Treatment Of Acne Is Important For Teenagers
Question: Our teenage daughter is very concerned about her pimples. This has been going on for well over a year. She has taken several different antibiotics as well as a gel prescribed by our doctor, and nothing seemed to help very much. The gel actually made her skin irritated. Her self-esteem is rock bottom, and she said that she wanted to die. Can you give us any suggestion?
Answer:
Pimple, also called acne, is one of the most common problems affecting young people. In a recent study from New Zealand, almost 90% of teenage boys and 80% of girls have pimples. Serious acne was found in 7% of these boys and 1% of girls.
In order to understand the treatment of acne, one has to know about the structure of normal skin and how one gets acne. Each hair on our skin grows in a hair follicle, which is a tube-like structure in the skin. Some hairs are long and dark, like on the scalp, while others are very short and hard to see.
Connected to each hair follicle is a sebaceous gland that produces a mixture of oily material called sebum. This oily sebum acts as a natural lubricant to protect the skin from becoming too dry.
On our face, earlobes, neck, shoulders, and the V-shaped areas of the upper chest and back, the hair follicles have much larger sebaceous glands than in other parts of the body. These follicles are called sebaceous follicles. Their sebaceous glands produce much more sebum, especially under the influence of testosterone during teenage years.
Teenage boys have more testosterone than teenage girls, that is why severe acne is more common in boys. However, girls also produce small amount of testosterone from the adrenal glands (two small glands sitting above the kidneys) and the ovaries. Girls who have severe pimples, especially those with hair growth like boys, should be checked to make sure that there is no hormonal imbalance.
Research has also shown that bacteria are involved in the development of pimples. A group of bacteria called Propionibacterium acnes have been cultured from pimples of many teenagers. This may partly explain why antibiotics can help those with severe pimples.
Most people can identify “blackheads” as pimples. Blackhead, also called “open comedone,” is a mixture of sebum and skin cells coming through the opening of hair follicle. The black colour is caused by the skin pigment melanin. If one gently squeezes the skin around blackheads, one can see the wormy greasy material coming out. These blackheads usually improve without treatment.
If the openings of hair follicles are blocked, sebum and skin cell mixtures cannot escape. These will appear as very small whitish elevations under the skin, and they are called “closed comedones.” They are very small, no more than 1 to 2 mm in diameter, and are difficult to see.
Very often, bacteria will grow in closed comedones, and then rupture the wall of the hair follicles. This will cause inflammation of surrounding tissue, and result in red pimples. They are irritating and painful, but worst of all, they look horrible on the face and chest of teenagers.
Occasionally, closed comedones can progress into larger lumps (nodules and cysts) deep under the skin. These are the ones that can cause permanent scars. Aggressive treatment of this type of acne is most important because of the danger of scarring.
Treatment of acne is a complicated issue. The acne may not appear to be too severe to the physician, but in the sensitive minds of teenagers, even minor acne can cause serious anxiety and affect their self image.
The overall strategy of treatment is to remove and prevent comedones. It is important to point out that there is no quick fix for acne. If blackheads are the only problem, gentle expression of the greasy sebum will remove the blackheads. Some over-the-counter strips can do the same.
Many teenagers also use a topical medicine called benzoyl peroxide, marketed under many brand names by different companies. This medicine can reduce the growth of Propionibacterium acnes. It can be used alone in mild to moderate acne, but can also be used in combination with other topical medications.
Closed comedones are harder to remove since they are located under the skin. They are more dangerous because they can progress into red pimples and deep nodules. A topical medicine called tretinoin, also known as Vitamin A Acid, can help to open these closed comedones.
Tretinoin comes in solution, gel, and cream. Solutions cause the most side effect, while creams are the mildest. There are three different strengths: 0.01, 0.025, and 0.05%. Common side effects are irritation and peeling of the skin, and they tend to increase with the strength of medicine. It is often necessary to begin with the lowest strength to allow the skin to get used to the medicine. If this is not effective enough, then gradually increase the strength.
In more serious conditions, oral antibiotics like tetracycline or erythromycin can be used. The only caution is that tetracycline should not be given to children under 8 or 9 years of age, because of possible damage to their permanent teeth.
For those teenagers with more severe acne, especially when nodules and cysts are present, isotretinoin (Accutane) may be the medicine of choice. There is, however, one major side effect: if taken by pregnant women, isotretinoin can damage the fetus and cause miscarriage. It is important to discuss with your doctor about the pros and cons of isotretinoin before starting.
Before I finish, I should clarify some of the myths of acne. It is not caused by poor personal hygiene. Greasy foods and chocolates do not cause pimples. Gentle pressure can be used on the skin to remove blackheads, although excessive pressure can cause rupture of hair follicles, leading to red pimples.
I hope the above explanation can help you to discuss with your doctor and make meaningful plans to treat your daughter’s acne.