While there have been big advances in the way we treat teenage acne in the past few years, there is no single approach that works for every patient. For the best results, dermatologists need to match the treatment to the teen.

Dr. Valerie Goldburt, a leading expert on teen acne and dermatologist at Advanced Dermatology and its Center for Laser and Cosmetic Surgery, said there’s more to finding the best treatment than just examining the patient’s pimples.

“If you want to see results, you need to consider a teen’s active lifestyle,” she says. Despite the fact that today’s therapies can effectively treat the problem, patient compliance is often as important as the therapies themselves.

Acne often causes serious social, emotional, and psychological problems, she adds, and its symptoms can vary dramatically with age, heredity, habits, and beliefs. “Lots of teens have misconceptions about the causes of acne and unrealistic treatment expectations. They often have trouble incorporating the treatment into their daily lives or sticking with it long-term after they start to see results.” Doctors and patients need to discuss the patient’s lifestyle, family history, and habits—as well as his or her expectations—and then decide together which medicines are best, she explains.

Treatment Options for Teens
Dermatologists most often recommend topical medications for teens with acne. The most common nonprescription options are benzoyl peroxide, mild acids like salicylic acid, and sulfur-based products. Prescription-strength topical medications include topical antibiotics, sulfer based products and retinoids (derivatives of Vitamin A) such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac). All of these medicines are available as gels, lotions, creams, soaps, liquids, and pads. They require compliance, meaning the teen needs to be consistent in using them. Goldburt says, “I always ask teenagers, if I prescribe a topical medicine, will you use it? Half the time, the answer is no.” She believes that, especially among the young male population, there is a stigma associated with cream use. “Liquid soaps are sometimes a better topical choice, because the soaps can be used in the shower, where there is already an activity (the shower) in progress.”

Additionally, many a teen has heard their dermatologist tell them that sometimes things get worse before they get better. “That’s because the medications speed up the life cycle of all the pimples, including the little baby pimples that would have taken a lot longer to come to a head without medicine.” Also, topical acne medicines can easily be over-used, especially by teenagers who follow the more-is-better mantra, because they are often desperate to get an instant clear complexion. Most acne medications need to be used in small amounts so this approach can cause side effects like dryness, irritation, burning, or redness. This will force patients to stop using the medications before they’ve had a chance to work. Some medications may interact with the sun. Goldburt said the dermatologist needs to talk with the patient about ways to minimize and manage the side effects.

Stronger options include prescription oral medications: antibiotics, isotretinoin (Sotret, Claravis, Amnesteem, formerly sold as Accutane), and hormonal therapy (birth control pills and spironolactone). These pills could interact with medication or birth control pills, so care must be taken. As with any pill, these drugs need to be taken as prescribed, meaning a teen who’s less-than-perfect at sticking to a schedule may not do very well on them. However, many teenagers prefer pills to creams, since there is a perception that they are easier to use. Frequently, the teen who won’t use topical medications will be extremely compliant with oral medicines. Occasionally, Dr. Goldburt comes across a teen who hasn’t learned how to swallow pills.

“Most pills are smaller than the bites we take out of food, so there’s definitely a psychological barrier. You can get practice with tic tacs, and once you swallow those little pills, you realize the other pills are only slightly bigger and go down easily with some water,’ she said.

She recommends teenagers discuss how to take pills properly with their dermatologist.

In addition, dermatologists can use in-office procedures such as laser or light therapy, acne surgery and corticosteroid injections for large or painful pimples and to permanently fix the acne scarring. These procedures don’t require compliance (with the exception of making it to the appointments), and as a result are usually a good option for teen patients.

Valerie Goldburt, MD, PhD, is a dermatologist with New York & New Jersey-based Advanced Dermatology and the Center for Laser & Cosmetic Surgery. advanceddermatologypc.com