Acne: For Some, It May Not Be a Problem That’s “Just Skin Deep”

By Robin P. Gehris, MD, FAAD, FAAP, Chief, Pediatric Dermatologic Surgery, Children’s Hospital of Pittsburgh of UPMC

Dr. GehrisNow that its summer and we’ve peeled off all the layers of winter clothing, many of us are realizing that our skin could look better than it does! We may notice new or changing moles, or even some acne that had gone unnoticed in the colder months. These are both conditions that can be evaluated and treated by your pediatric dermatologist.

Acne especially has become one of the most universal medical problems in school-aged children, teens, and young adults. Despite how prevalent acne may be, many patients still feel hesitant or embarrassed about seeking medical care or discussing their acne with their physician or provider and instead seek to treat it themselves with one of the many products they can buy over-the-counter or online. While this may be a reasonable first approach, some patients unfortunately end up spending hundreds of unnecessary dollars on multi-step skin care regimens that ultimately are ineffective. Others attempt to modify lifestyle factors such as diet, which have not been proven in most large studies to improve acne.

Several recent eye-opening medical studies have shown that children, teens, and young adults with acne perceive themselves (and are often incorrectly perceived by others) to be less clean, less attractive, less successful or even less intelligent. While some parents may regard acne as a “rite of passage,” these studies have made us realize that acne should be taken more seriously. Acne is not always a problem that is “skin deep.” It can have serious social and emotional repercussions that may affect a person’s self-confidence. If left untreated, it can persist into adult years, especially in cases where scarring results. The great news is that there are many medical options that can treat current acne and then continue to prevent future acne outbreaks.

What causes acne?

Acne is caused by the pores, or hair follicle openings, of the skin becoming clogged, at first on a microscopic level and next on a visible level, with natural skin secretions known as sebum. Sebum creates a sticky plug in the previously open pores; sebum naturally increases around the time of puberty, but it can occur in infancy or well into adulthood and cannot be controlled by diet. Washing one or two times per day with a gentle cleanser may help rinse some of these secretions from the skin, but more frequent washing usually does not completely prevent the start or progression of acne.

The ideal time to begin medical treatment for acne is at this stage. Topical medicines that open the clogged pores chemically can be prescribed and typically take four to six weeks to become effective. Once the pore becomes clogged, it can then develop secondary bacterial overgrowth and inflammation, which appears as redness of the bumps or “pus” bumps.  This represents a serious level of acne that requires immediate medical attention so permanent scarring does not result.

Who should I call if someone in my family has acne?

Since each person has a unique skin type, it takes specialized medical training and clinical experience to learn which product combinations are best tolerated and most effective for each individual.  For a child or young adult, the medical professionals most highly trained to diagnose and treat acne arepediatric dermatologists, who have formal training and board certification first in adult dermatology and then specialized fellowship training and board certification in pediatric dermatology. Some pediatric dermatologists even have a background and board certification in general pediatrics so that they can better understand a child’s skin problems in the context of any other medical problems he/she may have.

A pediatric dermatologist should pay specific consideration to your child’s skin type, activities, and schedule as well as the safety of the medications. A good pediatric dermatologist also should provide you with reasonable treatment options that are affordable or will be covered by your child’s insurance so that you don’t spend a fortune treating his/her acne. If you are concerned about your child’s acne and desire treatment, don’t wait to make an appointment. Many treatment options begin working maximally after four to six weeks and then show continued improvement thereafter.  Starting a new treatment program a few days before an important social event like homecoming, the prom, an interview, or the start of a new school year may not allow enough time for that program to be successful. The best results require a minimum of several weeks to become effective and give you and your child the results you envision. Luckily, there are many safe and effective treatment options available to children with acne so that they can present their best self physically and emotionally to the world and develop that strong self-esteem we all desire.

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