The skin-care products available today “are vastly superior to what they used to be,” says Dr. Eichenfield. Over-the-counter medications may be more than adequate for managing mild to moderate acne. “Topical benzoyl peroxide is usually recommended as a first-line treatment,” he says. “It works mainly by reducing the bacteria in the skin.” As a keratolytic agent, benzoyl peroxide also slows down the sloughing off of follicle cells. You can find many brands of this preparation, which comes in various forms (creams, gels, lotions, pads, washes) as well as in 2.5 percent, 5 percent and 10 percent strengths.
“Often,” says Dr. Eichenfield, “the lower-strength benzoyl peroxide is just as effective, and with fewer side effects.” When using a topical medication, your teen should apply a thin film to the entire area where pimples might sprout, not just dab it on current blemishes. Acne products tend to dry out the skin, so it’s best to avoid the delicate areas around the eyes, mouth and nostrils. After four to six weeks without satisfactory results, a youngster can try one of the higher-strength products.
More severe acne may call for a prescription medication. “The classes that are most effective are the retinoids [tretinoin, isotretinoin] and the retinoidlike agents [adapalene, tazarotene],” says Dr. Eichenfield. These derivatives of vitamin A (all topical except for isotretinoin, which is a systemic tablet) “stop the blockage in the skin,” he explains. “They also bring whiteheads to the surface and prevent new whiteheads from forming.”
Isotretinoin is usually reserved for extremely severe acne that has not responded to therapy with topical or systemic antibiotics, and/or has caused scarring. Dr. Eichenfield calls it “absolutely the most potent medicine that we have.” The drawback to isotretinoin, however, is its side effects, which include birth defects and possibly depression. Isotretinoin should be used under the supervision of a clinician well versed in prescribing the drug. It is never to be taken during pregnancy. Female patients are typically placed on birth control pills (which themselves may improve acne) before and during isotretinoin use.
For any acne product to work, teenagers must follow the manufacturer’s instructions to the letter. That includes resisting the temptation to slather on the medication, on the mistaken assumption that using more than the recommended amount will bring better/quicker results. Applying too much can damage skin to the extent that the doctor has to discontinue the drug temporarily. Let’s also remind kids to be patient: It typically takes six to eight weeks before they can expect to see any improvement.
Because the medications described above eradicate acne so effectively, says Dr. Eichenfield, “surgical procedures are far less common than they used to be.” A dermatologist might occasionally use a small needle and an instrument called an extractor to pierce (lance) whiteheads and blackheads, but surgery’s current role in acne treatment is mainly to minimize residual scars. Techniques include dermabrasion and laser resurfacing.
In dermabrasion, the physician uses a high-speed rotary instrument with a sandpaper-like wheel or brush to smooth rough, pitted skin. A new layer of skin replaces the abraded layer. Laser resurfacing, too, removes old skin cells so that fresh cells grow there. The intense beam of laser light literally vaporizes unwanted scar tissue. Both procedures are performed on an outpatient basis.