Q: My teenage daughter has acne. What can be done to help?

Acne can occur at any age, however, it is most common in teenagers. It often runs in families. Acne generally resolves when a person is in their mid-twenties. It primarily affects the face, neck, shoulders, upper arms, back, and chest. The good news is, there is a range of available treatments which can significantly curtail outbreaks. Such treatments can also reduce the incidence of scarring that is frequently associated with severe acne.

What causes acne?

At puberty, there is a significant increase in the production of androgens, for both boys and girls, which results in increased oil production in the face, neck, shoulders, upper arms, back, and chest. When the openings of these oil glands become blocked, there is the retention of oil in these glands, along with bacteria becoming trapped within.
The oxidation of the retained oil results in its hardening. The enclosed bacteria (Propionibacterium acnes) can proliferate within these glands resulting in them becoming infected.

Acne can be triggered and or worsened by:

• Medicines – Corticosteroids, lithium, barbituates.
• Progesterone-only contraceptive injections and pills.
• Menstrual periods.
• Pregnancy.
• Stress.
• Simple carbohydrates e.g: sugar, sugary foods and drinks, syrups, malts, goods made from white flour, white rice, many breakfast cereals, etc.
• Oily and greasy products applied to the skin.
• Skin pressure – e.g: tight clothing/ collars, phones, helmets, caps, backpacks, pimple squeezing.
• High humidity.

Acne treatments

• Diet: Avoid the aforementioned simple carbohydrates. A low glycemic diet inclusive of green vegetables, celery, raw carrots, lentils, tomatoes, sweet potato, barley, garlic, and fish often help reduce acne flares.
• Topical preparations in the form of gels, lotions, creams, soaps, foams, and pads are often used.
• Over-the-counter topical preparations with the active ingredients benzoyl peroxide, adapalene, azelaic acid, alpha hydroxy acids, sulfur, acetic acid, or salicylic acid can help when acne is mild to moderate. It generally takes one to two months of consistent application before positive results can be seen.
• Prescription topical preparations containing antibiotics, tretinoin, and or dapsone are prescribed for moderately severe acne.

Prescription oral medications are mostly used in cases of moderate to severe acne and include:

• Oral antibiotics: The most commonly prescribed are tetracyclines, clindamycin, and erythromycin. These antibiotics not only reduce the growth of the bacteria within the lesions but markedly reduces the inflammation associated with acne. For optimal results, these antibiotics should be taken daily for 3 months or more.
• Androgen-suppressing OCPs: These may be prescribed to women whose acne is worse during their periods.
• Spironolactone: This can be used in adult women where hormonal fluctuations cause outbreaks. Usually used in cases where most other treatment options have failed.
• Isotretinoin (Accutane): This is a very strong acne medication that is generally reserved for very severe acne. This should never be used in pregnancy or while breastfeeding. It can also rarely induce suicidal thoughts; everyone taking isotretinoin and their family, respectively, need to be aware of such a potential side effect.
• Other treatment modalities include chemical peels, blackhead extraction, dermabrasion, and laser therapy.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.