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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Acne -- What Parents Need to Know

May 14, 2013

By Claire McCarthy


Acne: It's a part of life for most adolescents. Three-quarters or more of them have acne at some time. It's so much a part of life that it's easy for parents to ignore it — or at least think of it as no big deal. But for the adolescents who are getting those pimples, it can be a very big deal.

Until now, there haven't been standard treatment guidelines for acne in children and teens. The American Academy of Pediatrics (AAP) is recommending that pediatricians follow the guidelines from the American Acne and Rosacea Society. A panel of expert dermatologists (skin doctors) and pediatricians reviewed the medical literature. They identified the most effective ways to treat acne in children. The AAP published the guidelines in the May 2013 issue of Pediatrics.

Here are some highlights:


It's a common myth that acne is caused by poor hygiene. Actually, cleaning too much, or cleaning with a harsh cleanser, can make the condition worse. Instead, wash twice a day with a gentle, soap-free, pH-balanced cleanser.

Facial toners can help with cleaning and removing excess oil — but they also can be irritating, especially if overused. So teens should use them sparingly, if at all.

Over-the-counter treatments:

The most effective over-the-counter treatment is benzoyl peroxide. It comes in different formulations (including leave-on preparations and washes) and concentrations (2.5% to 10%). Stronger isn't necessarily better; higher concentrations can be irritating and cause setbacks.

Salicylic acid is the active ingredient in many over-the-counter acne medications. It can be helpful, but doesn't generally work as well as benzoyl peroxide.

Prescription treatments:

The next step in treating acne is usually a topical retinoid. These include:

  • Tretinoin
  • Adapalene
  • Tazarotene

They come as creams or gels. The most common side effect is skin irritation, but that can usually be avoided if they are used very sparingly. The best way to use them is by spreading a pea-sized amount over the whole area, rather than trying to get it on individual pimples.

Antibiotic creams and lotions are sometimes prescribed, although they aren't very effective by themselves. There are some preparations that are combinations of antibiotics and either retinoids or benzoyl peroxide; those work better.

What Causes Acne?

Acne is probably related to a natural increase in androgen hormones during the teen years.

These androgens stimulate the sebaceous (oil-producing) glands to produce excess sebum. Skin cells are not shed normally. They block the skin's hair follicles, trapping the sebum.

Then, bacteria multiply within the blocked, oil-filled follicle. This leads to inflammation, redness and pimples (pustules). Blackheads and whiteheads are a type of acne.

Antibiotics taken by mouth (usually doxycycline, minocycline or tetracycline) are also helpful in killing the bacteria that make acne worse. They each have possible risks and side effects that you should discuss with your doctor, but most teens take them without any problems.

Oral contraceptives are sometimes prescribed for some girls with troublesome acne. There are three types that the U.S. Food and Drug Administration has approved for the treatment of acne:

  • Ortho Tri Cyclen
  • Estrostep
  • Yaz

They, too, have possible risks and side effects that you should discuss with your doctor.

Isotretinoin is a retinoid that is taken by mouth instead of spread on the skin. It's used when acne is severe, is not responding to other treatments or is causing scarring.

As with antibiotics and oral contraceptives, various risks and side effects are possible, but they can be more serious, so this medication should only be used when necessary. If isotretinoin is taken early in pregnancy, it can cause birth defects. Girls who are taking it need monthly pregnancy tests. There is also a concern that it may cause depression, so parents should closely watch any teen who is taking it for signs of depression.

Bottom line: Teens don't have to wait for acne to go away. There are many possible treatments. Teens and their parents should talk to the doctor about these treatments. The doctor can help to find the regimen that works with the fewest side effects. It can take time and patience, and sometimes a visit with a dermatologist (skin doctor) is necessary. But there is lots of reason for hope.

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Claire McCarthy, M.D., a senior medical editor for Harvard Health Publications, is an assistant professor in pediatrics at Harvard Medical School. She is an attending physician and Medical Communications Editor at Children's Hospital Boston.


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