s not unusual for kids in a family to respond to medications differently.”

If over-the-counter products don’t work and the acne won’t go away, becomes red and inflamed, or if you have a family history of acne scarring and the acne is affecting your teen’s self image, it’s time to see a dermatologist.

Acne myths

Contrary to long-held popular beliefs, acne is not caused by poor hygiene, nor can it always be prevented with good hygiene. Becky Donelson of Richmond Says no matter how well her 14-year-old son washes his skin “the acne just doesn’t go away.” This is because the problem lies beneath the skin; excessive washing or hard scrubbing can actually make acne worse. Acne is not caused by diet either. Greasy foods like French fries and pizza won’t create or exacerbate acne. So what really causes it?

Sebum is to blame. A naturally occurring oil, sebum production increases during puberty as hormones surge. Increased amounts of sebum then crowd and block pores. This becomes a breeding ground for P. acnes, a bacteria that normally lives on our skin but that thrives and multiplies in the excess oil, inflaming the pores and causing acne. The type of acne that results – blackhead, whitehead, or cyst – depends on what happens inside the clogged pore. Blackheads occur when sebum and dead skin cells clog the pore, but the surface remains open revealing that familiar black color. The same thing happens in a whitehead except that the opening to the pore is closed. Cysts form when inflammation reaches down deep into the pores. This is the most painful and severe type of acne and can result in permanent scarring if left untreated.

What to expect at the dermatologist

“Teenagers often expect perfection tomorrow,” explains Hoover, who says that treatment for acne usually takes a minimum of two months to reach full effectiveness. There are no quick fixes.

Hoover says she may prescribe a combination of treatments including topical antimicrobial creams which reduce P. acnes and inflammation, topical retinoids (a derivative of Vitamin A) which unclog pores, and oral antibiotics which also reduce P. acnes and the inflammation that comes with it. Girls may also be prescribed oral contraceptives which inhibit overactive sebaceous glands and thus reduce the amount of sebum in the skin.

Keeping treatment on track

The biggest mistake teens make in their treatment is not complying with instructions and lapsing in using their medications says Seely. “They think it’s supposed to work in two weeks so they get frustrated and give up or they get busy and they forget,” she explains.

To combat typical teenage forgetfulness, Dolliver posted the dermatologist’s directions on her son’s bathroom mirror and labeled her son’s medications with a marker to help him remember to use the products in the right order. A hockey player who often travels for matches, he has a separate travel-pack of skin care products to use on the road.

What else can parents do to help teens stay on track with their skin care?

Keep their medications and products in plain sight near their toothbrush and encourage them to perform their skin care regimen at night since summer mornings can be unpredictable. Be sure they use sunblock regularly during beach and pool season because some acne medications can cause increased sensitivity to sunlight. Buy your teen a daily moisturizer with sunblock for added protection.

Dolliver adds, “I have also made a conscious effort to give my son positive reinforcement when I see him doing a good job taking care of his skin.”

Wood has found her 15-year-old daughter’s biggest incentive to keep up with her skin care regimen has been her clear skin. “She realized that if she doesn’t use the products, she’ll have more acne.” And what could be more motivating than that?

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Erin Parkhurst is a freelance writer and editor and mother of three. She lives and works in Richmond.

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