Acne: The Scourge of the Teen Years

Acne is the scourge of youth. If you had it, you know exactly how miserable it felt to have all those little red and white bumps and scars on your face, and how helpless you were to prevent them.

People of all races get acne, boys as well as girls. It usually starts at the age of 11, though outbreaks can appear up until the age of 30, and some people suffer from it into their forties and fifties.

Acne is not a health threat, but it can cause significant emotional distress for adolescents--as well as for their parents. A field guide of acne lesions would include everything from pustules, or simple pimples, to papules, or small pink bumps on the skin that are tender to the touch, to very large nodules, which are painful solid lesions locked deep in the skin, to cysts, those deep, painful, pus-filled lesions that can cause scarring.

Knowing what acne is doesn't make it any better, but I'll tell you anyway. What we know about acne is that it results from the actions of hormones on the skin's oil glands. An excess of oily secretions clogs up the skin's pores and produces bacterial outbreaks that we call zits or pimples. Acne can affect any part of the human body, including the back, chest and shoulders, though we mostly tend to think of acne as a facial problem because that's where the problem is most visible.

Other than the role of hormones, and in particular the male hormone, androgen, the exact cause of acne is not known. During puberty there is an increase in the androgen hormone in both boys and in girls, causing the oil glands to enlarge and produce more oil. Genetics are thought to play a factor in acne, so if one or both parents had acne, the child probably will, too.

Sometimes the early use of cosmetics can lead to the premature clogging of skin follicles, worsening an acne condition. The changes in hormone levels in adolescent girls two to seven days before a menstrual period can also trigger an outbreak. So can backpacks and sports equipment, like tight helmets. Hard scrubbing of the skin, especially young skin, can lead to acne, too. So can stress, which is, again, a very common problem in the teen years.

If not treated adequately, acne can lead to scarring of the skin. So the goal of treatment is to heal the existing lesions, stop new lesions from forming, and minimize the psychological stress and embarassment acne causes.

All the medications available for acne basically attempt to decrease the oil production, the inflammation, and any secondary infection caused when bacteria is trapped under the skin. These medicines range from over-the-counter to prescription and involve both pills and creams.

Comonly used over-the-counter products for mild inflammatory acne include benzoyl peroxide and salicylic acid. For more moderate to severe inflammation there are topical antibiotics and vitamin A-derived medicines, like Retin-A.

For severe acne infection doctors will prescribe oral medicines, commonly Accutane, which is extremely dangerous for women who are pregnant and should be taken only under strict medical supervision.

Risks of Accutane

Offered as treatment for serious cases of acne, Accutane is a synthetic form of vitamin A, and many of the side effects of Accutane resemble the side effects from an overdose of vitamin A.

Among the serious and potentially life-threatening risks associated with Accutane are birth defects, kidney failure, heart problems, and death. According to the FDA, Accutane may also cause violent behaviors, depression, psychosis and, rarely, suicide.

Accutane is regarded as a "last choice" treatment for patients who have not responded to conventional acne therapies such as antibiotics. In early 2006, the FDA initiated the iPledge program, which requires registration of the drug providers, health-care providers and patients who want to use Accutane. Patients who are prescribed Accutane now have to agree to be monitored.

Busting Acne Myths

Chocolate causes acne: False

Greasy food cause acne: False

Dirty skin causes acne: False

Those myths should actually be characterized as "False...but" statements. Doctors will say that there is little evidence (meaning there is some evidence) that foods have much of an effect on the development and course of acne in most people (meaning that it can in some people.)

And while dirty skin will not cause acne, it can promote bacteria and cause infections in acne lesions that may have been picked at by the acne sufferer.

Caring for Your Skin

What instructions should we give our kids about taking care of their skin properly?

--One is to gently clean their skin, especially the face, once in the morning and once in the evening, and also after strenuous exercise.

--Avoid using strong sopas or rough scrubs, especially on young skin.

--For boys, it's a good idea not to introduce shaving before it's necessary, though young boys are always eager to experiment with their fathers' shavers.

--For girls, hold off on the use of cosmetics; once they do start using them, choose them carefully: always make sure they are oil-free.

--Teenagers should avoid sunburns, which can damage the skin and cause even small lesions to grow and become a major problem.

--Don't wait to get treatment for acne. It's a tremendously difficult condition, and it can put unnecessary strain on your teenager's life. Many treatment options exist, and often tesults are quick to come by.

Be nice to your skin--remember, it's got you covered.

Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007).

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.