Not too long ago I wrote an article for GENERATIONS Magazine on 12 things you should know about teen acne. I thought the time might be good to review these again. In this first post I’ll cover the first 6.

1) The primary causes of acne in the adolescent years are due to hormonal fluctuations associated with puberty. Male and female sex hormones increase the production of oil in the oil gland, or sebaceous glands. This increased oil production then allows for the bacteria involved in acne vulgaris to flourish and proliferate. The oil production also decreases the skin exfoliating process resulting in more clogging of the pores, then creating an even more desirable environment for the above mentioned bacterial growth. The body then mounts an immune response creating redness inflammation and pus. These are the primary focused areas for medical intervention with topical and orals medications. Controlling raging teen hormones however is not so easy!

2) Depending on the age or onset of puberty each adolescent is going to be different. Hormones will increase in puberty anywhere from 8-13 years old, in females and 12-14 in males. The underlying culprit is in fact the hormones that are simulating the oil glands. In females the fluctuations of hormones may last well into adult life, and if not controlled may even result in chronic adult acne. I have also seen in females an onset of adult acne prior to menopause that may have never had teen acne. Males will usually balance out in the late teens to early 20’s. The acne may become more sever or change in quality as puberty progresses, and this may be the difference in one school year. Acne can be controlled in these years with proper medical intervention and good skin care, and sometimes in females the addition of exogenous hormones, such as oral birth control, may be used to balance the hormones earlier.

3) I do see an equal amount of problematic acne in both males and females. Girls will usually experience the onset of acne at an earlier age since puberty onsets between the ages of 8 and 13. Males will often experience a more severe form of acne including cystic acne due to the elevated levels of testosterone. There seems to be more of a correlation with family history or ethnic heritage than gender. The imbalances, or peaks and troughs of hormones are equal in both sexes. While we do see a longer duration often in females, again due to hormonal fluctuation throughout life such as pregnancy and pre/peri-menopause, females will often come out of the woods at an earlier age since puberty onsets earlier.

4) Acne is usually categorized in Grades I-IV. Grade I consists of small bumps, not red, that may start on the nose forehead and mid cheeks. This results from the follicle being clogged with dirt and oil and skin debris and includes small partially clogged pores or blackheads also called open comedomes (clogged pores with oxidized oil and dirt presenting as a black dot or plug). Grade II then increases to more inflammatory lesions or bumps and are often referred to as pimples. This indicates an immune response to this plug of dead skin and oil, resulting in a red papule. As the acne advances and there becomes more of infection with bacteria, a whitehead forms consisting of oil and dead skin cells that clog the follicle, or pore. This is still a closed pore or closed comedome with pus, which usually requires some treatment with antimicrobial agents. This is also referred to as a non-inflammatory pimple. Grade IV acne refers to more cystic acne or hard nodules under the skin. This can lead to very painful lesions that will often cause scarring. There is a deeper infection with bacteria and the follicle is completely clogged leading to a more severe immune response of a sore hard lesion. This is the most difficult form of acne to treat and usually requires more aggressive acne treatment.

5) While there are few to no conclusive studies that support the theory that greasy or sugary foods contribute to acne, I do believe that there are in fact food triggers for acne. Because of the inflammatory component to acne there are some foods allergies known to increase inflammatory conditions such as acne. I have seen a direct correlation with wheat in teens and acne. Again this is usually due to the inflammatory nature of these types of foods in certain people. Another problematic food for teen acne is dairy products. There are in fact more studies that support this correlation. Milk and dairy foods are filled with growth hormones. These hormones contribute to the production of acne. I also believe that sugary foods do in fact increase the inflammatory response in the body and may worsen or exacerbate acne. With foods like chocolate there is the combination of the sugar and dairy, hence worsening acne. I will usually do dietary counseling with teens and allow them to see the response when they cut out, wheat, dairy and sugar. They will usually find their own food triggers, which empower them to take responsibility for their skin condition. Usually I will have them discontinue these food items for a minimum of four weeks then have them reintroduce each item singly to observe their skin response. Many teens will notice a direct correlation to one of the food items. Food allergy testing may be a helpful tool to identify inflammatory triggers.

6) Many teens will purchase and apply very harsh abrasive cleansers and products thinking that this will dry out the acne and make it go away. They will also think that there is no need for moisturizer since they are already oily. This is a very common misconception since the overdrying of the skin will actually cause the skin to produce more oil and thus acne. The balance of hydration is a very tricky game with acne. We see many teens using infomercial products for a couple months that then result in a severe rebound break out. Decreasing oil production and drying of the skin is important but there has to be a balance and the moisture must be replaced. Other misconceptions are that sitting in the sun will help dry out acne, when in fact it will worsen it and drastically increase the likelihood of scarring.

Acne is not fun for anyone, but especially for teens. While there are some great treatments out there, the first step is understanding what it is and why it might be happening. Come back next week for the next 6 things to know about teen acne.