Girl Teen Acne Questions

Hello, 

Teen acne is SO hard.  It could be that you're right about too many products, but it also could be that your daughter does need prescription topical or oral medication to help control the acne.  Just cleaning her face may not be enough, and it's pretty demoralizing for teens to have to live through weeks and months of pimples.  It definitely sounds like it would be good to get a second opinion about treatment, but it seems that if you limit yourself to dermatologists who will only look at topical treatments, and if she turns out to be one of the many teens who needs more intensive treatment, then you may delay getting her the kind of help she needs.   

I recommend you see an actual dermatologist and get a medical opinion. One who specializes in teen acne. There are many options in our area, two include Dr Icecreamwala and Dr Ting. Both are good. Your assesment is unlikely to be accurate - it's most likely the type of acne your daughter has. In my family, we have very little acne and I didn't take my son's acne seriously. It started around 12 and was nuts by 14. He was miserable and we tried EVERYTHING including many diet modifications and aestheticians, blue light - you name it. Finally we went to a dermatologist who took one look and said, it's cystic acne, it has already scarred him, and he needs to use isotretinoin (accutane). I was appalled and immediately went for a 2nd opinion. Exact same response. I waited another 6 months in fear, and finally relented under my son's begging and after speaking with numerous doctor friends. Within 2 weeks of starting, the acne was dramatically reduced on his face. It took 2-3 months to stop on his back. After 4-5 months the scarring started to reduce (but will always be there because I waited so long, especially on his shoulders). His skin has been perfect for about 18 months now. He is MUCH happier and I only regret waiting so long.

How difficult that your daughter is experiencing acne—the bane of a teenager's existence! When changing routines, acne generally gets worse before it gets better. Be patient, it may take a month or two to recalibrate.

My daughter began having acne around age 11. It was painful and embarrassing for her. I steered her toward simple routines that she could keep up. She tried several and had to adjust over the years as products stopped working. We both agreed to not use oral medications or birth control pills. At 19 she has a simple and affordable skin care routine. She has beautiful skin and rarely wears makeup other than mascara and lip gloss.

Here are two routines that worked particularly well:

1. Zapzyt products: cleaner and gel, and a very mild, fragrance-free face lotion.

2. Morning: 2.5-5% benzoyl peroxide cleanser (Neutropenia Clear Pore, Panoxyl, etc.), moisturizer with SPF 30-50 (only zinc or titanium dioxide sun block, not chemical sun screens)

Evening: Wash with gentle non-medicated non-foaming cleanser (such as Cetaphil or Cerave).  Wait 15 to 20 minutes then apply adapalene 0.1% cream (retinoid) one pea-sized amount to acne prone areas of face. Start gradually and increase to nightly as tolerated over several weeks. lf skin is dry, follow with bland moisturizing cream (example Cetaphil, Cerave, Vanicream, Aveeno, Eucerin).

Note that benzoyl peroxide products will bleach textiles (towels, bedding, clothes). Also, makeup primer and foundation can exacerbate the problem, as much as she may want to cover up the acne, encourage her to wear it less often.

Let her know she's beautiful, acne and all, as she settles into the long haul of getting through adolescence. Maybe shift her focus on some part of her appearance that she's satisfied with (hair, nails, etc.)—don't compare, just say how nice her hair looks or spend a little more on shampoo or a good cut, for example. Over time, and with care, hopefully her skin will settle down.

She doesn't need to use a lot of fancy products on her skin- but if she has acne she may need something.  I recommend checking out r/skincareaddiction on reddit- lots of info there about how to cut through the hype and find products with active ingredients (and little else) that work.  People have spent a lot of time reading the science out there- most of skincare has minimal effectiveness outside of a few active ingredients.  Thus you are paying generally for a brand "look", a scent, and fillers that aren't helping.  So your instincts are right but it sounds like your daughter may need more than water (she also has maybe more environmental pollution and face masks to deal with that we didn't have when teens).  The good news is that is doesn't sound like cystic acne, so the below should work well for most, although sensitivities/allergies etc.. mean YMMV.  

Here is a basic, relatively inexpensive skincare routine that I use for my teens that works very well (I've spent a lot of time helping them with this because I remember the agony of youth myself).  Products are low/no scent and all can be bought at CVS, Walgreens, Target:

Skincare for teen with low acne:

Face wash: Cerave hydrating or foaming facial wash (both are good, just depends on level of dryness in skin)

Red Stridex Pads or Salicylic acid 2% treatment (the Ordinary or other brand with no added scents and reusable cotton pads) (usually at night only)

Moisturizer: Cerave daily moisturizing lotion.  Follow with sunblock!  (I don't have a real winner here to recommend).  

For acne-prone teen/moderate acne:

Face wash: Cerave Acne Foaming Cream Cleanser (contains benzoyl peroxide, which is highly effective on acne).  My daughter uses the contact method which has essentially eliminated her moderate acne and limits the drying of the product, which can be an issue.  To do this, wet the face, apply the wash and then leave on the skin for 10 minutes or so.  Rinse off.  Be careful, benzoyl peroxide can and will bleach clothing so have her not take shirts on and off or hug anyone while it's on her face.  

Some people also add Salicylic acid once a day or every few days if tolerated or needed.  

Moisturizer: Cerave daily moisturizing lotion, and sunblock in AM.  

If those don't work there are ways to bump up, get a leave-on benzoyl peroxide product, etc... And there is clinical evidence for the effectiveness of Differin.  But at that point maybe consult a dermatologist.  Good luck to you and your daughter- it can take awhile to find the right routine but it doesn't have to be complicated or expensive, I promise!

I also have "mediterranean" skin, meaning that in my 50s I have no wrinkles and still get the occasional zit. I developed acne in my 30s when I decided I wanted to "go natural" and stopped taking birth control pills. My skin got so bad that I not only very quickly went back on birth control pills, but discovered ProActiv which I use to this day. To get the acne under control, use their basic three step system. Once my skin had settled down I found I could use just the cleanser, step 1. I use it in the shower because it does bleach everything if not rinsed off completely (benzoyl peroxide will bleach towels, sheets and clothes). But it works. My son, of course, will not use it for his teen acne, but clindamycin get seems to be working for him. Best of luck!

Has your daughter considered looking at her diet as a possible cause (or cure) for the acne? The daughter of a friend of mine had terrible acne and ended up doing a bunch of research into the microbiome -- and her skin improved quite a bit once she switched her diet. (I know this partly because she wrote a phenomenal college essay about the experience, which she shared with us recently... So if nothing else maybe this ordeal will provide your daughter with good materials for her college entrance applications?!) I can't recommend a specific practitioner but you might look for a naturopath instead of or in addition to a good dermatologist -- they take a much more holistic approach to medicine. When my son was small he had terrible excema which ended up being caused by food sensitivities -- discovered and fully treated with the help of a naturopath (in Vancouver). Skin outbreaks are often symptoms of systemic issues.

Good luck!

I'm unclear why the resistance to medication is. If her acne is hormonal (including a genetic predisposition) than all of the creams and washes in the world aren't going to help. My teens got my family's genes for acne and both had it, pretty badly. They started washes & OTC creams and then saw a dermatologist and went on topical medication. They did medication--starting low scale--and tried that for 18-24 months. They still had pretty bad acne, the kind that was going to pit and scar. After trying all the other options, both decided on acutane and it was a game-changer. I'm sorry we didn't make that option available to them earlier but I was hesitant. Acne--and all that comes with it re: self-image, social life, scarring, etc.--is more than just a skin care issue. I'm in my 50s and can still remember the psychological cost of it. Unlike back in the 80s, dermatologists don't put kids on antibiotics for 5 years (hello!) anymore. Serious acne is a medical condition and there are treatments for it. Jason Fung, MD in Oakland has been a terrific partner to my kids in their acne treatment. Good luck.

Have her try zinc oxide on her face before she goes to bed at night.  The white sunblock that lifeguards use or even the diaper rash cream.  

I’ve dealt with acne for almost 40 years, starting at a young age. I also didn’t want to use prescription treatments. What I finally found to work, and which my adolescent kid also uses now, is a really simple routine of California Baby products. We wash our faces with the tea tree body wash (you can also use it on hair and body). And then just apply their all sensitive (fragrance free) body lotion afterward. These two products have finally cleared up my skin, and they keep my kid’s breakouts to a minimum. Pipette is a good sunblock for not causing breakouts; if I’m putting sunblock on, I go really light with the lotion first, skipping the oilier areas since the sunblock will add some moisture. 
 

We order the California Baby products from their website. Target has the Pipette online. 

Other things that make a big difference are changing pillowcases more often (they absorb oil from skin and hair), and being careful of not applying a lot of hair product that can clog pores. Using a heavy conditioner can cause breakouts, too. Everything from the hair can migrate down onto the face. It’s also important not to pick at the skin or touch it with unwashed hands. 
 

For us, the solution ended up being low-tech, and just paying attention to little things. I hope this is helpful!

She needs acutane. Your reluctance to treat it may scar your daughter in more ways than just literally. My husband was scared psychologically by his acne so when our daughter began to get pretty bad acne at 12 first we tried antibiotics, topical stuff, facials for about 6 mos without significant improvement. Accutane was a miracle. The AWFUL dried lips were worth it to her- after 4 months her skinned GLOWED! She used it again her senior year of high school (age 17) for only 3 months this time and her skin still is acne free aged 22.

I haven't stopped breaking out since I was 11.  Decades later, it's better, of course, but facial scars never went away.  Nor did the feeling of ugliness.  Your daughter is not me and may not have such strong feelings about her complexion (I certainly hope she doesn't!)  But if Accutane had existed in the late '60s, I would have taken it in a heartbeat.

I'm in my 30's and just started accutane. I wish I had done it as a teenager and saved myself 20 years of skin stress, scarring, and god knows how much $$$$ on useless products. People will advise you to do all sorts of stuff (diet changes, "organic" products, facials, lasers, colored lights) but if your daughter really has acne prone skin, it is not going to make a difference. Retinoids will. If accutane seems overkill, maybe try tretinoin? It can make things worse before they get better, but you will see results. 

If a teen is concerned about acne, I say take that concern seriously and help them deal with it. It can really impact self-esteem in the long-term. (Obviously it the kid doesn’t mind, it’s not a problem!) This might be something like accutane but not necessarily. Going on a birth control pills (certain ones) helped my daughter because her acne was partly hormonal. She also has a skincare routine from her doctor that includes using certain cleansers and moisturizers as well as Differin at specific times (all sold at the drugstore). She also uses a prescription cream when pimples do pop up. This program keeps her acne in check but it wouldn’t work for everyone. She never had severe cystic acne, and that is more likely to require Accutane or at least retinol products. 

Taking a break is a good idea I think- my daughter has a medicine cabinet full of products and I think it's overkill. I'm a cetaphil cleanser person, and have been trying to influence her that less is more. With skin, things get worse before they get better so it's not surprising to me that the break from all the products is producing breakouts. If she can hang in there for a little bit longer I think it will be worth it. Also- I didn't have this when I was younger by my daughter always breaks out before she gets her period. It's hard because masks make it all worse (I'm pro-mask- I've just noticed that when I wear them for a long time and it's hot my skin gets itchy). Is she taking omega fatty acids?