Teen acne: Help!

Q: Help! Our teenage son has terrible acne. Over-the-counter products are just not working. Is this a hormone issue? Would prescription medications fix it?

A: Yes, it’s a hormone issue. And, yes, there are many prescription options that can work if the over-the-counter products aren’t helping.

Acne results from increased sebum (oily substance) accumulating within pores of the skin. Pores can subsequently become plugged by increased production of skin cells, which can lead to infection of the pores and even inflammation of the surrounding skin. In severe cases, you can get serious disruption of the underlying skin structure (cystic acne) and subsequent scarring after the acne has cleared. 

Many teenagers can control the eruption of pimples through a combination of diligent face washing and application of over-the-counter products, such as benzoyl peroxide. If these measures aren’t working, then talking with your primary-care clinician is the next step. 

The next level of treatment is typically a combination of topical antibiotics and a “desquamating agent” to reduce some of the extra skin cells blocking the pores. 

If that level of care isn’t working, oral antibiotics in combination with stronger desquamating agents can be used. If these don’t work, referral to a dermatologist is often suggested. 

A dermatologist may have other treatment methods that other clinicians generally don’t prescribe, including the use of Accutane (isotretinoin) for very severe cases. 

There are a number of very important cautions people need to be aware of with this medication, but it can also be game-changing in terms of its effectiveness in managing severe acne.