Q: My son and daughter, a teen and “tween,” both have acne. How do you know when it’s just a minor problem that can be dealt with over-the-counter products and when is it severe enough to need a doctor’s attention?
A: With very few exceptions, the treatment plan for acne is largely based on the acne’s impact on the child. There are some teenagers who become quite concerned if they have one small pimple, while other teenagers have clinically severe acne but are not bothered by it. Most teens are somewhere in the middle. However, given that any treatment, no matter what the type, works only if used consistently, it generally is ineffective to push treatment unless the teenager is interested in getting treated.
Many cases of acne can be largely controlled by using over-the-counter products. The two treatments that the best studies have been shown to be the most effective are topical salicylic acid and topical benzoyl peroxide. Other treatments include facial toner and products with active ingredients such as sulfur, sodium sulfacetamide, and resorcinol. These can be effective, but the data for these are less consistent. Additionally, use your best judgment when purchasing these, as several (especially the ones that are bundled like a home phone/cable/Internet package) are needlessly expensive; buying the preparations separately would be just as effective. Also, it is important to use rigorous sun protection (including in winter) when using these treatments, as they can increase sensitivity to UV rays.
As with any condition, it is important to minimize the things that make it worse! These include excess oil, the use of harsh cleansers (counterintuitive!), and makeup that contains oil or is “comedogenic,” which means “causing pimples.” Oil-free, non-comedogenic makeup does not worsen the severity of acne and can be an important “cover-up” treatment for many children who are self-conscious about their acne. It is untrue that poor hygiene causes acne, and it is also untrue that eating chocolate causes acne!
If, despite avoiding acne triggers and consistently using salicylic acid and benzoyl peroxide, the symptoms are not improving (or not improving enough), it is worth scheduling an appointment with your pediatrician. He or she can provide further guidance, prescribe other classes of medication or make a referral to a dermatologist.
Remember: be consistent and be patient! It takes a lot of hard work for acne to clear up!